When Julie Allred heard that Emory was exploring alternate treatment options for patients with “brittle” or unstable type 1 diabetes, she didn’t realize that she would be the first to receive her transplant via a minimally invasive transplant technique in the interventional radiology suite at Emory Hospital, instead of the operating room.
Julie was diagnosed with type 1 diabetes at age 10. She got her first insulin pump in 1992 and has used several different types of pumps over the years. Despite her efforts to carefully watch her diet and test regularly, she developed many problems over the past couple of years with unstable hypoglycemia (low blood sugar).
Living with hypoglycemia affected Julie’s ability to do many of things she enjoyed. She was constantly worried about how she could or would be affected by the unpredictable changes in her blood sugar, including being caught unaware at night while asleep. Julie was never free—day or night—from the worry of a condition called hypoglycemic unawareness, which unpredictably causes unconsciousness.
“I wanted to have the transplant because I’ve seen so many changes in the treatment of diabetic patients over the years, from the first glucometers to new medications,” Julie says. She was placed on Emory’s islet transplant wait list in early July and received the call eight days later while at her dentist’s office on July 19, which was “a record for the shortest wait,” she notes.
Julie lives several hours from Atlanta in the Charlotte, NC, suburb of Concord, where she has worked as a nurse for the past 20 years in obstetrics and pediatrics. Julie made the trip to Atlanta for her islet transplant at Emory, which was performed by Dr. Kevin Kim, director of interventional radiology and image guided medicine, and Dr. Nicole Turgeon, kidney, pancreas and islet transplant surgeon.
“Our protocol is designed to treat patients who have had type 1 diabetes for at least five years and have experienced severe hypoglycemic unawareness,” reports Dr. Turgeon. She is principal investigator of the study and collaborated with Dr. Kim for more than a year to develop Emory’s protocol.
“We’re able to perform this type of transplant because of Dr. Kim’s expertise in image guided treatment of liver tumors in the interventional radiology suite and Emory’s experience in islet transplantation and the development of new treatment regimens to protect transplant grafts from rejection,” she says.
According to Dr. Kim, “The interventional radiology procedure involves a small access. We thread guidewires and catheters and a central line through the patient’s right side into the portal vein, which leads into the liver. The entire system is through a less than a quarter inch skin access, and there are no stitches required—only a bandage on her skin. There is no general anesthesia required, and the entire procedure is performed under moderate sedation. In fact, we were talking to Julie during the entire procedure.” The fragile islets implanted in Julie’s liver serve to take over the job of making insulin.
The conventional islet transplant involves a two- or three-inch incision in the abdomen. This open surgical approach can be painful, whereas, Julie experienced no side effects and took only one pain pill following her less invasive transplant.
Julie has been able to gradually taper her insulin from about 50 units a day pre-transplant to 8 to 11 units a day four weeks post-transplant. She is now free from the unpredictable changes in her blood sugar and has had no hypoglycemia.
“My doctor told my mother when I was first diagnosed that I wouldn’t live to age 30 or be able to have children. But because of these advances, I’ve been able to prove him wrong twice,” Julie chuckles. Thanks to the procedure, Julie was able to happily celebrate her daughter Meredith’s 16th birthday at Disney World in January of this year, and turned 43 years old on July 23rd, two days after her transplant.