Work to prevent or reverse Diabetes Type 1

[Zach]

http://www.eurekalert.org/pub_releases/2008-05/chop-nva052808.php


New vaccine approach prevents/reverses diabetes in lab study at Children's Hospital of Pittsburgh

Results of study are published in Diabetes, a journal of the American Diabetes Association

Microspheres carrying targeted nucleic acid molecules fabricated in the laboratory have been shown to prevent and even reverse new-onset cases of type 1 diabetes in animal models. The results of these studies were reported by diabetes researchers at the John G. Rangos Sr. Research Center at Children’s Hospital of Pittsburgh of UPMC and Baxter Healthcare Corporation.

In a research study at Children’s Hospital, the scientists injected the microspheres under the skin near the pancreas of mice with autoimmune diabetes. The microspheres were then captured by white blood cells known as dendritic cells which released the nucleic acid molecules within the dendritic cells. The released molecules reprogrammed these cells, and then migrated to the pancreas. There, they turned off the immune system attack on insulin-producing beta cells. Within weeks, the diabetic mice were producing insulin again with reduced blood glucose levels.

Results of the microsphere study are published in the June issue of Diabetes, the journal of the American Diabetes Association.

In type 1 diabetes, T cells from the immune system travel to the pancreas and destroy beta cells, which produce insulin. The scientists – led by Massimo Trucco, MD, and Nick Giannoukakis, PhD – found that the microspheres reprogram dendritic cells to block the signaling mechanism that sends T cells to destroy beta cells. The microsphere research builds on previous research by Drs. Giannoukakis and Trucco in which they used dendritic cells delivered to the pancreas in another method to turn off the immune system’s attack on insulin-producing beta cells, thereby allowing the cells of the pancreas to recover and begin producing insulin again.

Drs. Trucco and Giannoukakis anticipate that the latest research involving microspheres represents a significant improvement over their previous approach to extract (through a process known as leukapheresis) and reprogram the dendritic cells.

“The microspheres prevented the onset of type 1 diabetes and, most importantly, exhibited a capacity to reverse hyperglycemia, suggesting a potential to reverse type 1 diabetes in new-onset patients,” said Dr. Trucco, chief of the Division of Immunogenetics at Children’s. “This novel microsphere approach represents for the first time a vaccine with the potential to suppress and reverse diabetes. This finding holds true promise for clinical testing in people with type 1 diabetes.”

Currently, Drs. Trucco and Giannoukakis are conducting a clinical trial of their leukapheresis-based dendritic cell approach in humans at Children’s. This Phase 1 clinical trial has been approved by the U.S. Food and Drug Administration (FDA).

“Our ultimate goal is to offer this dendritic cell vaccine or microsphere-based therapy to children at risk for or newly diagnosed with type 1 diabetes. We want to make the procedure as safe and comfortable as possible,” Dr. Giannoukakis said.

The trial began late last year and enrollment is ongoing. The study, which plans to enroll a total of 15 adults over age 18 with type 1 diabetes, is expected to conclude later this year.

If the leukapheresis-based approach continues to show exceptional safety, the researchers hope to launch a national clinical trial that will assess the effectiveness of the dendritic cells in pediatric patients to prevent diabetes or reverse the disease right after it is clinically confirmed. At a later date, it is anticipated that Baxter Healthcare will collaborate with Drs. Trucco and Giannoukakis in a clinical trial utilizing the unique microsphere-based approach.

Leukapheresis is a process that allows for the collection of dendritic cell precursors from the patients in the study, which takes two to four hours. After the precursors are collected, they are treated in the lab with specific growth factors that turn them into dendritic cells. The growth factors are also combined with short DNA sequences that specifically block the expression of molecules that are found at the surface of dendritic cells known as CD40, CD80 and CD86. Once these reprogrammed dendritic cells are tested in the lab, they are injected back into the patient. They then orchestrate an anti-diabetic effect by suppressing the activity of T-cells which are responsible for the impairment and destruction of the pancreatic insulin-producing cells.

“Using microspheres will be much less invasive for the patient and much more efficient for clinicians. We wouldn’t need to harvest a patient’s dendritic cells, and it would eliminate the need to genetically reprogram the dendritic cells in a sterile, off-site facility. Instead, the patient would receive the microsphere injection with a small needle in a clinic setting in a matter of minutes,” Dr. Giannoukakis said.

