GLOSSARY OF TERMS
Created for the Insulin-Free World Foundation by Vanesa Sutherland
A B C
D E
F G H
I J K
L M N
O P Q
R S T
U V W
X Y Z
Acute
Happens for a limited period of time; abrupt onset; sharp, severe.
Albuminuria
More than normal amounts of a protein called albumin in the urine. Albuminuria is an early indicator of
diabetic nephropathy (kidney disease) and affects more than a third of all those who have had diabetes for more than 20 years.
Allograft
A tissue or organ transplanted from one member of a species to
another member of the same species. A kidney from a human donor to a human
recipient is an allograft. Synonym: Allogeneic graft, homologous graft.
Alpha Cell
A type of cell in the islets of Langerhans in the pancreas that make and release a hormone (glucagon) that raises the level of glucose in the blood.
See also beta cell; delta cell.
Amino Acid
The building blocks of proteins; the main material of the body's cells. Insulin is made of 51 amino acids joined together.
Amylase
An enzyme excreted by the exocrine pancreas whose role is to divide starch and
glycogen into simple sugars as part of the digestion process. Amylase concentration in the blood is called Serum Amylase. In normal circumstances such concentration is marginal but when high it could be an
indicator of pancreatitis. Due to the inflamatory process the enzyme leaked through the capillary barrier
and reach the blood stream. In the case of an individual with a pancreas transplant elevated Serum Amylase could indicate a process of rejection going on. Nevertheless, rejection can occur in the abcense of a significant Serum Amylase increase. A widely used site to attach the pancreas is the bladder. This allows the incorporation of the graft to important veins and arteries in the recipient , the secure attachment to another organ and the excreation of Amylase through urine. Low Urine Amylase has become an important marker for rejection as it is known that such process attack the exocrine tissue. Glucose rise when 95% of the pancreas has been destroyed by rejection and in most cases the process cannot be reversed.
Angiopathy
Disease of the blood vessels (arteries, veins, and capillaries) that effects most people with diabetes over time. There are two types of angiopathy: macroangiopathy and microangiopathy. In macroangiopathy, fat and blood clots build up in the large blood vessels, stick to the vessel walls, and block the flow of blood. In microangiopathy, the walls of the smaller blood vessels become so thick and weak that they bleed, leak protein, and slow the flow of blood through the body.
Antagonist
One agent that opposes or fights the action of another. For example, insulin lowers the level of glucose in the blood and glucagon raises it; therefore, insulin and glucagon are antagonists.
Antibodies
Proteins that the body makes to protect itself from foreign substances. Occasionally, the body also makes proteins against normal parts of the body. These proteins are called autoantibodies.
Antigens
Substances that cause an immune response in the body. The body recognizes antigens as harmful or foreign and produces antibodies to try to fight them.
Artery
A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins.
See also: Blood vessels.
Asymptomatic
No symptoms; no clear sign of disease present.
Autograft
A tissue or organ removed from an individual and transplanted back into the
same individual. For instance, an individual suffering from pancreatitis
requiring removal of the pancreas could have (if he or she is not diabetic),
his or her islets extracted from the pancreas and transplanted into the
liver as an "autograft" to prevent diabetes.
Autoimmune Disease
Disorder of the body's immune system in which the immune system mistakenly attacks and destroys body tissue that it believes to be foreign. Insulin-dependent diabetes is an autoimmune disease because the immune system attacks and destroys the insulin-producing beta cells.
Autonomic Neuropathy
A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system and the digestive system. These nerves are not under a person's conscious control and function automatically.
Also called visceral neuropathy.
See also: Neuropathy.
Beta Cell
A type of cell in the Islets of Langerhans in the pancreas that make and release insulin.
See also: alpha cell and delta cell.
Beta Cell Transplantation
See: Islet cell transplantation.
Blood Glucose
Glucose that is derived from food carried to each cell through the bloodstream. However, cells cannot use glucose without the help of insulin and so, for people with diabetes, the blood glucose level is the measure by which insulin doses and diet requirements are determined.
Blood Pressure
The force of the blood on the walls of arteries. Two levels of blood pressure are measured-the higher, or systolic pressure, which occurs each time the heart pushes blood into the vessels, and the lower, or diastolic, pressure, which occurs when the heart rests. In a blood pressure reading of 120/80, for example, 120 is the systolic pressure and 80 is the diastolic pressure. A reading of 120/80 is said to be in Sthe normal range.
Blood Urea Nitrogen (BUN)
A waste product of the kidneys. Increased levels of BUN in the blood may indicate early kidney damage.
Brain Death
When the brain has permanently stopped working, as determined by the attending physician and appropriate consultants. Donor organs can only be taken from persons declared brain dead.
Brittle Diabetes
A term used when a person's blood glucose (sugar) level often swings quickly from high to low and from low to high. Also called labile and unstable diabetes.
