Dear Paula,

First, I'm so glad to hear you're exercising and in good shape, in a way you did your pancreatic islets as best a service as possible towards a possible boost. They're really sensitive little things that shouldn't be exposed to any damage, with very low self-repair going on with them.

There's a paper that came out after our work was published about the fact that 50% of individuals with type II diabetes have below-normal AAT. The connection between all these elements is real and it is important, and it is one word: inflammation. The cells in your body don't distinguish between one stress form or another, be it inflammation, oxidation, mechanical stress or an immune attack. You probably saw it happen and never knew it -- if you stretch say a section of your skin hard enough (don't do it it's painful!) it will become red and swell, immune cells will rush in to see what happened and soon enough it will start to recover and scar; this is the very same sequence of events that you'll see if you (a) burnt the skin (b) exposed it to a toxic agent (c) had your immune cells do the job, as in psoriasis... the actions are the same. As if inside the boundaries of the cell membranes the language is rapidly converted into a program to be executed and followed until the damage is resolved. During this time, remarkably, cells refuse to 'listen' to insulin and glucose rises in the blood, to help the brain be at its best. We actually enter a sort of temporary intentional type II diabetic state. Yet as many things in our modern life-style go, physiological reflexes are turned against us in an environment so much different than the one our bodies developed in. The excess in glucose is toxic for islets, and these might suffer greatly from chronic elevated glucose (which incidentally we have no way of sensing, short of an exacerbation as in type I diabetes).

AAT is one of the molecules we make to dampen inflammation. In our lab we keep generating results and are still amazed when we discover how well it helps damaged cells. We're looking for mechanisms and slowly are coming to realize that it's smarter than the smartest scientists..! Well at least the ones I know in person. See we may focus on a multi-step pathway in cells that we know mediates damage, and we add AAT, and find that the entire pathway is halted at its tracks! We expected perhaps portions of the pathway to be inhibited, but not so, AAT has a way of grabbing the most initial of events and disconnecting them from the chain of events that lead to inflammation.

In your case, being a PiZZ deficient individual, with these low levels of AAT in your circulation, I'd say that many inflammatory events are free to reach the point of damage. You probably do take care of yourself very well and so are able to avoid some outcomes of deficiency. But I want to focus on insulin, both activity and source. I'm certain that your cells can respond better to insulin if inflammation were to be reduced by AAT. Also, there's a recent report that shows that AAT actually prevents insulin from being degraded too fast, and you then should enjoy more normal-lasting insulin after meals. Lastly, I have no way of knowing how your islets are (for this I need to see insulin levels in your blood), but I'm certain that they don't like the glycemic environment, and can also benefit from AAT. Since you're eligible for augmentation therapy by definition, I'd recommend the following: Keep very tight glucose follow-up for a few weeks as much as you can (just a few readouts a day, write them all down). At the same time, see if your physician can have you get AAT. Mark the time AAT was introduced into your circulation, and then continue the glucose follow-up. If you see better numbers compared to a period prior to AAT, BINGO! I'd love that to be the case...! If not, then nothing lost and you can decide whether or not you want to continue AAT. It's that safe, absent of any harm, it's worth the shot. It's given by drip, make sure it's a slow drip or the rapid changes in protein values in the blood can make you dizzy for a short time, avoidable by making sure the rate is slow.

Paula, I wish you all the best and look forward to hearing your thoughts! Thanks for following our work.

Eli