###
The microsphere molecule delivery technology being used is Baxter Healthcare Corporation’s PROMAXX microsphere technology. Larry Brown, ScD, Vice President, Research and Chief Technology Officer and Kimberly Gillis, PhD, Director of Research at Epic Therapeutics (Norwood, MA), part of Baxter’s Medication Delivery business, worked with Drs. Giannoukakis and Trucco to develop the specific diabetes vaccine microspheres. The genetic reprogramming of dendritic cells is an approach developed by Drs. Giannoukakis and Trucco.

Type 1 diabetes is regarded as an autoimmune disease because a person’s immune system’s T cells attack and destroy the beta cells in the pancreas that produce insulin. Symptoms of type 1 diabetes usually develop over a short period of time and include increased thirst, frequent urination, constant hunger, weight loss, blurred vision and extreme fatigue. People with type 1 diabetes require numerous daily injections of insulin to survive. Type 1 diabetes also is known as insulin-dependent diabetes mellitus or juvenile-onset diabetes. The National Institutes of Health (NIH) reports that more than 1 million children and teenagers (age 19 and younger) have type 1 diabetes. According to the NIH, 5 percent to 10 percent of diagnosed diabetes cases in the United States are type 1 diabetes.

Dr. Trucco, an international leader in the field of immunogenetics, has dedicated his life’s work to finding a cure for diabetes. He also is the Hillman Professor of Pediatric Immunology at Children’s Hospital and a professor of Pediatrics at the University of Pittsburgh School of Medicine. His laboratory team at Children’s John G. Rangos Sr. Research Center has pioneered numerous important studies and also maintains a federally funded national bone marrow HLA typing center. For more information about type 1 diabetes or Dr. Trucco’s research, please visit www.chp.edu.

[jbeany]

Too late for me - but good news for my nephew, who is at high risk because he's got the same crummy genes I do!

[stauffenberg]

The best way to prevent new cases of type 1 diabetes from developing is for patients with type 1 diabetes, who have a 50 times higher than normal chance of producing diabetic children, never to have children.  One of my first thoughts when I was diagnosed as a type 1 diabetic at age 14 was that it was my moral duty to make my contribution to the fight against this disease by never having any children myself.

[BigSky]

The best way to prevent new cases of type 1 diabetes from developing is for patients with type 1 diabetes, who have a 50 times higher than normal chance of producing diabetic children, never to have children.  One of my first thoughts when I was diagnosed as a type 1 diabetic at age 14 was that it was my moral duty to make my contribution to the fight against this disease by never having any children myself.

 

Hell with a moral duty to society  wouldn't it be prudent that you end it now so not to be a financial drain onto society?

[Sluff]

The best way to prevent new cases of type 1 diabetes from developing is for patients with type 1 diabetes, who have a 50 times higher than normal chance of producing diabetic children, never to have children.  One of my first thoughts when I was diagnosed as a type 1 diabetic at age 14 was that it was my moral duty to make my contribution to the fight against this disease by never having any children myself.

What a selfless act. Now if we all would do that there would be no more problems in the world according to you. Sorry I dissagree.

[Romona]

It is personal decision. I feel that having a disease such as diabetes does not prevent people from living productive lives and contributing to society.  A couple that choses to have a child even though the risks are there, are making their own decision.

The best way to prevent new cases of type 1 diabetes from developing is for patients with type 1 diabetes, who have a 50 times higher than normal chance of producing diabetic children, never to have children. One of my first thoughts when I was diagnosed as a type 1 diabetic at age 14 was that it was my moral duty to make my contribution to the fight against this disease by never having any children myself.

That is your personal feeling on this subject. I think it could be a dangerous thought for people not to have children if there any chance of passing on genes that leads to disease or illness. It would be like trying to make a perfect or master race.

[Zach]

Eugenics anyone?

[stauffenberg]

As a potential parent you owe a duty to your future child NEVER to harm him in any way you can prevent.  This is why pregnant women are blamed if they drink during pregnancy and impose fetal alcohol syndrome on their offspring or if they fail to take folic acid supplements and impose spina bifida on them as a result.  It is thus obviously an extreme violation of this duty not to harm your own child if you choose to expose that future human to a risk of type 1 diabetes 50 times higher than normal.  Since you cannot consult the child and find out if it wants to live in view of that risk, or if it would rather not be born in the first place, it is cruel and arrogant to presume to decide for that child that it would accept that risk.  If you cannot know how another person would react to a risk, you have absolutely no right to take it for them.