C-Peptide
A substance that the pancreas releases into the bloodstream as a byproduct of insulin production. The C-peptide level is a rough indication of how much insulin the body is making.
Capillary
The smallest of the body's blood vessels. Capillaries have walls so thin that oxygen and glucose can pass through them and enter the cells, and waste products such as carbon dioxide can pass back into the blood to be carried away and taken out of the body. The capillaries of people who have had diabetes for a long time become weak---especially those in the kidney and the retina of the eye.
Capitation
A fixed price for a medical service.
Carbohydrate
One of the three main classes of foods and a source of energy. Carbohydrates are mainly sugars and starches that the body breaks down into glucose (a simple sugar that the body can use to feed its cells).
Cardiologist
A doctor who sees and takes care of people with heart disease; a heart specialist.
Cardiovascular
Relating to the heart and blood vessels (arteries, veins, and capillaries); the circulatory system.
Cerebrovascular Disease
Damage to the blood vessels in the brain, resulting in a stroke. The blood vessels become blocked because of fat deposits or they become thick and hard, blocking the flow of blood to the brain. Sometimes, the blood vessels may burst, resulting in a hemorrhagic stroke. People with diabetes are at higher risk of cerebrovascular disease.
Charcot Foot
A foot complication associated with diabetic neuropathy that results in almost painless destruction of joints and soft tissue. Also called "Charcot's joint" and "neuropathic arthropathy."
Chronic
Present over a long period of time. Diabetes is an example of chronic disease.
Clinical Trial
A scientifically controlled study carried out in people, and within the guidelines of the Institutional Review Board in order to assure safety. Clinical trials are usually undertaken to test the effectiveness of a new treatment or drug.
Coalition on Donation
A non-profit alliance of health and science professionals, patients, voluntary and transplant organizations. The Coalition serves to increase national public awareness of the critical organ shortage, thus creating a greater willingness and commitment to organ and tissue donation.
Conventional Therapy
A system of diabetes management wherein one or two insulin injections are taken each day, blood glucose is monitored daily and a program of nutrition and exercise is followed. The main objective in this form of treatment is to avoid very high and very low blood glucose (sugar).Also called: "Standard Therapy."
Coronary Disease
Damage to the heart. Not enough blood flows through the vessels because they are blocked with fat or have become thick and hard; this harms the muscles of the heart. People with diabetes are at a higher risk of coronary disease.
Coxsackie B4 Virus
An agent that has been shown to damage the beta cells of the pancreas in lab tests. This virus may be one cause of insulin-dependent diabetes.
Creatinine
An end-product of protein metabolism found in the blood and urine, that can be used to help assess if the kidneys are working adequately. A related test, using simultaneous measurements of a timed urine sample plus a blood creatinine test, is called the creatinine clearance.
Creatinine Clearance
A test to measure the kidneys' capacity to excrete body waste product as createnine. The test requires a urine sample over a period of time (usually 24 hours) and a blood sample. A comparison between the createnine concentration in blood and the amount of createnine removed from blood by the kidney
in units of time is done. Values are given in terms of 1.73m2 in order to give a common ground for comparison. While serum createnine level reflects other factors such as body weigh. height and body muscle mass, createnine clearance is a standarized measurement of glomerular filtration. In general, the higher the createnine clearance the better the kidneys are working, the higher the serum createnine the worst the kidneys are working. Normal values are between 100-140 ml/min.
Crossmatch
A test for patient antibodies against donor antigens. A positive crossmatch shows that the donor and patient are incompatible. A negative crossmatch means there is no reaction between donor and patient and that the transplant may proceed.
Cryopreservation
Maintenance of the extracted tissue or organ at extremly low temperature.
Cyclosporine
A drug used following organ transplantation to prevent rejection of the transplanted organ by suppressing the immune system
Dehydration
Great loss of body water. A very high level of glucose (sugar) in the urine causes loss of a great deal of water, and the person becomes very thirsty.
Delta Cell
A type of cell in the pancreas in areas called the islets of Langerhans. Delta cells make somatostatin, a hormone that is believed to control how the beta cells make and release insulin and how the alpha cells make and release glucagon.
Diabetes Control and Complications Trial (DCCT)
A multicenter randomized clinical trial designed to test
the hypothesis that tight control to maintain close-to-normal
blood glucose profiles can delay or prevent diabetes's secondary
complications. People between 13-39 with IDDM defined by
impaired production of C-peptides were divided in two groups.and
randomized to be treated with
Conventional Therapy or Intensive Therapy.
The Prevention group consisted of individuals with no evidence of
severe diabetic complication and who have IDDM from 1-5 years.
