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Friday, October 22, 2010
For an otherwise healthy 15-year-old with a taste for surfing and skateboarding, Michael Staveley-O’Carroll’s type 1 diabetes diagnosis came as a shock to his family. The symptoms—frequent thirst, urination, lethargy—presented when Michael was on his family’s boat in Florida, and he was diagnosed in a nearby emergency room. Michael’s mother, Nancy Brennan, was devastated by her son’s diagnosis, but immediately began consulting with physicians in her husband’s family and educating herself about the disease. Type 1 diabetes begins with the body’s beta cells, which are located in the pancreas. These cells make insulin, a hormone that regulates the blood’s sugar levels. Though people with type 1 diabetes are born with a full supply of beta cells, at some point in their lives their bodies begin to attack the beta cells, compromising the regulation of blood sugar levels, which can lead to serious complications.
“I had to hit the ground running,” Brennan says, knowing participants must join clinical trials like the one she found at MassGeneral Hospital for Children (MGHfC), within the first three months of diagnosis.
Michael Staveley-O’Carroll (right) with endocrinologist Nicole Sherry, MD
Brennan’s research led her to endocrinologist Nicole Sherry, MD, a leader of the clinical trial for a drug treatment that aims to preserve the patient’s own beta cells, and the newly appointed director of the MassGeneral for Children Diabetes Center. “We developed a rapport,” Brennan says of her preliminary conversations with Dr. Sherry. “So I took Michael for an appointment with Dr. Sherry. Since Mass General is Man’s Greatest Hospital, I knew the care would be excellent.” Sherry recognized Michael as a candidate for the worldwide trial, which she was leading at MGHfC. The trial required two weeks of treatment for six hours each day, and a booster treatment of the same amount six months later. The trial drug seems to work on the body’s T-cells, which are the part of the immune system responsible for attacking the beta cells that produce insulin. While researchers are working to explain the exact effect of the drug, the theory is that it turns T-cells from “attack mode” to “police mode,” Sherry says. In police mode, the T-cells back off, recognizing that the beta cells are not a danger to the body. “The beauty of that is that instead of having to continually give this medicine, we can give a short course, because this population of police cells that develops can continue to monitor the body’s immune system even after the treatment is stopped. If new cells arise that want to attack those cells, the police cells will keep them at bay,” Sherry explains.
When he began treatment four years ago, Michael was being home-schooled in his Massachusetts hometown. Today, he is enrolled in public school and is participating in the trial’s three-year extension, which measures the safety and efficacy of the treatment. “He’s doing great. It’s been a really nice thing for him,” Sherry says. Most patients with type 1 diabetes go through a short “honeymoon phase,” or a period after diagnosis when they require less insulin to keep their sugar levels steady. Michael’s honeymoon phase has extended much longer than the average six to nine months. For the past three years he has continued to not need insulin with every meal. “I think it’s been wonderful,” Nancy Brennan says of the trial. “It was a bit of a time commitment, but I thought the benefits would outweigh the inconvenience and that he might be able to benefit from any discoveries in the future, if his pancreas was still functioning.” Sherry says the trial has worked nicely for other teenage patients like Michael, who often struggle with such a diagnosis after having grown up without the disease. “I think it’s great that we’ve had a lot of teenagers come through, because it gives them that extra cushion. They get those extra years. Now Michael is 18 and he’s just at the end of his honeymoon phase and he’s becoming more mature,” Sherry says. “He’s had beautiful control through his teenage years, much better than we would usually see.” Of Dr. Sherry, with whom Brennan stays in contact via email and telephone, Brennan says: “We’ve developed a relationship.” She says the family also appreciated getting to know the MGHfC nurses. “I was there every day and I got to know them,” she says. “It’s a nice atmosphere, everybody’s very friendly, I would say it’s been a good experience,” Brennan adds. At a recent check-in with Dr. Sherry, Michael talked candidly about high school and his thesis project about nutrition and diabetes. Every six months for two weeks Michael keeps a diary card of his food intake and sugar levels, but he remains especially aware of his diet at all times. “If I didn’t have diabetes and I was my age now, I wouldn’t be as healthy as I am,” Michael says. The experience has also played a part in his career goal: to enter the medical profession. “I want to do something in health. I want to help people,” he says.
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