This has nothing to do with eugenics, since the goal is not to create a master race but is to avoid hurting another human being.  It in no way denies that a person with type 1 diabetes may have a valuable life, or that such a person should be fully respected as an equal human being once alive, but instead it simply refuses to impose a high risk of this dreadful injury on another person -- especially a person to whom you owe the very highest duty of care and protection.  This has nothing to do with the costs to society of a person having type 1 diabetes, but everything to do with the injury to the person suffering from the disease.

Why do we have ultrasound examinations of the fetus prior to birth?  Why do we examine the fetus for inherited defects by amniocentesis prior to birth?  Why is the intermarriage of closely related people forbidden by law all over the world?  Why are abortions permitted, even in jurisdictions that severely limit this right, when antenatal diagnosis establishes that a severely deformed child will be born?  It is obvious that it is universally accepted in our society that we should be pro-active in trying to avoid lives being burdened with future medical miseries which the medical profession cannot cure or treat adequately.

[Zach]

Why do we have ultrasound examinations of the fetus prior to birth?  Why do we examine the fetus for inherited defects by amniocentesis prior to birth?  Why is the intermarriage of closely related people forbidden by law all over the world?  Why are abortions permitted, even in jurisdictions that severely limit this right, when antenatal diagnosis establishes that a severely deformed child will be born?  It is obvious that it is universally accepted in our society that we should be pro-active in trying to avoid lives being burdened with future medical miseries which the medical profession cannot cure or treat adequately.

That is why the development of this vaccine is so important.
 

[paddbear0000]

Alright stauffenberg, those are fightn' words!!!! My husband and I have done a lot of research on this topic and have spoken to a number of doctors. And they all agree, that there is nothing wrong with a type 1 diabetic having children. According to the American Diabetes Association, if one parent has  type 1 diabetes, there is only a 6% chance of the child getting type 1 diabetes if it's the father who is the type 1 diabetic, and only a 4% chance if it's the mother who is diabetic. And that is if the mother is under the age of 25 at the time of the birth. If she is over 25, it drops to 1% if it's the mother who is diabetic. If the diabetic parent was diagnosed before they were 11, than the chance only goes up to 8%, 12% and 2% respectively.  Exactly where did you get this 50 times higher information?! Like others have said, quote your sources! I have done a ton of research on this subject recently, and have never come across this. The figures vary by source, but they are all very close to what I just stated.

Diabetes IS NOT a death sentence. People live perfectly normal, happy lives. My mother-in-law is an elementary and middle school nurse who deals everyday with 8 diabetic students and every single one of them are happy, outgoing, healthy (except for the diabetes) children. After the last discussion we had on IHD regarding this subject, I had her ask them how they felt about their diabetes. All but one was fine with it and didn't think there was anything wrong with themselves. Nowadays, it's hard to find a child who doesn't have something--diabetes, food allergies, allergies in general, asthma, ADD, obesity, etc. Should everyone just stop having children? Why doesn't the human population just stop reproducing all together and wipe out all diseases?!

My husband and I have been having serious discussions lately about what to do about children. We desperately want a child, someone to love and someone to love us back. We have thought long and hard about what we want to do. We are young and we want a biological child. My husband is from a traditional Catholic family and I come from a family who loves children as well. We have been feeling the strong urge to have a child. I feel empty and alone. I feel like I have no purpose in my life right now. I know this sounds cliche, but unless you are a woman, one who wants a family, you have no idea how it feels! We plan on having a child, no matter what it takes, or how long, or regardless of how much it costs us! Whether it's via me or a surrogate, we will have a child! And I DO NOT want you to start preaching at me about how I am being cruel to a child, bringing them into this world! We have been through this all before, and I don't want your self-preaching.

[Chris]

The feeling I get when I read a post from stauff is that he is mad at his parents because he was diagnosed with diabetes at 14 and can't let his teenage mentality go at hating his parents for it. Which leads me to my opinion along with a couple others of disagreement with what he has stated. Just because I am the only one in my family who has diabetes and have had a crappy time with it, I still would have kids. As humans, we can adapt. I have never let diabetes get me down, I grew up normally like everyone in my class, just with precautions.

[stauffenberg]

Doctors are not experts on ethics, and since deciding to expose your own children, to whom you owe the highest duty of care, to a considerable risk of a hideous disease just out of the selfish desire that YOU want a child, no matter what HORRORS you have to put the child through to get  one, is an ETHICAL, not a MEDICAL choice, there is no way on earth that doctors can in any sense rule on whether that choice is moral or not.