The Intervention group was constituted by individuals that had
IDDM for 1-15 years and present mild complications. In general,
results show that Intensive Therapy reduced risk of complications as
well as the incidence of complications such as nephropathy ,
retinopathy and neuropathy in the prevention group. In the
intervention group a slow in progression and reduce risk is patent
except for neuropathy. Although the study was not designed to asses
the impact on macrovascular disease, levels of cholesterol were
lower with Intensive Therapy. The Intensive Therapy's side effects
are mainly hypoglycimia and weight gain.
Diabetes Insipidus
A disease of the pituitary gland or kidney, not diabetes mellitus. Diabetes insipidus is often called "water diabetes" to set it apart from "sugar diabetes." The cause and treatment are not the same as for diabetes mellitus. "Water diabetes" has diabetes in its name because most people who have it show most of the same signs as someone with diabetes mellitus-they have to urinate often, get very thirsty and hungry, and feel weak. However, they do not have glucose (sugar) in their urine.
Diabetes Mellitus
In general Diabetes Mellitus is characterized by the body's inability to regulate its blood glucose level The two most prevalent 'Types' of diabetes, Type I and Type II, have different origins, yet both require some regimen of tablets or injections, blood glucose monitoring and diet. In Type I, or insulin-dependent diabetes (IDDM), the pancreas makes little or no insulin because the insulin-producing beta cells have been destroyed. This type usually appears suddenly and most commonly in younger people under age 30. In Type II, or noninsulin-dependent diabetes (NIDDM), the pancreas makes some insulin but the insulin is not effective. NIDDM is treated with diet, exercise and daily blood glucose monitoring. Sometimes oral drugs that lower blood glucose levels or insulin injections are needed. This type of diabetes usually develops gradually, most often in people over 40 years of age.
Diabetic Complications
There are both acute and chronic complications of diabetes. Hypoglycemia and hyperglycemia are acute complications that are caused by volatile blood sugar levels. The chronic complications of diabetes (secondary complications) include damage to the retina of the eye (retinopathy), the blood vessels (angiopathy), the nervous system (neuropathy), and the kidneys (nephropathy).
Diabetic Ketoacidosis (DKA)
Severely high blood sugar level that needs emergency treatment. The body starts using stored fat for energy and ketone bodies (acids) build up in the blood. The signs include nausea and vomiting, which can lead to loss of water from the body, stomach pain, and deep and rapid breathing. Other signs are a flushed face, dry skin and mouth, a fruity breath odor, a rapid and weak pulse, and low blood pressure. If the person is not given fluids and insulin right away, ketoacidosis can lead to coma and even death.
Diabetic Retinopathy
Retinal changes occurring in diabetes of long duration marked by hemorrhages , microaneurysm and waxy deposits. In its proliferative state blood leakage appears as well as the formation of new less efficient vessels that tend to break and caused macular edema. In some cases even retina detachment occurs. Early diagnosed and treatment with laser (photocoagulation) can stop or delay its progression ,
Diabetogenic
Causing diabetes; some drugs cause blood glucose (sugar) to rise, resulting in diabetes.
Diabetologist
A doctor who sees and treats people with diabetes mellitus.
Dialysis
A method for removing waste such as urea from the blood when the kidneys can no longer do the job. The two types of dialysis are: hemodialysis and peritoneal dialysis. In hemodialysis, the patient's blood is passed through a tube into a machine that filters out waste products. The cleansed blood is then returned to the body. In peritoneal dialysis, a special solution is run through a tube into the peritoneum, a thin tissue that lines the cavity of the abdomen. The body's waste products are removed through the tube. There are three types of peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD), the most common type, needs no machine and can be done at home. Continuous cyclic peritoneal dialysis (CCPD) uses a machine and is usually performed at night when the person is sleeping. Intermittent peritoneal dialysis (IPD) uses the same type of machine as CCPD, but is usually done in the hospital because treatment takes longer. Hemodialysis and peritoneal dialysis may be used to treat people with diabetes who have kidney failure.
Diastolic Blood Pressure
See: Blood pressure.
Diuretic
A drug or substance that increases the flow of urine to rid the body of extra fluid.
DNA
abbreviation for deoxyribonucleic acid which makes up genes.
Durable Power of Attorney
A document in which individuals may designate who should make medical decisions for them when they are unable to speak for themselves.
Edema
A swelling or puffiness of some part of the body such as the ankles. Water or other body fluids collect in the cells and cause the swelling.
Encapsulation - Microencapsulation, Macroencapsulation
The use of porous membranes to surround transplanted cells (e.g. islets or beta cells)to prevent their rejection. The pore size allows small molecules such as insulin and glucose to pass back and forth maintaining normal function , but does not allows lymphocytes (white blood cells) or large molecules like antibodies to pass thus preventing a rejection attack. Usually the term microencapsulation refers to the individual encasing of islets put in the peritoneal cavity. Macroencapsulation refers to a more complicated devise that consist of a cylinder within a cylinder (chamber) which one end is attached to a vein and the other to an artery. The external cylinder contains the islets, the internal one allows blood to pass. Nutrients contained in the blood come into contact with islets through a common membrane wall .
