Sitting on a burlap bag and squirming a bit, Mary Anna Kralj-Pokerznik took a look down the 100-ft. length of undulating fiberglass slide, sucked in a deep breath and pushed. "There are some risks I won't take," Kralj-Pokerznik, a junior high school math teacher, says later. "The trouble with having a science degree is that all the principles of physics kept running through my head." Having conquered the slide, Kralj-Pokerznik then did something really daring: She devoured every crumb of a large, sugar-dusted, deep-fried pastry. "I am doing things I never dreamed I would," she says.
Kralj-Pokerznik, now 30, has juvenile (or Type 1) diabetes. Less than a year ago, chowing down on a hunk of junk food could have made her nauseated and sick. Since being diagnosed at age 11, her existence has been ruled by mood swings, energy dips, illness and a ritual of needles, blood tests and insulin shots. She would set her alarm to rouse herself two or three times nightly so that she could complete the drill. "You feel like you are juggling," she says, "and if you drop one ball, everything comes crashing down."
Remarkably, that may all be behind her now. Part of an experimental pancreatic-cell transplant study conducted at the University of Alberta in Edmonton, she and 12 others with juvenile diabetes have gone without insulin for more than a year—with no negative side effects. "I am really functioning as a non-diabetic," says Edmonton lawyer Robert Teskey, 54, also in the trial. "It's been a miracle in my life."
Juvenile diabetes, which strikes 1.2 million North Americans each year, is caused when the pancreas produces little or no insulin, a hormone that turns blood sugar into fuel for the body. The diagnosis can mean lifelong doses of insulin, which is not a cure. Possible complications from diabetes are nerve damage, stroke, blindness, kidney and heart failure and amputation. In a procedure first attempted 25 years ago and designed to reverse such possible degeneration, pancreatic cells from a donor organ are harvested, mixed with a special enzyme, then injected into the patient's liver, where they immediately produce insulin. Most procedures failed routinely until the Alberta team, led by Dr. James Shapiro, modified how . donor cells, also known as islets, are prepared and used. International research facilities are now trying to duplicate his process. With the changes, says Shapiro, "it's the easiest transplant I ever did." And surely one of the most successful. "I would have been happy for one day without insulin," says Kralj-Pokerznik. "Now it is over 14 months."
Growing up in Edmonton, the only child of Frank Kralj, 65, who owns a bumper-and-chrome repair shop, and his wife, Anna, 67, a homemaker, Kralj-Pokerznik enjoyed a normal childhood until 1981. That summer, after returning from a visit to her parents' families in their native country of Slovenia, she began, to lose weight. Without explanation, she shed 30 lbs. in just two weeks. After a few tests, the family got the bad news: Her body had ceased producing insulin; she was diabetic. "It was like a death sentence," says Kralj-Pokerznik. Robin Yost, 30, a friend since kindergarten, recalls, "When you are that young and suddenly told not only can you not have candy anymore but you have to have needles every day, that is a big thing."
Her teen years weren't much easier. Rebellious and tired of the regime, Kralj-Pokerznik balked at following her diet. "I took my medication, but I would sit for a half hour just staring at my needle," she says. After high school she was so distracted by testing her blood sugar and giving herself injections that she didn't hold jobs for long. Ultimately, she deckled to return to school to study science at the University of Alberta.
Visiting Slovenia in 1987, she met Aleksander Pokerznik, now 37 and a metal fabricator. It was a natural connection—their parents are from the same village and Pokerznik went to school with her cousins. Also, coincidentally, she had dated his friends. "He was the last one left, so I had to marry him," she jokes. They were wedded on Oct. 3,1993, in Edmonton and again in Selnica ob Dravi, Slovenia. Pokerznik was drawn to her in part for the courage she showed: "I saw how hard Mary Anna had to struggle, and I fell in love with her."
In the spring of 1999, when her endocrinologist offered to help her get into Shapiro's clinical trials, Kralj-Pokerznik eagerly said yes. After a first transplant in May 1999, she needed only a few units of insulin a day; after a second, none. Teskey required a third transplant, but even he is free of insulin-which inspired him to host a party in February for patients and doctors. "We discussed how we are feeling, what's new in our lives," says Kralj-Pokerznik. "Finally, we all felt just like normal people."
Giovanna Breu in Edmonton
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