There are no clear statistics on the prevalence of type 1 diabetes in the population, but in the United States it is estimated to range anywhere between one in 300 to one in 600.  A fifty times higher risk of a one in 600 chance is a one in 12 chance, or an 8% risk, which is about the SAME figure that you are citing as the risk for a type 1 diabetic male having a diabetic child.  Before you resort to personal insults, you might want to check your math.

After 42 years of personal, everyday experience with type 1 diabetes, during which I have suffered 10,000 hypoglycemic episodes, 100 of which were bad enough to cause unconsciousness, and 10 of which were sufficiently severe to require hospitalization, as well as enduring all the horrors of the diabetic complications, the discrimination against diabetics, and the exhausting regimen of managing the disease, I can say with the authority of nearly half a century of 24/7 experience that it is truly catastrophic illness.  Many diabetics refuse to be honest with themselves or with other people about how bad they feel about their disease, largely because their own sanity depends on lying to themselves about what they are enduring.  It is interesting that one of the major correlates of suicide among dialysis patients is the co-morbidity of diabetes.  I think this is because diabetes wears down the spirit over the decades to the  point where there is no ability to endure further medical horrors by the time dialysis begins. (Paul Kimmel, "Psychosocial Factors in Dialysis Patients" Kidney International, vol. 39 (2001) p. 1599.)

Michael Jackson was universally condemned when he dangled his child from the balcony of a Berlin hotel, but was this as great a risk of as great a harm as he would have exposed that child to by bringing it into the world with a 50 times higher chance of type 1 diabetes?  The first act you commit towards your future child should not involve arrogantlly according to yourself the right, with no consultation with the child being possible, to decide for the child that life with a high risk of diabetes is worth it

[Zach]

The whole point of this article is that some day you too, stauffenberg, can have children without worrying "that life with a high risk of diabetes is worth it."

[paddbear0000]

First of all, doctors do rule on ethics--that is their job!!! Ever heard of the Hippocratic oath??!!

Second, you would never have a child because there is ONLY an 8% chance of them becoming diabetic? 8%! You have approximately the same odds of being in a car crash when you leave your house. Are you telling me you wouldn't leave your house just in case you might get in a car accident? You lead a very sad life if that's all you do, worry that something MIGHT happen.

You say that bringing a child into this world is selfish, given the potential for medical problems? Well, bearing the child brings a whole of potential issues on the mother as well. They can have a stroke, a heart attack, pre--eclampsia, or go into renal failure. But you know what? I am willing to risk MY health to do so. It's not just about the child and what MIGHT happen.

I have lived with diabetes for 25 years. My dad lived with it for 56 years. And my grandfather lived with it for 27. My grandfather never had complications, he died in a car accident. My father never did either. He died of Lou Gehrig's. I've had only 2 complications--fluid in my eyes (which was taken care of years ago and I've never had a problem since), and gastroparesis, a very manageable condition. The only reason my kidneys are failing is because of hospital error when I was there for bronchitis. I have lived a very good life being a brittle diabetic, as did my family. From the sounds it, you, my friend have not. I mean, my god! 10,000 hypoglycemic episodes?? What on earth have you been doing? That equates to about 238 hypos per year! Almost one a day! Please don't assume your problems are universal. They aren't. You are obviously an extremely negative person. If you don't want to have a child, than, good. As my husband said, at least your genes won't corrupt another generation!

[Chris]

 As my husband said, at least your genes won't corrupt another generation!

Screw political correctness, when I read that part, I had to 

[monrein]

Stauffenberg, I totally respect your decision not to have children based on your experience with diabetes which sounds truly awful and I can understand your concern that they might suffer a similar fate.  I think the comment about your genes not corrupting another generation was unfair, uncalled for and mean.  However,  Paddbear and her husband have to make their own decision about the risks involved for both her and the child and to characterize them as potentially cruel and arrogant is also unfair and extreme.  It actually drives me a bit nuts that you often make, what I consider to be, very valid points but then because of the way you state them as broad absolutes that should be applicable in  all circumstances, people react personally because they don't fit with their experiences.  I know that when I've reacted strongly to your posts this was how I felt.  And then I feel badly because you have a lot of valuable things to add and it prevents me from really considering your points and seeing how I could possibly integrate them into my thinking. 

I'm not a diabetic so I can't speak to that at all.  I too chose not to have children and it was a tough thing to accept as we wanted them and as a woman I know how that biological urge tugs hard at us.  My sister even offered to be a surrogate for us but no one could offer me sufficient reassurances about the fertility drugs interactions with the cyclosporine which was new at the time and I feared for the baby's health.  I also worried about my own health and about possibly losing my transplant.  These things concerned my husband too and so we made the decision.  I have no idea if it was the right decision or not.  What I do know is that we did many things that would not have been possible had we had kids and those have meaning for us too.  That time in my life was also one of the most difficult and I heard many opinions about what other people would do but it was us who had to decide for us.