Endocrine pancreas
The part of the pancreas that produces hormones that govern sugar metabolism. Compare with the exocrine pancreas.
Endocrinologist
A doctor who treats people who have problems with their endocrine glands. Diabetes is an endocrine disorder.
Endogenous
Grown or made inside the body. Insulin made by a person's own pancreas is endogenous insulin. Insulin that is made from beef or pork pancreas or derived from bacteria is exogenous because it comes from outside the body and must be injected.
Engraftment
Incorporation of the graft (e.g. islets) into the body. Not all of the islets transplanted may engraft, only a percentage. The higher the percentage the better the engraftment.
End-Stage Renal Disease (ESRD)
The final phase of kidney disease; treated by dialysis or kidney transplantation.
See also: Dialysis; nephropathy.
Epidemiology
The study of a disease that deals with how many people have it, where they are, how many new cases develop, and how to control the disease.
ESRD
End Stage Renal Disease. Kidneys have failed so either dialysis or kidney transplant is needed to sustain life. Diabetic lesions in the glomeruli due to hyperglycemia lead to uremia . Loss of the ability to get rid of body waste produces: urine output volume to decrease, blood pressure increases dangerously high (increase in normal blood pressure appears before ESKD) , high createnine, nausea and vomiting. Other diseases can cause ESKD.
Etiology
The study of what causes a disease; also the cause or causes of a certain disease.
Euglycemia
A normal level of glucose (sugar) in the blood. Compare to hyperglycemia and hypoglycemia.
Exocrine pancreas
The part of the pancreas that produces enzymes that are needed in intestinal digestion. Compare with the endocrine pancreas.
Exogenous
Grown or made outside the body; for instance, insulin made from pork or beef pancreas is exogenous insulin for people.
Fasting Blood Glucose
Amount of glucose in the blood in the morning before a person has eaten. The normal, non-diabetic range for blood glucose is from 70 to 110 mg/dl, depending on the type of blood being tested. If the level is over 140 mg/dl, it usually means the person has diabetes (except for newborns and some pregnant women).
Gastroparesis
A form of diabetic neuropathy (nerve disease) that affects the stomach. Food is not digested properly and does not move through the stomach in a normal way, resulting in vomiting, nausea, or bloating and interfering with diabetes management.
See also: Autonomic neuropathy.
Gene
a functional unit of heredity which is a segment of DNA located in a specific site on a chromosome. A gene directs the formation of an enzyme or other protein.
Gestational Diabetes Mellitus (GDM)
A type of diabetes mellitus that occurs when a woman is pregnant. In the second half of the pregnancy, the woman may have glucose (sugar) in the blood at a higher than normal level. However, when the pregnancy ends, the blood glucose levels return to normal in about 95 percent of all cases.
Glomerular Filtration Rate
Measure of the kidneys' ability to filter and remove waste products.
Glomeruli
Network of tiny blood vessels in the kidneys where the blood is filtered and waste products are removed.
Glucagon
A hormone that raises the level of glucose (sugar) in the blood. Glucagon is made by the alpha cells located in the Islets of Langerhans in the pancreas. An injectable form of glucagon, which can be bought in a drug store, is sometimes used to treat insulin shock.
Glucose
A simple sugar found in the blood. It is the body's main source of energy; also known as dextrose.
Glycosuria
Having glucose (sugar) in the urine.
Glycosylated Hemoglobin
Reflects the average blood glucose (sugar) level for the past month . Measure how much Glycol (sugar) is attached to hemoglobin .
Hemodialysis
See Dialysis.
Hemoglobin A1C (HbA1C)
Dominate fraction of Glycosilated hemoglobin. Aic normaly accounts for 6% of total hemoglobin. The higher A1c the worst the diabetic control. The higher the A1c the higher the rate of increase in risk of suffering from diabetic complications.
Histocompatibility Antigens
Molecules found on all nucleated cells in the body that characterize each individual as unique. These antigens are inherited from one’s parents. Human leukocyte antigents determine the compatibility of tissues for transplantation from one individual to another.
HLA (Human Leukocyte Antigen)
A pattern of cell surface proteins that identifies the cell to the immune system as 'self' or 'non-self'. Certain patterns (haplotypes) as defined by DNA analysis can indicate a susceptibility to Type 1 diabetes.
Homeostatis
When all of the systems of the body are in balance.
Hyperglycemia
Too high a level of glucose (sugar) in the blood; a sign that diabetes is out of control. Many things can cause hyperglycemia. It occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy. Signs of hyperglycemia are a great thirst, a dry mouth, and a need to urinate often. For people with insulin-dependent diabetes, hyperglycemia may lead to diabetic ketoacidosis.
