疾病的类型和严重程度差别很大，需要专业的评估

[00:00:00] Host Amber Smith: 以下是来自上州医科大学的移植外科医生马修·加纳的一些专家建议. 糖尿病患者如何知道自己是否需要胰腺移植?

[00:00:12] Matthew Garner, MD: You really can't. You have to come see us. 因为要确定你是否会从中受益是非常具有挑战性的，我甚至不能指望大多数肾脏医生对此有一个很好的解释.

What I can tell you is that if you have renal failure, if you're being referred for a kidney transplant, and you also have diabetes, 你应该去做胰腺和肾脏移植的中心看看. 因为你想要别人从你的角度来看你, could this person be a pancreas candidate? The answer to that may very well be no. And that's OK. 因为最终我们想为你做的是给你最好的治疗. 对一些病人来说，那就是做胰腺移植. For other patients, it's to say, "look, 这个手术对你来说风险太高了，因为它是一个更大的手术, 所以我们要做的是和你的内分泌医生一起在肾移植后更好地控制血糖."

但是如果你去一个只做肾脏移植的中心, 没有一个好的方法去做胰腺移植. 同时做肾脏和胰腺比先做肾脏后做胰腺要容易一些. We can do that. 但这有点复杂因为每次你做手术, 这使得肾移植手术有一点风险. 这种风险在一次性发生时更容易忍受. When you do it afterwards, and then the kidney doesn't work because of a problem, that's a tough pill to swallow. 所以如果需要的话，我们会这样做，因为有些病人仍然从中受益. 但我们会优先尝试同时做这两件事，以避免这种情况.

Additionally, you get a kidney and a pancreas from the same donor, the immunological burden on the patient is lessened, 因为他们只有一个捐赠者的组织，而不是两个捐赠者的组织.

现在我们描述糖尿病的方式可能有点令人困惑. 所以一般来说，我们把不分泌胰岛素的人称为1型糖尿病. 它们已经被破坏了，通常是由自身免疫过程造成的，也就是身体攻击自己. They no longer produce insulin of any kind.

2型糖尿病的特点是胰岛素抵抗. 什么是胰岛素抵抗，当你的身体习惯于产生大量胰岛素的时候. This is more common in people that are overweight, 但它也可能发生在正常体型的人身上. 这种抵抗意味着你的胰腺需要产生越来越多的胰岛素来达到同样的效果. 在某一点上，发动机全速运转. It's making as much insulin as it can. 但是它不能产生足够的来控制血糖，你就会得糖尿病. 然后你必须服用额外的药物，甚至可能是胰岛素来补充.

有些人用一个术语叫做糖尿病.5，这不是一个官方术语，因为它有点令人困惑. What that effectively refers to is a type 2 diabetic, 有胰岛素分泌和胰岛素抵抗的人, but doesn't really make much insulin anymore. 所以当你的胰腺达到一定程度，它必须尽可能地努力工作来制造胰岛素，因为你有胰岛素抵抗, what can happen to that over time is, in layman's terms, it sort of gets tired. It burns out. 所以它能产生的能量，就像一个引擎，你运转得太用力太快了. It produces less and less insulin.

So sometimes we see patients who have type 2 diabetes, 他们的胰岛素分泌非常低，基本上就像1型糖尿病患者一样. 这一点非常重要，因为当我们植入一个新的胰腺时，它会正常地产生胰岛素, but it's just a normal pancreas. It's not a super pancreas. 它不会比你的旧胰腺在最佳状态下产生更多的胰岛素. So if you are a type 2 diabetic, that still produces a lot of insulin, well, 即使我再放一个胰腺，它也能以最大容量工作, that may still not be enough for you. 然后我做了这个手术，你还在注射胰岛素，你还患有糖尿病. I haven't really helped you. So we try to avoid doing that.

On the other hand, if you're the sort of person who was a type 2 diabetic, saw that you were, lost weight, got some of your other diabetes under control, but still has it, and when we test you, we find that you don't make much insulin, 现在你是那种即使你是2型糖尿病患者, you're kind of behaving like a type 1. And that's a person because your problem, even though initially was insulin resistance, now it's more of a production problem. You're not making enough insulin. 我们要做的就是把胰腺移植到病人体内, 它产生的额外胰岛素现在足以弥补失去的胰岛素. And, you can take someone and correct their diabetes.

这些病人的复发率会更高, obviously, 因为他们确实有一些1型糖尿病患者通常没有的胰岛素抵抗. 但是在仔细挑选病人的过程中，你可以找到仍然可以从中受益的人. 但总的来说，一般的2型糖尿病患者不会从胰腺移植中受益.

[00:05:24] Host Amber Smith: 您收听的是来自上州医科大学的移植外科医生马修·加纳.