[stauffenberg]

For your information, Paddlebear, doctors don't take the Hippocratic Oath any more, even though laymen think they do.  Since some of the things that the Hippocratic Oath forbids is removing renal calculi and performing abortions, it would be a pretty absurd situation if modern doctors actually did swear this oath.  Doctors do make ethical decisions, but generally they have no more expertise in this area than anyone else.  I attended a medical ethics course at the University of Berlin in 1985 which contained only four students out of three hundred officially urged to attend.  I was there because I was interested in the topic, but the other three were exchange students from Arab countries who spoke so little German they thought medical ethics was a required course, which it was not.  No doubt the education of physicians in ethics is equally poor elsewhere.

An 8% chance of a truly terrible disease is a VERY SERIOUS risk, especially when you are taking that risk not for yourself but for another human life.  The situation becomes even more morally acute when you decide that that risk is acceptable for someone to whom you owe the highest duty of care NEVER to expose them to such a risk.  Life is full of background risks which all people face, but deliberately and recklessly to expose another person to a life burdened by the UNUSUAL risk of a very serious disease goes beyond what is regarded as acceptable.

It is utterly idiotic to pretend that deciding to expose a future child to a risk of a serious illness is somehow a private matter for the two people who decide to condemn an innocent child to that fate, because the act of these two people affects another innocent person whose interests should come first -- the child.  And just as I have a right to speak up to protect the life of a perfect stranger being injured by his own family members, so too I have the absolute right in the name of humanity to speak up to prevent people conspiring to injure the future life of an innocent child.  This is a matter of human morality, not private choice.

I think it is quite normal for a labile, type 1 diabetic to have thousands of hypoglycemic episodes in the course of a lifetime.  In my case, the blood sugar level fluctuates spontaneously up and down by about 3 (= +/- 64 on the US scale).  This means if I try to maintain an average value close to normal, it has to go low several times a day just by the Bell curve distribution of values.  The 10,000 hypoglycemic episodes include those at a blood sugar which is low but not so low as to produce symptoms obvious to anyone else but me.

[Chris]

So basically what you want everyone to do who has an illness is what the Nazis where trying to do to the Polish, get rid of them all and call it ethical. Forget about medical science, go back to the time where anyone who was sick was sacrificed to some god and that would supposedly make the world a better place, Don't think so! Or as in the movie Gattica, sex could not happen naturally and that having a child could only happen in a lab. I hope that this research works even if it hapens slowly, at least there is an effort. Life is full of chances and an 8% chance is low compared to a 85% chance of something happening. Having kids is a crap shoot anyway with the way some of them turn out no matter how you brought them up even from a healthy person.

[Romona]

Call me totally irresponsible. I can not guarantee that my children will not get high blood pressure, heart disease, diabetes, thyroid problems, suffer from blood clots, leukemia, and various other cancers in the family tree. 2 of my 4 kids wear glasses. 3 out of 4 have had braces. The last one is too little for braces yet. My girls hate their hair that is just like mine. Will they be successful? Is life going to be perfect for them? Are they going to get through life with out heart ache or disappointment. I don't know! But I wouldn't trade any of this for the world.
So I guess call me utterly idiotic because my husband and I have had four children that may at some point in their lives suffer disappointment, possible health problems, economic problems, academic problems, and other things that make up life! After all isn't emotional  health just as important as physical health. There are no trust funds for these kids when they turn 21, oh my they will have to make it on their own. Isn't financial security important too? Well watch for me on Oprah, I'm sure my kids will have me on for bringing them into this world.

[Chris]

Call me totally irresponsible. I can not guarantee that my children will not get high blood pressure, heart disease, diabetes, thyroid problems, suffer from blood clots, leukemia, and various other cancers in the family tree. 2 of my 4 kids wear glasses. 3 out of 4 have had braces. The last one is too little for braces yet. My girls hate their hair that is just like mine. Will they be successful? Is life going to be perfect for them? Are they going to get through life with out heart ache or disappointment. I don't know! But I wouldn't trade any of this for the world.
So I guess call me utterly idiotic because my husband and I have had four children that may at some point in their lives suffer disappointment, possible health problems, economic problems, academic problems, and other things that make up life! After all isn't emotional  health just as important as physical health. There are no trust funds for these kids when they turn 21, oh my they will have to make it on their own. Isn't financial security important too? Well watch for me on Oprah, I'm sure my kids will have me on for bringing them into this world.

