Though in recent weeks Lofstrom had experienced rapid weight loss, increased urination, and that constant thirst, she was not prepared for the results of her blood test. “I really hadn’t planned on finding out I had diabetes,” she says about the disease that has, in some way, touched the life of almost every person in America. Statistics compiled by the National Institute of Diabetes and Digestive and Kidney Diseases cite that nearly 21 million people in the United States have diabetes mellitus, with close to one-third of this population as of yet undiagnosed. As of 2002, an additional 54 million were estimated to be pre-diabetic, with many of those expected to develop type 2 diabetes within 10 years.

Second-Century Greek Roots
Meaning “a siphon,” the word diabetes was coined by the second-century Greek physician Aretus the Cappadocian, who routinely observed one of the classic symptoms of diabetes—frequent urination—by his patients. A metabolic disorder, diabetes is the result of high levels of sugar in the blood. After food is broken down during the digestive process, sugar in the form of glucose enters the blood, becoming the main source of fuel for the body. In order for glucose to enter the cells, insulin, a hormone produced by the islet cells of the pancreas, must also be present in the blood. In a nondiabetic individual, for glucose absorption to occur, the pancreas automatically produces the correct amount of insulin. In people with diabetes, however, either little or no insulin is produced (type 1), or the body’s cells do not sufficiently respond to the insulin that is produced (type 2). The consequent build up of sugar in the blood spills over into the urine and out of the body. A third type of diabetes, gestational diabetes, occurs in 3 to 8 percent of women during pregnancy. While gestational diabetes usually disappears after the baby is born, women with this type have a 20 to 50 percent chance of developing type 2 diabetes within five to 10 years.

Lifelong Treatment Regimen
A diagnosis of diabetes is generally made through a fasting blood glucose reading of greater than 126 mg/dc (deciliter) done on two separate occasions. Lofstrom’s visit to the ER yielded a blood glucose reading of 650; random blood glucose readings should be below 200 mg/dc. Individuals like Lofstrom with type 1 diabetes are taught to give themselves insulin, from one to four times daily. Continuous-flow insulin pumps, worn at all times, are also available; a new insulin inhaler was given FDA approval in 2006 and can replace some of the daily injections. A program of regular physical activity is prescribed, as insulin balance is achieved by food intake and daily exercise. Blood glucose levels by finger sticks must be done several times daily to ensure that sugar neither rises too high nor drops too low. Type 2 patients are not immediately prescribed insulin for their disease but a treatment plan of exercise, diet modifications, and, if needed, oral drugs that lower the amount of sugar in the blood.

Pandora’s Box of Complications
Though a veteran of the diabetes regimen of insulin dosing, Lofstrom, now a doctoral candidate at Illinois Institute of Technology and senior manager for corporate communications at the Healthcare Information and Management Systems Society, says the thought of problems arising from so many years of having the disease is never far from her mind. “Monitoring diabetes is very trying at times for me—and for my family,” she admits. “I worry about having high blood sugar so sometimes I over-amp my insulin, which results in low blood sugar.” Lofstrom credits her family for their constant support and keen observation in providing another level of checks in her proper monitoring of insulin, which she now administers via an insulin pump. They can tell by one word whether or not her levels are askew. “They know by the way I am talking that it is low. I am used to doing the finger sticks to check my blood sugar, but the worry about the long-term effects never disappears. So far, after almost 30 years with the disease, I am lucky: no complications.”

Vincent Turitto, director of the Pritzker Institute of Biomedical Science and Engineering and chair of IIT’s Department of Biomedical Engineering (BME), understands Lofstrom’s concerns about her future. “If you don’t keep your glucose levels low, you tend to run into complications 10 or 20 years down the road,” says Turitto, whose brother has type 1 diabetes. “By not monitoring sugars well, you end up with a whole host of disorders—advanced cardiovascular disease, loss of kidney function, neuropathies, abnormal wound healing, and blindness.” Moreover, many type 2 patients develop a need for insulin injection treatment and with the growing numbers of such patients developing this disorder at earlier ages, they are likely to develop the long-term complications associated with type 1 diabetes.

Three dimensional image of blood vessels (red) growing into a tissue engineering scaffold (white), a technique used to study wound healing processes in diabetes.	Infrared reflectance (IR) image of the region above the optic disc of a normal rat retina; the arterial and venous vessels are protruding from the optic disc.	Structure of collagen fibers in the skin of diabetic patients; the structure of the fibers is altered relative to non-diabetic patients.

First-of-Its-Kind Center
IIT faculty-researchers are investigating many of the disorders associated with diabetes at the university’s Engineering Center for Diabetes Research and Education (ECDRE), the first engineering center in the nation to focus on the treatment and cure of diabetes. Formed two years ago, ECDRE is directed by Ali Cinar, vice provost for research and professor of chemical and biological engineering (ChBE). It is one of several centers under the Pritzker Institute, which seeks to develop and coordinate relationships with traditional science and engineering departments within IIT, as well as with outside institutions. The ECDRE’s collaborative relationships with various institutions, including the University of Chicago (U. of C.), a longtime leader in medical diabetes research, as well as with faculty from Armour College of Engineering, the College of Science and Letters (CSL), the Institute of Psychology, and Chicago-Kent College of Law, distinguish it as being unique in what it is able to offer.

One priority initiative being jointly investigated by ECDRE and the U. of C. is on the only “cure” currently available for type 1 diabetes patients: the development of a bioartificial pancreas through islet cell encapsulation. Naked pancreatic islet cells from two donor cadavers are injected into the patient’s liver, where they lodge in the blood vessels and respond appropriately to sugar levels. “It has been shown that patients injected with functional islet cells from cadavers will actually become insulin independent; they won’t have to inject themselves with insulin,” says Turitto. “But the long-term studies are not in yet. Some fail, some are successful. It’s not yet clear why they fail, and it’s not clear what the maximum lifespan would be.”

U. of C. surgeon Marc Garfinkel, along with Emmanuel Opara, ECDRE associate director and BME research professor, and Seda Kizilel (Ph.D. BME ’04) have already published one paper on the topic. Kizilel, now working at U. of C., is spearheading an islet project using biopolymer hydrogels—another ECDRE priority initiative—as a means of encapsulation. Garfinkel has also collaborated with BME Assistant Professor Connie Hall on blood clotting and islet cell transplantation. “As is demonstrated by these projects, the unique combination of engineering science and biologic science has tremendous potential to impact many diseases, but particularly type 1 diabetes,” notes J. Michael Millis, professor of surgery and chief of the Section of Liver Transplantation and Hepatobiliary Surgery at U. of C.

Collaborators in diabetes research, L to R: Jennifer Kang Derwent, Eric Brey and Rong Wang from IIT

Collaboration is also taking place within IIT’s traditional science community as researchers from Armour and CSL have joined to study type 1 diabetes. An interdisciplinary team that includes BME Assistant Professor Eric Brey and Jialing Xiang, assistant professor of biology, and Rong Wang, associate chair of the Department of Biological, Chemical, and Physical Sciences and associate professor of chemistry, is advancing bioartificial pancreas research through two projects: differentiating human embryonic stem cells into functional, insulin-producing islet cells and developing novel cell encapsulation methods for islet cell delivery. The project is one of nearly 30 funded by Pritzker Institute seed grants over the past two years.