My 18 year female friend has lived with diabetes for ten years, and unfortunately, about one month ago, she became very ill. Now she needs a pancreas transplant, and the specialists are not optimistic about her survival. Is there anything that can be done to help?

People with type�1 diabetes need insulin to survive (as everyone does). Having a pancreas transplant is one way of treating type 1 diabetes. Since the new pancreas secretes insulin, the person usually no longer has to take insulin injections. But this is not the only way to treat diabetes. People can take insulin injections indefinitely, and I do not know of any situation in which someone would “have to” have a pancreas transplant instead of taking insulin injections. In fact, in many places, pancreas transplants are done only in people who also need a kidney transplant.

Your friend may have been very sick from her diabetes being out of control. Perhaps she had DKA [diabetic ketoacidosis]. This is a life-threatening condition caused by high blood glucose levels and not enough insulin. Once it has been treated, however, people can do very well if their diabetes is kept under control with strict attention to insulin dose and fingerstick glucose levels.

I do not know details about your friend’s condition, but it sounds like she needs help from a diabetes care team that includes endocrinologists and diabetes educators. Her condition should be able to be managed with frequent visits to her health care providers, and a lot of close attention by her to her glucose levels and insulin doses. Please encourage her to get close follow-up, as there is a lot that can be done to help in the treatment of her diabetes now and to prevent long-term complications in the future.

ML

[Editor’s comment: See: Friedman AL, Appropriateness and timing of kidney and/or pancreas transplants in type 1 and type 2 diabetes. Adv Ren Replace Ther 2001 Jan;8(1):70-82.

SS]