See also: Euglycemia and
Hypoglycemia.
Hyperinsulinism
A condition in which insulin blood levels are above the normal range, usually as an abnormal resistance of the body to the action of insulin (for drive glucose into the cell). Insulin resistance causes the pancreas to make more insulin than usual in an attempt to lower blood sugar. Obesity is the most common cause of insulin resistance and hence of hyperinsulinimia. Insulin injection can also cause an abnormal concentration of insulin. High insulin levels particularly with insulin resistance may predispose to atherosclerosis.
Hypoglycemia
Too low a level of glucose (sugar) in the blood. This occurs when a person with diabetes has injected too much insulin, eaten too little food, or has exercised without extra food. A person with hypoglycemia may feel nervous, shaky, weak, or sweaty, and have a headache, blurred vision, and hunger. Taking small amounts of sugar, sweet juice, or food with sugar will usually help the person feel better within 10-15 minutes.
See also: Euglycemia and
Hyperglycemia.
Hypoglycemia Unawareness
A situation in which the usual epinephrine-induced symptoms of a fall in blood sugar are, for a variety of reasons, either not felt or not recognized. This situation may be dangerous, as the patient may go from functioning normally to unconscious within a short time. It is generally thought that if such a patient is allowed to maintain somewhat elevated blood sugar levels for several weeks, that the hypoglycemic unawareness may resolve.
Hypotension
Low blood pressure or a sudden drop in blood pressure. A person rising quickly from a sitting or reclining position may have a sudden fall in blood pressure, causing dizziness or fainting.
IDDM
See: Insulin-dependent diabetes mellitus.
Immune response
The body’s defense against foreign objects or organisms, such as bacteria, viruses or transplanted organs or tissue.
Immune System
The role of the immune system is to protect us against bacteria, viruses and other pathogens that can cause disease. Exterior defenses like acidity in skin and body fluids can prevent the entry of pathogens into the body. Once inside the body the immune system acts at a cellular and molecular level. Some important cells in the immune system are produced by organs (B cells are make in the spleen and bone marrow) but others like the T cells are make in glands (like thymus and lymph nodes). There are two principal cell groups: 1) Lymphocytes and 2) Phagocytes. All of them can move to the various organs and vessels and function by a variety of mechanisms, collectively called the immune response. The immune response consists of two phases: 1) lymphocytes recognize antigens in foreign organisms (differentiating self from non-self). 2)lymphocytes orchestrate an attack to eliminate the source of the antigen. Two important characteristics of the immune system are its specificity (action directed against particular antigens) and memory ( the second time the immune response is stronger and can prevent recurrent disease, such as measles).
Immune Tolerance
A state of specific immunological unresponsiveness to the graft with an otherwise normal immune response.
Imunology
The science that studies the structure and function of the immune system. Therefore is also concern with immunity, sensitivity and allergic reactions.
Immunosuppression
The artificial suppression of the immune response, usually through drugs, so that the body will not reject a transplanted organ or tissue. Drugs commonly used to suppress the immune system after transplant include prednisone, azathioprine (Imuran), cyclosporine, OKT3 and ALG.
Informed Consent
A process of reaching an agreement based on full disclosure. Informed consent has components of disclosure, comprehension, competence and voluntary response. Informed consent often refers to the process by which one decides to donate the organs of a loved one.
Immunosuppression Drugs
Drugs that impaired the body's ability to fight infection or recognize foreign substances that enter the body. A person receiving a transplant is given these drugs to stop the body from rejecting the new organ or tissue.
Insulin
A hormone that helps the body use glucose (sugar) for energy. The beta cells of the pancreas (in areas called the islets of Langerhans)) make the insulin.
Insulin Resistance
Characterized by a defect in the insulin action required to stimulate
cells use of glucose. (See Insulin). The b-cells of insulin resistant
individuals release extra insulin in an attempt to keep plasma glucose
within normal range. If b-cells are successful in overcoming the cells
inadequate use of glucose, the individual will be free of diabetes,
although the level of insulin in his/her plasma (See Hyperinsulinimia)
will be higher than normal. If the individual's b-cells can not overcome
the cells inadequate use of glucose, Type 2 Diabetes will appear.
Insulin resistance can be present in individuals with Type 1 Diabetes
with poor control because hyperglycemia desensitizes cells to the action
of insulin. Lowering blood sugar levels in these cases can reverse
insulin resistance.
