Our entire human practice of type 1 diabetes is more like a pathway into the world of patients. In the communication with doctors, we understand the current treatment difficulties and psychological pressure faced by patients. And face-to-face interviews with patients, let us go into their inner world to understand their real problems and needs. In the Integrated Human Practices section, we hope to truly enter the world of stakeholders through dialogue, so that we can continuously improve our projects to be closer to our ultimate goal.   In the human practice project, we start from the actual problem, with the idea of exploring and solving the problem into the relevant groups, through contact with different stakeholders, to understand the thinking and needs of the project from different angles. This provides valuable ideas and inspiration for us to better carry out related work.

Q1:What are diabetics like in your impression?

A:In fact, I have the impression that the majority of diabetic patients are elderly people, but in recent years, it seems to have a younger trend. Controlling diet and paying attention to exercise are their important life keywords.

Q2:It sounds like your answer is more about type 2 diabetes. So do you know about type 1 diabetes ? This is a type of diabetes that often occurs in young children.

A:I have heard of type 1 diabetes, which seems to be a different type from the more common type 2 diabetes. But ashamed, my understanding is not much, limited to some introduction from the film or literary works.

Q3:Do you guess what difficulties patients with type 2 diabetes will face in their daily life and social interaction ?

A:I have noticed that these patients need to strictly control their diet, pay attention to blood glucose changes, and need to inject insulin from time to time. Such needs may bring some trouble to life on the one hand, and may also be misunderstood and treated unequally by others on the other hand.

Q4:What do you hope to learn if there is a science campaign on type 1 diabetes?

A:First of all, of course, I want to understand what kind of disease type 1 diabetes is, how it is formed and what kind of symptoms it has. Secondly, I am more curious about the precautions in the daily life of patients with type 1 diabetes. From their perspective, what difficulties are they facing ? What should we ordinary people think about the group of patients with type 1 diabetes ?

@是陈粤 is a type I diabetes patient.
She was diagnosed at the age of 13 and has a history of diabetes for nearly ten years.At the same time, she is an uploader of social media, whose video content is mainly about the lives of type I diabetics.

Q1:How much do you know about type 1 diabetes before getting sick ?

A:Before I had diabetes, I didn 't even know about diabetes, and I hadn 't heard of type 1 diabetes. Before I fell ill, I was like many people, simply thinking that diabetes is caused by eating sugar, drink milk tea and drinking too much. There is no genetic history in my family, so I always think that diabetes is far away from me. Until admission, it was learned that the original diabetes was also classified. “Sugar friends” like us who “ can 't secrete insulin by themselves ”are classified as type 1 diabetes.

Q2:What is the most significant problem that type 1 diabetes poses to you ?

A:Because I can 't secrete insulin, I need to rely on foreign aid injection to maintain the health of blood sugar. Compared with the pain of insulin injection, what makes me more upset is the high and low blood sugar. Type 1 sugar control is not as simple as insulin injection. It is also related to the injection dose of insulin, the onset time of insulin and the determination of the glucose level of food. A little inattention will cause a huge fluctuation of blood sugar, so the high and low blood sugar is not only bad for our blood vessels, but also let the complications come earlier. This also has a huge psychological pressure. ( Can 't eat a lot of food is also sad )

Q3:What is the reaction of relatives and friends to suffering from type 1 diabetes ?

A:My relatives are shocked that I have type 1 diabetes, they have never heard of this disease. And want to cure me as fast as possible, try a lot of outrageous methods. I know that type 1 diabetes is currently incurable. When I refused those blind treatments, relatives would attack me with “diabetes”. Say I “insulin does not live long” , “can not get married and have children” and so on... On the contrary, my friends give me a lot of encouragement and will take care of my diet at dinner. Help me block when injecting on the announcement occasion. Thank you to my friends.

Q4:How to adjust the mood after illness ? Have you sought psychological help from the outside world ?

A:No, I had a very dark period after the diagnosis of diabetes, washing my face with tears every day. I started taking insulin when I was 19, and I felt like I was going to be finished with my whole life. Thankfully, I got through it. It turned out that diabetes was not as miserable as imagined. Compared to other diseases, type 1 diabetes is already free too much. We are lucky in misfortune. Even if I have diabetes, I can still use my eyes to see the beautiful world and walk thousands of miles with my legs. I also like to watch friends’ vlog about sugar control to watch them eat delicious food. These make me feel very cured, and my mentality has become increasingly optimistic.

