Can a pancreas transplant get rid of diabetes? And other questions

Welcome @joeazucena1. Good questions about pancreas transplant as a treatment option for diabetes. I encourage you to register for an upcoming event where you can ask your questions to Mayo Clinic's Dr. Tambi Jarmi, transplant nephrologist and Dr. Jessica Wilson, endocrinologist.

See more details here:
- Managing Diabetes and the Treatment Option of Pancreas Transplant https://connect.mayoclinic.org/event/managing-diabetes-and-the-treatment-option-of-pancreas-transplant/

In the meantime, I'd like to bring @cehunt57 @2011panc @tbingheim @pamherman into this discussion to connect with you and to share their experiences with pancreas transplant and diabetes.

Joe, do you have type 1 diabetes? Are you currently on the transplant wait list?

Are you referring to type 1 or type 2 diabetes? They are very different.

@joeazucena1 hi I am Cheryl (@cehunt57) that Colleen referred to. I had a pancreas transplant going on 17 years ago. It did not “cure” my diabetes as such. I am still diabetic BUT the transplant helped make a huge difference in day to day living and quality of life. I refer to it as my personal miracle.
Pre-transplant - my diabetes was very “brittle”. My blood sugars bounced from less than 30 to over 300 and back throughout most days. I had hypoglycemic unawareness. I had peripheral and autonomic neuropathy. I had retinopathy. The A1C test was always in the double digits. My Dr. advised that if I wanted to see my daughters graduate high school I should consider transplant.
I did. I was evaluated and accepted for transplant. I was told it could be a year and a half or more wait due to listing and matching factors. Just 2 weeks later there was a near perfect match and I received my transplant. Three weeks after transplant my A1C test was 5.3. I have never had any evidence of rejection troubles in the past almost 17 years. Hence “my miracle designation”.
Post-transplant - I am still diabetic BUT I can stay in range (90 - 140) through diet, insulin, exercise and testing. I no longer have hypoglycemic unawareness. The retinopathy and peripheral neuropathy reversed. My daughters graduated high school and college. One completed graduate school. They are married and I have 6 grandchildren. I feel very blessed.
That is my story. My hope and prayer for you is to find a treatment that will be beneficial to your situation.

Type 2

I always thought pancreas transplants were only for type 1's, but apparently not. This article outlines the criteria for type 2's:
https://pubmed.ncbi.nlm.nih.gov/21150617/
Purpose of review: This review will provide evidence that selected patients with type 2 diabetes mellitus (T2DM) may benefit from vascularized pancreas transplantation (PTX).

Recent findings: Initial experience with simultaneous pancreas-kidney transplantation (SPKT) in patients with T2DM and end-stage renal disease (ESRD) suggested that augmentation of endogenous insulin production by PTX in patients with C-peptide-positive, insulin-requiring diabetes resulted in insulin independence, improved glucose counter-regulation, and enhanced quality of life. A number of single-center retrospective studies have documented equivalent outcomes in patients with either type 1 diabetes mellitus (T1DM) or T2DM undergoing predominantly SPKT, although clearly a selection bias exists for patients in the latter category. Selection criteria for SPKT in T2DM include patients less than 55-60 years of age with a BMI less than 30-32 kg/m², insulin-requiring for a minimum of 5 years with a total daily insulin requirement less than 1 u/kg/day, a fasting C-peptide level less than 10 ng/ml, absence of severe vascular disease or tobacco abuse, adequate cardiac function, and presence of 'complicated' diabetes. Data from the International Pancreas Transplant Registry show that up to 7% of SPKT recipients are classified as having T2DM and that outcomes in these patients are comparable to those undergoing SPKT and classified as having T1DM.

Summary: Consequently, characterization of the 'type' of diabetes may be irrelevant and insulin-requiring diabetic patients with ESRD should be evaluated for PTX based exclusively on their predicted ability to tolerate the surgical procedure and requisite immunosuppression as well as comply with a stringent posttransplant follow-up regimen.

Hi Joe,
I had Type 1 for 21 years then a PTX 20 years ago and it is still working very well, no insulin shots, no diet restrictions, A1c of 5.2-5.4. I am very blessed to say I do not have diabetes anymore for 20 years. It stabilized my eyes and stomach issues, So forth.

@22shannon, Welcome to Connect! You have made a beautiful first post - "PTX (Pancreas Transplant) 20 years ago and it still working very well ...". I am 13 years post liver/kidney transplant, and your 20 year record is inspiration to me. What brings you to Connect?

Thank you, when I see how far treatment in Type 1 has improved in 20 years to me that means, as well as I am doing, that a transplant can be way better than 20 years ago too and love helping to make the process easier if I can. I am always looking for improvement.

But a transplant means taking an immune-suppressant. Has that caused any problems for you?

Yes, it was brutal at the beginning, however that is why I say 20 years later it must be easier today than when I did it. However, a Nephrologist transplant doctor explained things about my case, and so I followed his individualized after care for me. I have to credit him for why I am doing so well.