Insulin-Dependent Diabetes Mellitus (IDDM) (Type 1 diabetes)
A chronic condition in which the pancreas makes little or no insulin because the beta cells have been destroyed by an autoimmune disorder leaving the body unable to use the glucose (blood sugar) for energy. IDDM symptoms usually appear abruptly, although the damage to the beta cells begins much earlier. The most common signs of IDDM are a great thirst, hunger, a need to urinate often, and loss of weight. IDDM usually occurs in children and adults who are under age 40. This type of
diabetes used to be known as "juvenile diabetes," "juvenile-onset diabetes," and "ketosis-prone diabetes." Contrast with Non-insulin-Dependent Diabetes Mellitus
Intensive Management
A form of treatment for insulin-dependent diabetes in which the main objective is to keep blood glucose (sugar) levels as close to the normal range as possible. The treatment consists of three or more insulin injections a day or use of an insulin pump; four or more blood glucose tests a day; adjustment of insulin, food intake, and activity levels based on blood glucose test results; dietary counseling; and management by a diabetes team.
See also: Diabetes Control and Complications Trial
Islet Cell Antibodies (ICA's)
Specialized proteins, called antibodies, that are found in the blood of many people with Type 1 diabetes at the time of diagnosis. Most people with Type 1 diabetes have antibodies to a variety of islet cell proteins that are apparently released as a consequence of damage to the beta cells of the pancreas. The presence of these antibodies therefore is a useful indicator that the autoimmune process has begun.
Islet Cell Transplantation
Moving the beta (islet) cells from a donor pancreas and putting them into a person whose pancreas has stopped producing insulin. The beta cells make the insulin that the body needs to use glucose (sugar) for energy.
See also: Pancreas Transplant.
Islet Cells (Islets/Islands of Langerhans)
(Pronunciation: EYE-let cells). The clumps of cells within the pancreas that include; beta cells, which make insulin; delta cells, which make somatostatin; and PP cells and D1 cells about which little is known. The islet cells appear under low-power magnification to be islands (islets) within the pancreas. First described by Dr. Paul Langerhans in 1869.
Juvenile Onset Diabetes
Former term for insulin-dependent or type I diabetes.
Ketones (Ketone Bodies)
Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma.
Kidney Disease
People who have diabetes are at high of a kidney disease called nephropathy that progresses to end stage renal disease in more than 30% of all those who have diabetes for more than 20 years.
Kidneys
Two organs in the lower back that clean waste and poisons from the blood. The kidneys are shaped like two large beans, and they act as the body's filter.
Labile Diabetes
A term used to indicate when a person's blood glucose (sugar) level often swings quickly from high to low and from low to high. Also called brittle diabetes.
Macrovascular Disease
A disease of the large blood vessels that occurs in people who have diabetes for a long time. Fat and blood clots build up in the large blood vessels and stick to the vessel walls. Three kinds of macrovascular disease are coronary disease, cerebrovascular disease, and peripheral vascular disease.
Macular Edema
A swelling (edema) in the macula, an area near the center of the retina of the eye that is responsible for fine or reading vision. Macular edema is a common complication associated with diabetic retinopathy.
See also: Diabetic retinopathy;
retina.
Medicaid
Similar to the Medicare program, Medicaid was designed for the medically indigent and administered by the states. A tendency in Industrialized countries has been to try to transform assistance into a right with published scales, regulations and opportunities to appeal.
Medicare
Federal administer compulsory health insurance. Covers most persons over 65 years old and covers a percentage of the cost of outpatients fees, hospital care, limited stays in skilled nursing home facilities
and people who needs dialysis or kidney transplant irrespectively of age. Financed by Social Security taxes went into effect in 1966 after 20 years of legislative debate.
Microalbumin
Small amounts of protein in the urine that are often the early warning sign of diabetes. If there is persistent microalbumin over several repeated tests at different times, the risk of diabetic nephropathy and macrovascular disease are both higher.
Microaneurysm
A small swelling that forms on the side of tiny blood vessels. These small swellings may break and bleed into nearby tissue. Microaneurysms in the retinal vessels of the eye are the first indication of diabetic eye disease.
Microvascular Disease
Disease of the smallest blood vessels that occurs in people with diabetes. The walls of the vessels become abnormally thick but weak, and therefore they bleed, leak protein, and slow the flow of blood through the body.
Morbidity
Sickness.
Mortality
Death
Myocardial Infarction
Also called a heart attack; results from permanent damage to an area of the heart muscle. This happens when the blood supply to the area is interrupted because of narrowed or blocked blood vessels.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
One of the 17 institutes that make up the National Institutes of Health, an agency of the Public Health Service.
Neovascularization
The growth of new, blood vessels in a new place, for example, in the the retina. See also: Diabetic retinopathy.
Nephrologist
A doctor who sees and treats people with kidney diseases.
Nephropathy
Disease of the kidneys caused by damage to the small blood vessels or to the units in the kidneys that clean the blood. Many people who have had diabetes for a long time have kidney damage.
Neurologist
A doctor who sees and treats people with problems of the nervous system.
