For Joanie Videen, having diabetes meant that she had to check her blood glucose levels every three hours, even in the middle of night.
Joanie, who developed adult-onset juvenile diabetes at age 35, followed this routine for 19 years. But as time went on, she struggled to balance her day-to-day life with worsening low blood glucose, also known as hypoglycemia. To make matters worse, Joanie is hypoglycemic “unaware,” which means her body doesn’t always give her warning signs that her blood glucose levels are dangerously low.
“My doctor told me to check [my blood glucose levels] every three hours,” Joanie said. “No matter where I was, I had to check my number. Every night, I got never more than three hours of sleep in a row. It was a real challenge at work. I had difficulty concentrating. ”
Joanie became interested in allo-islet transplantation, a procedure that is currently in clinical trials at the University of Minnesota. During the procedure, doctors infuse insulin-producing islet cells into a patient’s liver. Once placed into the liver, the cells begin creating insulin and sending it directly into the blood stream, essentially acting as functioning pancreas. Often, the procedure allows patients to go insulin free for long periods of time.
The idea of helping other diabetics by participating in a clinical trial appealed to Joanie. She met with University of Minnesota Health Transplant Physician Bernhard Hering, MD. Because there was nothing else wrong with her health, Joanie was eligible for allo-islet transplantation, which she chose to undergo in 2005.
At first, the procedure was successful: Joanie went insulin-free for 15 months after the first two allo-islet infusions.
“It was unbelievable. I would call my care team if something wasn’t right, and they were fabulous,” said Joanie.
But eventually the effectiveness of the allo-islet transplantation wore off. Joanie needed a different solution. Because of her type 1 diabetes, Joanie was eligible for a pancreas transplant, according to University of Minnesota Health Transplant Surgeon Raja Kandaswamy, MD, who is the director of pancreas transplantation. Doctors put Joanie on a pancreas transplant list. Less than six months later, Joanie underwent the life-changing surgery.
When Joanie came to the University of Minnesota for a pancreas transplant, she was tapping into a long and rich history of medical innovation.
This year, the University of Minnesota is celebrating the 50th anniversary of the first-ever pancreas transplant, which occurred in December 1966 and was undertaken at the University of Minnesota by surgeons Richard Lillehei and William Kelly. Since then, more than 50,000 pancreas transplants have been performed worldwide, and roughly 30,000 in the United States alone. University of Minnesota care teams have completed 2,300 of those, more than any other transplant center in the world.
Thanks to modern medicine, pancreas transplant procedures typically have high success rates. Decades ago, however, that was not always the case. With improvements to the transplantation procedure, the modern era of pancreas transplants began in 1994. Since then, the success rates have risen to nearly 90 percent, Kandaswamy said.
Advanced surgical techniques, improved immunosuppressive medications that decrease the chance transplant rejection and more effective antibiotics have all contributed to the improved success rates.
That’s good news for people with type 1 diabetes who are eligible for pancreas transplants. In 1992, one out of every six diabetics would not live to see their 40th birthday. That mortality rate increased if a patient suffered kidney failure, a common complication of type 1 diabetes. Pancreas and kidney transplantation offered a solution.
“Transplantation of a kidney and a pancreas not only improves a patient’s quality of life—making that person insulin and dialysis free—it also has been shown to extend life,” Kandaswamy said.
Pancreas transplants have quickly become a standard option for patients with type 1 diabetes and kidney failure. As transplant numbers continue to grow, researchers and surgeons are working to develop less invasive alternatives for those who require pancreas transplants.
One of the current developments is the allo-islet transplantation, which Joanie received.
“While minimally invasive, it is not currently as effective as a standard pancreas transplant. However, we expect the results to improve,” Kandaswamy said. “In the future, islet transplantation may become the new standard of care, with a pancreas transplant serving as an alternative option.”
Thanks to the continuous improvement and developments made to the procedure, patients like Joanie are able to do things they could not before.
“Shortly after the transplant, my husband and I went Scuba diving. I love being under water, but they won’t let you rent equipment when you’re diabetic. [Before the transplant], I didn’t think I would ever do that again,” said Joanie.
Beyond Scuba diving, Joanie is happy with her newfound freedom. She is able to take a red-eye flight by herself, go on road trips with her husband and even sleep all night.“It’s amazing how alert you can be during the day with a good night’s sleep,” said Joanie.