Sep 10, 2014


Interviewer: Coming up next on The Scope, if you are a brittle diabetic, a possible treatment option.

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Interviewer: If you suffer from a kind of diabetes called brittle diabetes, you might want to consider a different type of treatment you might not have heard of before. We're with Dr. Jeffrey Campsen from the University of Utah Health Care. He's a transplant surgeon here. The process is called pancreas alone surgery. What exactly is that?

Dr. Campsen: What we're talking about today are patients with type I diabetes that have very unstable diabetes, meaning they've tried their best to control it but they're still very brittle. What that means is they have swings in their sugar levels, their glucose levels, whether they go too high but more importantly they go too low. If you have too low sugars, it's known as hypoglycemia and that can be deadly. If you have the inability to control this with standard therapies, which is insulin and insulin pumps, one therapy we may offer you is a pancreas transplant.

Interviewer: All right. So if some of these other things haven't been working for whatever reason, a pancreas transplant might be the key. How would somebody know if this is something that would be right for them?

Dr. Campsen: Well I think first of all, there's two types of diabetes. There's type I diabetes, which means that your pancreas doesn't actually make the hormones that you need, insulin and glucagon and other things. Then there's type II diabetes, which means that you're resistant to the insulin. So a pancreas transplant doesn't work very well if I'm giving you a pancreas and you're already resistant to insulin, so we're just talking about the type I diabetics.
Once you know that you're a type I diabetic, and most people do know that, it's are you able to comfortably treat this safely. Many people use insulin, they have insulin pumps and monitors, but the problem is not only do they not produce insulin, but they don't produce a hormone called glucagon, which then keeps them from going too low. If they continue to have these episodes where they get too low sugars, then it risks their life. So if this is happening they're referred to as a brittle diabetic.
The final thing is that if they're brittle and the insulin levels are swinging back and forth and the glucose levels are swinging back and forth, they may have other complications. Whether or not they're going blind because of the diabetes, they have nerve damage, they have other issues, chronic infections. These may be reasons that we'll then offer you a pancreas transplant that you would then benefit from.

Interviewer: The name pancreas alone sounds interesting to me. Why is it called that?

Dr. Campsen: Historically the diabetes will attack the patient's kidneys over time. As their kidneys go into failure, we can give them a kidney transplant. But a kidney transplant in a type I diabetic doesn't work as long as it does in non-diabetics because the diabetes comes back and attacks the graft, the kidney transplant, and shortens the life of the kidney transplant. So historically we would give both a pancreas and a kidney to those patients that would need it to protect the kidney. The other school of thought is, why wait until your kidneys have already failed? Why not give you a transplant sooner, a pancreas transplant alone, that then protects your kidneys so you never need a kidney transplant?

Interviewer: So kind of the old school way of thinking was, when it gets to the really dangerous situation, that's when you do the transplant. This is a little bit more proactive.

Dr. Campsen: That's right. And you have to understand that there's a balance, because transplant surgery is a big deal. The surgery itself is a large vascular surgery, and on top of that you have to take immunosuppressive medications for the life of the transplant. So you're kind of trading diabetes for the disease of transplant. However the disease of transplant is much smaller and safer than this brittle diabetes that people talk about or kidney failure.

Interviewer: So if catching the patient before things get terrible is the key, how soon could somebody get one of these transplants?

Dr. Campsen: Many type I diabetics are diagnosed when they're children. That's probably too young because you have to have someone who's very responsible who can take care of the transplant. So we like to see the patients get at least towards their late teens if not into their 20s. They have to really show that they've really tried to manage their diabetes aggressively and very good compliance with their insulin and they've still failed.

Interviewer: All right. What should a patient know at this point? This isn't something that necessarily a lot of physicians would refer.

Dr. Campsen: Right. I think the interesting thing about type I diabetics is the only way that they survive is by really managing their disease. Obviously physicians, endocrinologists, medical doctors have to help them and support them to do this. But they're living every second of their day and their lives with this, and if they're able to control it, then they know a lot about diabetes. They know whether or not they're brittle. They know whether or not their other organs are starting to fail because of the diabetes. Then I think a patient who has this needs to realize that we now offer this as a therapy to help cure the diabetes.

Interviewer: What would be your one takeaway for somebody listening to this?

Dr. Campsen: I think if you're a brittle diabetic, and you know who you are, then pancreas transplant may be an option for you and you should come talk to us. You'll meet our transplant team, the professionals that manage different types of transplants at the University of Utah, and we'll sit down and see if you qualify for this and more importantly will you benefit from an organ transplant?

Interviewer: What are some of the benefits of getting the transplant versus not?

Dr. Campsen: Well I think that basically there's nothing better than a human organ. Everything that we do outside of transplant is approaching the quality that a human organ can give you, but there's nothing better than that. So if you're having trouble with your diabetes and you're noticing it's still damaging you, whether it's giving you heart disease, eye disease, nerve disease, all the kind of things that really happen because of type I diabetes, the fact that you're married to your insulin pump, then a pancreas transplant is an option that then will cure your diabetes. The moment that you have the transplant you're off insulin.

Interviewer: It sounds like the sooner that you contact somebody and talk about this, the better because I would imagine there is a wait time for pancreas transplants.

Dr. Campsen: There is a wait time. First of all you have to go through the workup, and then once you're listed the available organ has to be offered to you. It can be a year or two.

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