Islets of Langerhans

I was watching the TV monitor at the credit union where we bank.  My wife was waiting in line for a teller to call her.  The TV was streaming, I guess to entertain the customers who were waiting in the long line, and what caught my attention was a quiz that asked, “Islets of Langerhans are in what organ of your body?”  Then the picture shifted to something else, such as the bank’s 1.99 % rate for a new car loan and a 2.99% rate for a home equity loan under $100K, but promised to give the answer in a bit.  I was at the sideline, so to speak because my wife was actually the one standing there with the hapless crowd – my role was to drive her to the bank that day and for me to enjoy the bank’s complimentary Java Dark Roast, while waiting; granted customers had to pour their own coffee from any of four different dispensers, real sugar and artificial sweetener, regular cream or non-fat, etc.

Obviously, I became a captive anticipator for the answer to the question posed by the TV monitor.  I never heard of “Islets of Langerhans” before, what they do, and curious about which organ of the body the question was referring to?  It was one of those phrase words combo one heard for the first time then recalling and remembering them indelibly, such as, The Straits of Hormuz, The Gulf of Tonkin, Sea of Tranquility, Broca’s Brain, etc.  My wife was still about number 8 down the line so there was time for me to catch the answer before she could finish her transaction.

 Well, if you haven’t yet, as most people probably haven’t, you read it here first – Islets of Langerhans are in our pancreas.  So, as we headed back to the house, my compulsion was to Google it.  You see, unlike the guy whose T-shirt said, “I don’t Google, my wife knows everything”, I do not have that luxury; or misfortune, depending on how you look at it.

Indeed, “Islets”, small as they are, play a very significant role in what is one of today’s rising chronic illnesses – diabetes.  Let me back up.  The pancreas is one tiny organ. Islets of Langerhans make up just 1-2% of the total mass of our pancreas.  A healthy adult has a million of these islets – that’s how tiny they are - which contain the endocrine cells that produce insulin.  This then leads to how critical these cells are, when impaired, to the development of diabetes, which then leaves one to wonder how these tiny, almost insignificant particulates of tissue could be so important.

How it got its name goes back to 1869 when a German anatomist discovered these tiny dots in the pancreas. Paul Langerhans was that pathologist who perhaps fondly called them islets, for little islands of cells.

How could something that is a mere fraction of our anatomy cause such serious condition?  Indeed it is the little parts that give the whole so much issues – from a tooth cavity, a busted ear drum, a bursting appendix, trouble with the pituitary gland, an aneurism, etc. all involve little parts.  A blood clot from the leg can traverse through the blood stream and cause extreme damage at the artery near the heart or the lungs.

Directly or indirectly we know someone afflicted with the commonly known Type 2 diabetes. If TV ads for diabetes medication are any indicator, the condition seems to have reached epidemic proportions, although statistically it is just about 10 % of the general population in the U.S. But indeed, if one were to look at it from a particular context, it would mean that one of every ten of our relatives, friends, co-workers, has diabetes.  In fact, try naming ten relatives or friends, look at your work place, and you will have one diabetic in each group of ten.  The U.S. population alone will have over thirty million diabetic patients.  China and India, whether they have a slightly lower or higher ratio, each country has over 100 million diabetic patients.  It is therefore a non-trivial trend.  In a rapidly increasing age group of seniors, as more and more people get older, the proportion goes up to one in five, 21% !, although for 18-39 year olds, the stats bear only 2%.  However, by the time someone gets past the age of forty, the ratio goes up to 11 %.

Islets of Langerhans are critical because diabetes, or more precisely its development, operates at the cellular level. It begins at the tiniest level of our anatomy.

Here is a quote from the “Biology of Diabetes”

“The tissue cells of the muscle, fat, and liver are designed to take glucose (sugar) out of the blood, pull it into the cells and change it into energy.

These cells require insulin to absorb glucose. When these cells fail to respond adequately to circulating insulin, these cells lose their sensitivity to insulin (a condition known as insulin resistance) and blood glucose levels rise.

The body responds to this situation by signaling the pancreas to produce more insulin, causing insulin levels in the blood to become too high. This condition is known as hyperinsulinemia. The cells in the liver also become insulin resistant and respond by making too much blood sugar. Because blood sugar is not absorbed by the cells, it stays in the blood, causing blood sugar levels to rise — a condition known as hyperglycemia.”

“All of this leads to diabetic complications that can lead to blindness, kidney failure, amputation, heart attack and stroke. Other health issues include high blood pressure, high cholesterol, high inflammation markers, periodontal disease, and erectile dysfunction.”

We can say that diabetes is a new age condition.  Apparently, we can surmise that over two thousand years ago, or even earlier, diabetes may not have been a condition people worried about: (a) most folks probably didn’t get past the age of forty (b) they worked so much harder physically that excess sugar and glucose in their blood was unheard of; (c) there may not have been that much unused sugar in their diet, to begin with – just guessing.  As an aside, other age-related afflictions like cataract, glaucoma, even arthritis were likely very rare as well.  And likely still, obesity and gout were suffered only by the very rich.

Today, however, the million islets of Langerhans, can be overwhelmed by the million and one sugary foods out there – from M&Ms to sodas to cheesecakes to even bowls of rice or loaves of bread.  What are we to do when the sweetness of life, the delectable ingredients of our favorite snack, the staple carbohydrates of our basic food are to be doled out in small portions as to obliterate any vestiges of guilty pleasures from our lives?  Well, as Yoda might say, “0ne to thirty nine years had you with sugar and spice, suck it up you will do to live twice”.  Or, walk five miles a day or skip a bowl of rice; a bowl of ice cream or do ten miles.

Now, diabetes is not a death sentence anymore when caught early.  Tests are accurate and medicines are widely available.  Diet, if followed, helps greatly and recommended exercise regimen is effective.  That’s the good news.  The bad news is that sedentary life styles prevail in the developed world and sugar in many forms finds itself in most of what we eat; and, in the underdeveloped countries, health care management is still found wanting.

Since you have read this now and you are well aware of what the “islets of Langerhans” are, you have so much less excuse to ignore the warnings on diabetes.  We even have less reason not to read a bit more and find out about it in more detail, or at the very least raise our awareness.

We are not going to know everything but this we know – we all should take a pancreatic oath, requiring but a small sacrifice to take care of the million islets of Langerhans.

A sweet tooth is as real as the tooth fairy - resist it.