ABSTRACT
Given the very limited availability of donated pancreas, which has been estimated to be roughly 4000 to 6000 a year in the United States of America, relatively few patients with diabetes should be considered for beta-cell replacement. There are three general clinical situations that justify this approach. The first is recurrent hypoglycemia with poor symptom recognition despite optimal medical care. This is a complex area to consider. Recurrent hypoglycemia in diabetic patients is a direct consequence of administration of exogenous insulin. In circumstances where too much insulin has been given, patients inevitably become hypoglycemic. When patients become recurrently hypoglycemic, they develop a decrease in the perception of symptoms related to hypoglycemia. Normally, hypoglycemia causes warmth, hunger, sweating, and rapid heart rate. When hypoglycemia becomes very severe, additional symptoms such as visual loss, lethargy, coma, and even death can occur. With recurrent hypoglycemia, patients become desensitized so that the symptoms begin to occur at lower and lower glucose levels. Usually, humans experience symptoms of hypoglycemia when the blood glucose level drops below 55 to 57 mg/dL. When symptoms begin at glucose levels in this range, ample time is available to remedy the situation by ingesting substances containing sucrose. However, if the symptoms do not begin to develop until the blood glucose level is as low as 30 mg/dL, it continues to decrease, and not much time is left to stop this process before extremely dangerous levels of hypoglycemia are reached.
