Twins As a Lab for Type 1

Today's NYT science section has a long article about the plight of a family discovering that one member of their set of twins has type 1 diabetes. Until it is discovered, the teen is in diabetic ketoacidosis, and just shy of losing her life if not for her healthy twin sister urging their plastic surgeon father to urgently call for an ambulance at 3 AM. The markedly underweight girl is saved with intravenous fluids and insulin, and since the episode has apparently done well. The article then takes us to the treasure trove of information that the twins represent, and to the logic of using this human lab for further enhancing our knowledge about this disease. The rational has to do with the assumption that the twins face an identical genetic risk to get diabetes, and with the reality that only one of them actually does. Furthermore, with the assumption that the unfortunate newly diagnosed diabetic has succumbed to some environmental assault which has not compromised her healthy sister. That assault may be a virus, which causes the immune system of the individual to produce antibodies which are now damaging the insulin-producing cells(beta cells). Researchers are reasoning that if it were possible to avert or delay the immune response of the individual, damage to beta cells could be put "on hold". In order to "trick" the immune system, researching are using oral insulin in tablet form, taken daily by the healthy twin. A clinical trial is set up to which multiple twins are recruited, and treated with either oral insulin or a placebo (dummy pill). These twins are followed every 6 months with a glucose tolerance test in order to assess their tendency to develop diabetes. Results are far from being available, so at this point one can only speculate. Suffice it to say that if this indeed works and the immune system is tricked, that's great news. It means that all those individuals at risk of developing type 1 diabetes may look forward to a healthy and normal life. However, it may be that we are too optimistic and simplistic in our approach to this problem. Simply stated, the insulin protein as such, may not be the antigen in question at all. Other proteins may be playing a central role. How to identify these proteins is the real challenge. Let's all hope that their identity is soon to be realized, but until that time we all have to be vigilant in educating the public about diabetes in general, and about type 1 in children/teens, in particular. There's always hope that the right discovery is around the corner.