Q5:We watch your video and find that you currently control blood sugar by injecting insulin. Do you personally feel that it has a great impact on daily life ?

A:Not much, occasionally have an impact. I have been a very outgoing, cheerful and lively person since I was a child. In the days when I do not hide the fact that I have diabetes, even if someone discusses me, I will not care. Whether it is good or bad, I just want to make life more convenient. In public injection and blood glucose measurement is already a common thing, if you think diabetes is a very shameful thing, then will fall into the infinite ego internal friction.

Q6:There is a certain probability that insulin injections will leave scars on the body. Do you mind ?

A:It doesn 't matter, because I am not a delicate girl, hahaha. My relatives once said to me : ' In the future, if your husband looks at the scar on your stomach, he will definitely dislike you. ' Haha, it 's really funny. My own body I decide, care about others what things, can accept to accept, do not accept to leave ! The injection is very painful, so every scar on my body is a record of my bravery!

Q7:For our treatment program for type 1 diabetes, what problems do you, as a patient, feel are the most urgent to be solved ?

A:I don 't know much about the treatment of type 1 diabetes, because I ' m pessimistic about the cure of the disease, because many years ago, there seemed to be news about cures. Until now... is still under study. If there is oral insulin, it is better, haha.

Q8:We see that you have gained some attention by sharing your sugar control experience on social media. Why did you think of sharing the course of illness with everyone through the Internet at the beginning ?

A:Speaking of this I think it is very funny, this is a very accidental event. At that time, I just had diabetes, and I didn 't understand anything. My parents pulled me to do acupuncture treatment for type 1 diabetes.
My cousin is my attending physician. When she gave me acupuncture, she said : “ You can post your own acupuncture history and situation on social media, and also help me promote it.” At that time, there was nothing to do, I began to cut the daily video. But I didn 't think anyone would really look at my VLOG ! Seeing a lot of patients with the same disease, I feel good and happy ~ we are all the salvation of each other on the Internet. Slowly... my social media has gained attention ! I really like to share my sugar control daily with my patient friends, and hope that my optimistic attitude can drive more friends who have just got diabetes out of the darkest moment of life.

Wenqing Sun , deputy chief physician, has been engaged in pediatrics for more than ten years, and is good at the diagnosis and treatment of pediatric endocrine diseases, digestive diseases and respiratory diseases.
She is also the secretary of the Endocrine Genetic Metabolism Group of the Pediatric Branch of Heze Medical Association, the member of the Endocrine Genetic Metabolism Group of the Pediatric Branch of Shandong Medical Association, and the member of the Pediatric Endocrine Branch of Shandong Research Hospital Association.

Q1:What are the clinical manifestations of diseases related to abnormal insulin secretion ?

A:Abnormal insulin secretion can be attributed to two cases, one is excessive insulin secretion, and the other is insufficient insulin secretion. There are two clinical cases of excessive insulin secretion. One is hyperinsulinemia that can cause hypoglycemia, including congenital hyperinsulinemia and insulinoma. The other is insulin resistance, the body compensates for the secretion of excess insulin, which is common in type 2 diabetes. Inadequate insulin secretion in children The most common disease is type 1 diabetes, a reduction in insulin secretion caused by various factors.

Q2:What are the common clinical treatments for type 1 diabetes ?

A:Just mentioned that type 1 diabetes is caused by insufficient insulin secretion, and the treatment method is mainly to supplement insulin. There are two common methods for supplementing insulin, one is continuous subcutaneous insulin infusion ( CSII ) using an insulin pump, and the other is multiple daily subcutaneous injection ( MDI ). Regarding the choice of these two treatment options, for type 1 diabetes, we still recommend CSII treatment mode, but sometimes due to factors such as family economic conditions and family members ' acceptance of this mode of administration, some parents are still willing to choose MDI treatment.

Q3:What is the efficacy and prognosis of these commonly used methods ?

