A patient with severe, recurrent hypoglycemia and glycemic lability who underwent islet transplantation

Background A 48-year-old woman who was diagnosed with type I diabetes at 5 years of age presented to our Clinical Islet Transplant Program with severe, recurrent hypoglycemia and glycemic lability. She was diligent with her diet, used a continuous subcutaneous insulin infusion pump (32 U per day), and monitored her glucose levels typically eight times a day. The patient usually had one hypoglycemic reaction a day, experienced a severe reaction once a month, and had marked variability of her glucose values. On presentation, her HYPO score was 584 and her lability index was 868 mmol/l(2)/h per week. Investigations HYPO score, lability index score, screening for diabetes complications, and routine pretransplant evaluation. Diagnosis Severe, recurrent hypoglycemia and glycemic lability associated with type I diabetes. Management The patient underwent islet transplantation. Posttransplant, the problems with hypoglycemia abated and excellent stable glycemic control was attained, although some side effects from the immunosuppressive drug, sirolimus, were evident. Insulin was reinstituted 2.5 years after surgery, at lower doses than before the transplant because of deterioration in graft function. Occasional episodes of hypoglycemia have occurred and some glycemic lability has recurred, although endogenous insulin secretion is still preserved.