DEAR MAYO CLINIC: My wife is 31 and was diagnosed with type 1 diabetes at age 7. She had a baby three months ago, and her blood sugar levels were never really controlled. Doctors tested her kidney function and said there is “a little damage” but nothing to worry about. They said a pancreas transplant might be an option. How risky is this? What medications will she need to take following the transplant?
ANSWER: Most patients with type 1 diabetes do not require a pancreas transplant, because newer insulin regimens can keep their blood sugar under control. However, someone in your wife’s situation should consider a pancreas transplant, especially if she has frequent “insulin reactions” — meaning her blood sugar goes very low without her realizing it.
A pancreas transplant could fix the problems with her blood sugar control and prevent further injury to her kidneys. As with all transplants, a pancreas transplant is major surgery. Afterward your wife will need to take drugs to keep her body's immune system from rejecting the new pancreas. But overall, the risks associated with the transplant are likely to be lower than the risk of long-term organ damage that can result from uncontrolled blood sugar.
If successful, a pancreas transplant can restore the body’s ability to secrete insulin, reducing blood sugar levels and eliminating the need for insulin therapy. Insulin is a hormone. When you eat, the pancreas — a gland located just behind your stomach — releases insulin into your bloodstream. As insulin circulates through your blood, it allows sugar to enter your cells, lowering the amount of sugar in your bloodstream. If your body doesn’t have enough insulin, sugar can build up in your blood. Diabetes is the condition of having too much blood sugar.
People with type 1 diabetes are more likely to benefit from a pancreas transplant than are people who have type 2 diabetes. That’s because a damaged pancreas is usually the main cause of high blood sugar in type 1 diabetes. People with type 2 diabetes often have other factors, beyond the pancreas’s inability to produce enough insulin, contributing to their high levels of blood sugar.
Age and weight are also factors to take into account when considering the risks and benefits of a pancreas transplant. People younger than 55 and those who are not obese are at lower risk for complications associated with the surgery.
In addition to allowing her body to maintain the right blood sugar levels, a pancreas transplant would also slow down or stop the damage to your wife’s kidneys. Kidney damage is one of the most common and serious side effects of diabetes in people who have uncontrolled blood sugar. If left untreated, the damage can progress to kidney failure and may require dialysis or a kidney transplant. Because your wife is still in the early stages, the kidney damage she has may actually go away after a transplant, although that can take months or years.
In addition to kidney damage, people with diabetes who have poorly controlled blood sugar are at risk for damage to their peripheral nerves, eyes, heart and lungs. A pancreas transplant could significantly reduce these risks, as well.
That said, it is important to carefully consider having a pancreas transplant. A transplant can result in serious complications, such as blood clots, bleeding, infection and failure of the donated organ. After the transplant, your wife would need to take immunosuppressive medications for the rest of her life to keep her body’s immune system from attacking the donated pancreas. These medications can cause side effects, including bone thinning, high cholesterol and high blood pressure. In addition, she may be more likely to develop certain types of infections because these medications suppress her immune system. For many people who have a transplant, though, taking these drugs does not interfere with their quality of life overall.
Although a pancreas transplant can be a good choice for some people with diabetes, most do not need a pancreas transplant. That’s because insulin therapy can often keep blood sugar levels well controlled, so the risk for long-term organ damage due to diabetes is low. However, in your wife’s case, a pancreas transplant does sound like a treatment option worth considering. — Patrick Dean, M.D., Transplantation Surgery, Mayo Clinic, Rochester, Minn.