If she feels the urge, there`s nothing to stop 22-year-old Peggy Polopolus from downing a gallon of ice cream and a jumbo bag of jelly beans in a single sitting-which is what makes her so extraordinary to doctors. Eight years ago, Polopolus was a woman marked for Type I diabetes, a disease that not ony makes the body react strongly to sugar, bringing on hangoverlike symptoms, but also can lead to heart disease and blindness. Nor was there any sure way for her to escape her fate; over the years, doctors have treated the disease, but never prevented it.
So in 1983 Polopolus took a risk. She began taking daily doses of Imuran, a powerful drug that`s normally used to suppress the immune systems of transplant recipients so their bodies won`t reject the new organs. Imuran also had proven effective in halting the development of diabetes in rats, but it had never been tried for that purpose in humans.
”Peggy has been on the drug ever since, and she`s been fine,” says University of Florida endocrinologist William Riley, one of her doctors.
In short, Polopolus is a star patient. And each day that she wakes up in good health gives doctors more confidence that they`ll soon be able to postpone and maybe even prevent Type I diabetes in the 13,000 to 15,000 Americans every year who are expected to come down with the disease.
Type I diabetes occurs in people whose bodies have all but stopped producing insulin, a hormone that`s needed to metabolize sugar. Without insulin, the body`s cells are helpless to absorb sugar`s energy from the blood, and in desperation they begin to consume themselves for fuel. This self-cannibalism releases poisonous chemicals into the bloodstream that soon bring on coma and death-which is why the 1 million Americans who have Type I diabetes cannot go for much more than a day without injections of the hormone. But insulin production doesn`t shut down overnight. It tapers off, usually beginning in childhood or adolescence, when the immune system starts attacking its own tissues-in particular its beta cells, which produce the crucial hormone.
Using recently developed blood tests, doctors can now tell whether a person`s beta cells are under assault, and if so, how fast they`re dying off. ”In some patients, it can be 20 years before they develop the disease,”
says George Eisenbarth of Harvard University`s Joslin Diabetes Center. ”But in others we can say with some certainty that they`ll be diabetic within three years.”
That`s where Imuran comes in. By suppressing the immune system, it slows down the attack on the beta cells and may even stop the assault altogether. In Polopolus, the process does seem to have stopped: Six years ago her body could barely produce 1 percent of the insulin that a normal person secretes; now she`s up to 25 percent of normal.
Nonetheless, any time you suppress the immune system, you`re playing with fire.
Still, ”we believe it`s going to work,” says Riley. ”We`ll be able to suppress the disease. The question is, for how long?”
