Islet Transplantation (ITx) is a treatment option for patients with Type 1 Diabetes Mellitus (T1DM), recurrent hypoglycaemia and hypoglycaemia unawareness.
Our patient is a 68y old female who developed T1DM at the age of 18 months. She was referred to the Islet clinic in May 2005 complaining of recurrent severe hypoglycaemic episodes. She frequently lost consciousness and often relied on family members to recognise and treat hypoglycaemia. This was despite adhering to her insulin pump regimen under the care of an Endocrinologist and performing blood glucose testing up to 10 times a day.
Her medical problems included peripheral vascular disease and hypertension. Her hypoglycaemia severity score was 2163 (Ryan). A score above >1000 indicates severe hypoglycaemia. Her HbA1c was 7.5% and C-peptide undetectable.
Over a six month period we attempted to fine tune her glycaemic control. A 3 day Continues Glucose Monitoring System (CGMS) was performed to validate her glycaemic lability (Figure 1). Unfortunately her glycaemic control and hypoglycaemic episodes did not change and she was listed for islet cell transplantation.
In March 2009 she received her 1st ITx followed by 2nd ITx in September 2009. She became insulin-independent on 21/01/2010. After 5 years she remains free from hypoglycaemia. Her HbA1c is 6.0%, C-peptide 0.84 pmol/L with a fasting capillary blood glucose 7.3 mmol/L. Repeat CGMS shows normalization of blood glucose (Figure 2).
ITx is not without risks due to the procedure and the ongoing need for immunosuppressive therapy. Our case demonstrates that for selected patients who suffer severe and recurrent hypoglycaemic episodes, blood sugars can be normalized. In our patients own words “This is a life-changing procedure”.