Neuropathy
Disease of the nerves that effects many people who have had diabetes for for several years.. The three major forms of nerve damage are: peripheral neuropathy, autonomic neuropathy, and mononeuropathy. The most common form is peripheral neuropathy, which mainly affects the feet and legs.
See also: Peripheral neuropathy; autonomic neuropathy
NIDDM
See: Noninsulin-dependent diabetes mellitus.
NOD Mouse
A strain of mice in which the female has an especially high incidence of a diabetes similar to Type 1 in humans. Much used as a research model for prevention and new onset treatment.
Noninsulin-Dependent Diabetes Mellitus (NIDDM) (Type 2 diabetes)
The most common form of diabetes mellitus; about 90 to 95 percent of people who have diabetes have NIDDM. Unlike the insulin-dependent type of diabetes, in which the pancreas makes no insulin, people with noninsulin-dependent diabetes produce some insulin, sometimes even large amounts. However, either their bodies do not produce enough insulin or their body cells are resistant to the action of insulin (see Insulin Resistance). People with NIDDM can often control their condition by losing weight through diet and exercise. If not, they may need to combine insulin or a pill with diet and exercise. Generally, NIDDM occurs in people who are over age 40. Noninsulin-dependent diabetes mellitus used to be called "adult-onset diabetes," "maturity-onset diabetes," "ketosis-resistant diabetes," and "stable diabetes." It is also called Type 2 diabetes mellitus.
NOTA
The National Organ Transplant Act, passed by Congress in 1984, outlawed the sale of human organs and initiated the development of a national system for organ sharing and a scientific registry to collect and report transplant data.
Ophthalmologist
A doctor who sees and treats people with eye problems or diseases.
Optometrist
A person professionally trained to test the eyes and to detect and treat eye problems and some diseases by prescribing and adapting corrective lenses and other optical aids and by suggesting eye exercise programs.
Organ Preservation
Between procurement from a donor and transplant, organs require special methods of preservation. The length of time that organs and tissues can be kept outside the body vary, depending on the organ, the preservation fluid and the temperature.
Organ Preservation Time
- Organ Preservation
- Heart 4-6 hours
- Liver 12-24 hours
- Kidney 48-72 hours
- Heart-lung 4-6 hours
- Lung 4-6 hours
- Pancreas 12-24 hours
Organ Procurement Organization
Non profit entity whose purpose is to coordinate cadaver organ donation and distribution or allocation in a designated area of the country.
PAK
Pancreas after kidney transplant. A pancreas transplant that is performed in a person with diabetes who has previously
received a kidney transplant.
Pancreas
The pancreas is an organ behind the lower part of the stomach that is
about the size of a trout. It has two major responsibilities. The
endocrine pancreas makes insulin so that the body can use glucose
(sugar) for energy. The exocrine pancreas makes enzymes that help the
body digest food. Throughout the pancreas are clusters of cells called
the Islets of Langerhans. The cells in the islets as they are called
each have a special purpose. Alpha cells make glucagon that raises the
level of glucose in the blood. Beta cells make insulin. Delta cells make
somatostatin. There are also the PP cells and the D1 cells about which
little is known.
Pancreas Transplant
A surgical procedure that involves implanting a healthy pancreas that can make insulin in a diabetic individual. The healthy pancreas comes from a donor who has just died or from a living donor. A person can donate half a pancreas and still live normally.
At present, pancreas transplants are usually performed in persons with insulin-dependent diabetes who needs a kidney transplant, therefore will need immunosupressive drugs, or in people that prefer the side effects of such drugs to the potential secondary complications of diabetes and the problems of insulin management (brittle diabetes or hypoglycemic unawareness).
Pancreatectomy
A procedure in which a surgeon takes out the pancreas.
Pancreatitis
Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus and sometimes the cause is unknown..
Peripheral Neuropathy
Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy."
See also: Neuropathy
Peripheral Vascular Disease (PVD)
Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot
sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control.
See also: Macrovascular disease.
Peritoneal Dialysis
A way to artificially clean the blood of people whose kidneys have failed.
See also: Dialysis.
Photocoagulation
Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy.
Pluripotent
capable of giving rise to most tissues of an organism.
Polydipsia
A great thirst that lasts for long periods of time; a sign of diabetes.
Polyphagia
Great hunger; a sign of diabetes. People with this great hunger often lose weight.
Polyuria
Having to urinate often; a common sign of diabetes.
PRA
Panel Reactive Antibody. The percentage of cells from a panel of donors with which a potential recipient’s blood serum reacts. The more antibodies in the recipient's blood, the higher the PRA. The higher the PRA, the less chance of getting a good crossmatch. Patients with a high PRA have priority on the waiting list.
Proliferative Retinopathy
A disease of the small blood vessels of the retina of the eye.
See also: Diabetic retinopathy.
Proteinuria
Too much protein in the urine. This may be a sign of kidney damage.