Let me know when you'll be on, I might watch one episode of Oprah then.
or should we watch Mory, Salley, Jerry, or who else is left that would do tis...........................
Ohhhhhhhhhhhh DR. PHIL

[stauffenberg]

There is nothing Nazi about preventing a future life from harming the person who will be burdened with it when this is done for the benefit of the person concerned.  The Nazi 'racial purity' and 'euthanasia' campaigns were conducted against living persons who were not consulted about whether they felt it was to their advantage not to be burdened with existence, nor were they performed with the interests of the persons concerned.  Every actually living person has a full right to exist and their equal rights have to be respected.  To avoid imposing a significant chance of hideous illness on people who do not exist cannot violate the rights of anyone, since the unconceived have no rights.

Our society has long since reached the collective decision that cancelling a future existence if the person with it would  be too severely burdened with disease is a morally acceptable course of action.  Otherwise the widespread practices of fetal ultrasound to check for anatomical abnormalities, amniocentesis to check for genetic abnormalities, and genetic counselling -- all done to cancel future existences which would burden children with terrible diseases -- would not be universally accepted as ethical.  In the Netherlands now new-borns with severe spinal abnormalities, amounting to about 600 children per year, are actually being euthanized at birth.  While this is still controversial, it is general practice that anencephalic infants are simply left to die naturally after birth, and no one objects.

Of course life is full of risks, but the risks which you may not impose on other people without committing an illegal act are unusual, heightened risks above the normal background risk.  When you are driving on the highway with many other drivers, you are all imposing a more or less equal risk on each other by propelling quickly a huge hunk of steel on wheels, but no one does anyone else any legal harm by this background risk.  The risk that is punished in tort or criminal law is the extraordinary, heightened risk that comes from driving recklessly, since this is above the background level of risk which the law and morality both ignore.  The same logic applies to the case of having a child.  While it is normal practice to accept for the child the ordinary risks of life, deliberately and recklessly to expose the child to a heightened risk of a rare and hideous disease is doing something out of the ordinary, and so it is immoral.

To determine the significance of any risk, you have to multiply the size of the chance (which is here 8%) times the magnitude of the horror if the chance materializes.  Can you imagine what a court would award a plaintiff who became a type 1 diabetic because of some corporation's recklessness in manufacturing a drug administered to him?  He would probably win a $10,000,000 award.  So multiply the award by the chance, and staring you in the face is the grim fact that an innocent child, your own child, to whom you owe the highest moral duty of protection from harm, is being harmed by you by beginning life with an $800,000 loss imposed on him!

Don't think type 1 diabetes is not a horrible disease.  I knew a patient newly diagnosed with type 1 diabetes in her early 20s who attempted to commit suicide by swallowing Benedict's solution, a reagent that used to be used to measure sugar in the urine, which was readily available in the clinic where she was a patient.  Her life was saved by medical intervention, but she actively hated the people who had dragged her back into existence.  This clearly shows that there is a good chance a child would rather never have been born than endure a life with type 1 diabetes.

[Romona]

In your opinion Stauffenburg, who should have children? I am not asking to be sarcastic or anything. Just what would be not a burden for a child?

[stauffenberg]

If you know in advance that you will impose an extraordinarily high risk of a very bad outcome on the child, one significantly worse than the ususal range of human experience, then you should not have children.

Another factor people don't consider is the phenomenon geneticists call 'genetic anticipation,' in which inherited diseases caused by a cluster of genes, such as diabetes, tend to become more severe and strike earlier with each succeeding generation.  If a type 1 diabetic parent judges his own experience with the disease to have been sufficiently endurable to make life worth living, he should not automatically assume that the intensified version he is likely to  pass on to his child will also be that tolerable. 

Finally, diabetes becomes exponentially worse the longer the patient lives with it.  What may seem like a tolerable disease at the age when most diabetics are considering having children may only reveal itself as an in fact intolerable disease in the decades after that.  I have seen an old type 1 diabetic at dialysis whose retinopathy caused such disturbing light flashes in his blind retinas that his retinas had to be surgically destroyed to give him a moment's peace.  He hated being needled, so he used to sit in the chair helplessly, in his totally black world, essentially nothing but a torso with arms after his legs had been amputated, screaming his lungs out as the thick dialysis needles plunged into him from the darkness.  Who would wish this fate on their children?