Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus

Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP‐Tx, n= 55), and isolated kidney or liver transplanted non‐diabetic subjects on the same immunosuppressive regimen (CON‐Tx, n= 14), underwent 1‐day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP‐Tx had lower PG than CON‐Tx in the night and in the morning and higher insulin concentrations throughout the day. KP‐Tx had lower PG nadirs than CON‐Tx (4.40 ± 0.05 vs 4.96 ± 0.16 mmol l−1, ANOVA p= 0.001). Nine per cent of KP‐Tx had hypoglycaemic values (PG ≤3.0 mmol l−1) in the profiles, both postprandial and postabsorptive, whereas none of CON‐Tx did (p< 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia. Copyright © 1998 John Wiley & Sons, Ltd.