PTA
Pancreas transplant alone. A procedure in which a pancreas is transplanted without a kidney. Usually
performed for a person who has diabetes, but does not have kidney disease.
Rejection
The immunological response to incompatibility in a transplanted organ. Symptoms are different for different organs. By instance, pancreas rejection is usually accompanied by a decreased urine amylase (when pancreas is attached to the bladder instead of to the intestine), tenderness in the area, fever and sometimes soreness. Pancreas rejection when caught on time can be reversed with high dose of immunosuppresants. When blood glucose is high rejection has overtook almost 90% of the pancreas and is affecting the insulin producing beta cells; in this case prognosis is not very encouraging. If the pancreas is totally rejected immunosupressants are stopped and insulin therapy is resumed. Usually a rejected organ does not need to be removed.
Renal
A term that means having something to do with the kidneys.
Required Request
Hospitals must tell the families of suitable donors that their loved one's organs and tissues can be used for transplant. This law is expected to increase the number of donated organs and tissues for transplantation.
Retina
The center part of the back lining of the eye that senses light. The small retinal blood
vessels that carry oxygen to the eye are often damaged by diabetes.
See retinopathy.
Retinopathy
A disease of the small blood vessels in the retina of the eye.
See also: Diabetic retinopathy.
Retransplantation
Due to organ rejection or transplant failure, some patients return to the waiting list. Reducing the number of retransplants is a critical concern when examining ways to maximize a limited supply of donor organs.
Segmental Transplantation
A surgical procedure in which a part of a pancreas that contains insulin-producing cells is placed in a person whose pancreas has stopped making insulin.
Sensitization
Potential recipients are "sensitized" if there are antibodies in their blood, usually because of pregnancy, blood transfusions or previous rejection of an organ transplant. Sensitization is measured by PRA. Highly sensitized patients are more likely to reject an organ transplant than unsensitized patients.
Somatic cell
cell of the body other than egg or sperm.
Somatic cell nuclear transfer
the transfer of a cell nucleus from a somatic cell into an egg from which the nucleus has been removed.
Stem cells
cells that have the ability to divide without limit and to give rise to specialized cells.
SPK
Simultaneous pancreas and kidney transplant. A procedure in which both a kidney and pancreas are transplanted at the same time, from the same donor, to the same recipient.
Status
Indicated degree of medical urgency for patients awaiting transplants.
Steroid s
Normally the adrenal gland secretes corticosteroids. When given in an amount above the normal it depresses the immune system in general and helps allows the body to accept a graft. In doing so, opportunistic infections can occur due to the impaired immune system response to fight them. Widely used in transplantation is the steroid Prednisone which causes side effects like: osteoporosis, face swelling, headache, skin cancer. Not everybody develop side effects but the use of Prednisone increase the risk of diseases like cancer and osteoporosis. With new drugs like Cellcept and FK 506 the use of prednisone for long periods of time is decreasing.
Survival Rates
Survival rates indicate the percentage of patients or grafts (transplanted organs) that are still alive/functioning at a certain point posttransplant. Survival rates are often given at one-, three-, and five-year increments. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advancements. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates.
Systemic
A word used to describe conditions that affect the entire body. Diabetes is a systemic disease because it involves many parts of the body such as the pancreas, eyes, kidneys, heart, and nerves.
Systolic Blood Pressure
See: Blood pressure.
Tissue Typing
The examination of human leukocyte antigens (HLA) in a patient. Tissue typing is done for all donors and recipients in kidney transplantation to help match the donor and recipient.
Totipotent
having unlimited capability. Totipotent cells have the capacity to differentiate into extraembryonic membranes and tissues, the embryo, and all postembryonic tissues and organs.
Transgenic Animals
animals that have human genes inserted into certain
organs and tissues. Transgenic pigs may be referred to
as 'humanised' pigs.
Transplantation
Implanting in one part a tissue or organ taken from another part
or from another individual.
U.S. Scientific Registry of Transplant Recipients
A database of posttransplant information. Follow-up data on every transplant are used to track transplant center performance, transplant success rates and medical issues impacting transplant recipients. UNOS facilitates the collection, tracking and reporting of transplant recipient and donor data.
Urea
One of the chief waste products of the body. When the body breaks
down food, it uses what it needs and throws the rest away as waste.
The kidneys flush the waste from the body in the form of urea, which
is in the urine.
Vascular
Relating to the body's blood vessels (arteries, veins, and capillaries).
Vitrectomy
Removing the gel from the center of the eyeball because it has blood and scar tissue in it that blocks sight. An eye surgeon replaces the clouded gel with a clear fluid.
See also: Diabetic retinopathy.
Waiting List
After evaluation by the transplant physician, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: heart, lung, kidney, liver, pancreas, intestine, heart-lung, kidney-pancreas.
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