A:The treatment goal of type 1 diabetes is to control blood glucose and glycosylated hemoglobin within the target range and reduce the occurrence of complications. At present, the blood glucose of some children is still unstable, which is related to the health education of the medical unit, the insulin compliance of the children, the diet control and the supervision of the parents. The long-term blood glucose level is not well controlled, and some complications often occur. Diabetic nephropathy still occurs in clinical practice.

Q4:What are the defects and bottlenecks of the existing treatment methods ?

A:Whether it is multiple daily injections of insulin or continuous subcutaneous injection of insulin, some children still resist it. Missing insulin or removing the insulin pump after school have occurred from time to time in clinical practice. People still have resistance to repeated injections. At present, everyone hopes to have a better alternative to insulin injection.

Q5:How do you see the possibility of cell embedding in the treatment of type 1 diabetes ?

A:On the current study of cell embedding method, of course, is very looking forward to, I believe that patients and their families are also looking forward to ! Some questions need to be raised : how safe is this treatment ? Is there any other organ and immune function damage for patients ? Is there a price, can be accepted by ordinary families ? Is it possible to be included in medical insurance ?

Q6:What is the situation of patients with type 1 diabetes and their families ?

A:Type 1 diabetes requires lifelong treatment after diagnosis, so it is a huge challenge for patients and their families ! Many families in the initial will be in a state of sadness, anxiety, helplessness and hopelessness, slowly to accept the reality. Injecting insulin every day is a bolt from the blue for parents and children alike ! How to use insulin correctly, how to monitor blood glucose, how to adjust the amount of insulin according to blood glucose, these need to learn from children and their families ! We are often asked when there will be a better way to cure type 1 diabetes ? So these patients and their families have been looking forward to a cure or other better treatment.

Q7:What do you want to say about patients with type 1 diabetes ?

A:The most important thing for patients and their families is to hope that we should use insulin regularly under the existing medical conditions, monitor blood glucose regularly, review the relevant indicators regularly, and have the confidence to overcome the disease ! It is believed that with the development of medicine, there will be more convenient, effective and safe treatment methods !

His research team has developed a stem cell replacement therapy, combined with immunosuppressive therapy, which has made positive progress in phase I / II clinical trials, successfully helping the first patient to regenerate their own fully differentiated islet cells. This breakthrough is considered to bring new prospects for the treatment of type 1 diabetes.

 Professor Melton 's research began with his personal experience, as both of his children were diagnosed with type 1 diabetes. His goal is to produce functional islet cells through stem cell technology to replace insulin that patients need to inject for life. The core of this study is to use embryonic stem cells or induced pluripotent stem cells ( iPSCs ) to generate islet β cells and solve the problem of immune rejection. To this end, Professor Melton hopes to use genetic engineering techniques to prevent these cells from being recognized as foreign by the patient 's immune system, thereby avoiding rejection.

In addition, Professor Melton 's team is exploring ways to improve the efficiency of stem cell differentiation into β cells so that more patients can be treated in the future. With the deepening of research, this technology is expected to change the treatment of patients with type 1 diabetes, so that they no longer rely on insulin injection, but can regulate blood glucose levels through their own generated islet cells.

Professor Wang Wei from the Third Xiangya Hospital envisages the use of pig islet cells to treat type 1 diabetes through xenotransplantation technology. Their team has achieved a series of innovative technologies in biosafety, islet extraction and preparation, and clinical treatment. These techniques make it possible to transplant porcine islets into patients with type 1 diabetes, and breakthrough progress has been made in the clinical research stage. They have bred specific pathogen-free ( DPF ) donor pigs that meet the World Health Organization standards, known as ' five-star pigs ', and adopted new techniques to induce immune tolerance to reduce the rejection of transplanted cells in vivo.

In the clinical study, Professor Wang Wei 's team performed pig islet transplantation on several patients with type 1 diabetes. The results showed that the amount of insulin used was significantly reduced, and the level of glycated hemoglobin was decreased. This marks the great potential of heterogeneous islet transplantation technology in the treatment of type 1 diabetes.

1.Generation of stem cell-derived β-cells from patients with type 1 diabetes - Nature Communications, 2016.

2.Breakthrough within reach for diabetes scientist and patients nearest to his heart - Harvard Gazette, 2021