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Transcript: Officially Insulin-Free

Speaker 1: Thanks for tuning into the Diabetes Dish Podcast, brought to you by DiabeticLifestyle.com. Here's your host, Maureen Connolly.

Maureen C.: Maureen Connolly here, host of the Diabetes Dish, a podcast from DiabeticLifestyle.com, a Vertical Health digital property. Today's show is sponsored by our sister site, endocrineweb.com, which is a great patient and professional resource for hundreds of endocrine conditions, including hypothyroidism, and diabetes. Check out endocrineweb.com for more info.

Now for this amazing story. Wendy Peacock is a 44 year old Texas attorney, that you could argue she used to have severe Type 1 Diabetes, or to be more accurate, she's a Type 1 who's in remission. We say she used to have Type 1 Diabetes, because in August 2015, she made medical history, when she became the first recipient of a breakthrough procedure developed by the Diabetes Research Institute, at UHealth, University of Miami Health System. This surgery enabled her to become insulin free.

Wendy was diagnosed with Type 1 Diabetes when she was 17, and over time, she developed hypoglycemic unawareness, a rare, but very serious condition, where her blood sugar would go extremely low, and she was completely unaware of the low. This unawareness put her at great risk for serious injury, or even death. In fact, there was one incident that occurred in the middle of the night a couple years ago, where Wendy's blood sugar dropped to 22.

She fell getting out of her bed, hit her head against the wall, and was knocked unconscious. Wendy lives with her parents, and her 6 year old son John Paul, and something that evening told Wendy's mother to go check on her. In fact, Wendy's mom typically set an alarm at night, just so she could do this very thing, but this evening, something told her something was wrong.

She entered Wendy's bedroom, only to discover her lying on the floor. If she had gone much longer with her blood sugar so low, Wendy wouldn't have made it. Her parents called the paramedics, who started an IV of glucagon, and were able to revive her. Wendy's hypoglycemic unawareness, and the fact that her pancreas stopped producing insulin altogether a couple years ago, made her the perfect candidate for this experimental surgery, one that involved transplanting islet cells into her omentum. This is the fatty layer of tissue between the stomach and the abdomen.

Islet cells are clusters of pancreatic cells, that actually are able to sense blood sugars, and makes insulin as a result. People with Type 1 Diabetes don't have these islet cells, or they have impaired islet cells, so they require regular injections of insulin so that the body can get the energy it needs from blood sugar. Joining me today to share this amazing story, is Wendy Peacock. Wendy, thanks so much for being here.

Wendy Peacock: Oh, you're welcome, anytime I can share everything that's going on at the DRI, and I'm just honored to be able to share what they're doing there.

Maureen C.: Yeah, so before we go into the details of life post-surgery, I would love for you to quickly fill us in on how you even came to be part of the experimental surgery with Diabetes Research Institute. I know that you were approved for the procedure a few years ago, and at that point, your body wasn't making any insulin, but you'd also contacted them originally way back in 2002. Is that correct?

Wendy Peacock: Correct. I started wanting to see what was going on with cures for Type 1 Diabetes, so I started researching on my own back in 2002, and found the DRI and what they were doing in Miami, Florida. I was at the time, living in Houston, Texas, so I looked them up, contacted them, and long story short, I flew to Miami at that time, to undergo initial testing. I was still producing a small amount of insulin, so I would say unfortunately, I was still producing a small amount. I was disqualified from the trial, and good thing for Type 1, but I was producing a very minimal amount. My islet cells were ... So anyway, so I didn't qualify that time.

Well, I remained on top of research. I wanted to still see what was going on, and kept up with everything they were doing. At that time, back in 2002, they were doing islet cell transplants, but it was into the liver. I still followed their progress. That brought me all the way up to 2014, so I contacted them again, and again went through the application process, it's very in-depth, flew to Miami again, and of course, no longer producing any insulin. By that time, I'd had diabetes for 26 years.

It was a very lengthy application process, and they screen you for everything. I do have to say patient safety is their number one priority, so it's a very in-depth process. I went there several different times, staying for three days, undergoing lab testing. So long story shorter, I passed all of the initial testing, and I was put on the transplant list, let's see, April of 2015. I remained on the list beginning in April of 2015, and then finally received that phone call in August, and received the phone call on a Sunday morning, flew down to Miami. That was a Sunday, and stayed in the hospital for a few days, and the transplant took place on Tuesday.

Maureen C.: Wow, so for those who are listening, in order to do an islet cell transplant, these islet cells come from the pancreas of a deceased organ donor, so there's a lot of things that go into obviously, timing, right?

Wendy Peacock: Right.

Maureen C.: And also compatibility, and how healthy this person was, and how healthy you are at the time, in order to ensure that the best outcome. I guess just backing up a little bit, before we go into the details of the actual surgery, what were some of the things, you said you had lots of tests done, safety's their first priority, what kind of requirements did you meet, that people would be interested in hearing? I mean, give us some sense of what they were asking you about, or testing you for.

Wendy Peacock: Well, you know, it's almost essentially ... I mean, you have to be healthy, except for your diabetes. I mean, they test ... Oh, goodness, I'm just trying to remember everything that's tested. Your heart, liver, oh goodness, I underwent chest X-rays. Very intense testing. Also, psychological testing, because as you can imagine, it's a huge transformation. It's a very in-depth, but I obviously ... it has to be.

Everything is scrutinized by the FDA as well, since this is still considered research, so very in-depth testing. They were in touch with my endocrinologist, in terms of keeping ... and they still are today, in touch with my endocrinologist here in San Antonio. I think it was the initial application, I think I submitted at least four weeks of blood sugar testing, so I was sending them logs of what I ate, what my blood sugar readings were, when I exercised. You have to keep very detailed records and send that along with your application.

Maureen C.: Okay. You're just going along, normal life with your son, and work, and just they put it out there at some point, "You might get a call, be ready," but beyond that, that's just all you had to do?

Wendy Peacock: Right, yeah. They said that I was activated on the transplant list, so as you mentioned before, if the donor pancreas comes in, they extract islet cells from that, from the donor pancreas. Of course, they have to test everything there, and there obviously has to be the blood type match, and that donor pancreas has to be healthy.

They do their initial testing, and I believe with mine, they received the call about the donor pancreas, I believe it was on a Friday. They did not contact me until Sunday morning, to make sure that that particular donor pancreas was healthy. When they determined it was, then they called me, and I had to immediately get down to Miami. They called me like at 7:30 Sunday morning, I was on a flight at 12:30 that same day. I flew down to Miami, and they checked me, and so yeah. It has to be pretty quick.

Maureen C.: What are you thinking at this point? You're on the plane-

Wendy Peacock: I had a bag packed.

Maureen C.: Oh, you had a bag packed, ready to go, and you kissed your son goodbye, or did he come with you, or your parents?

Wendy Peacock: No, he did not. Actually, my father did come with me. My son stayed with my mom. He had just started kindergarten, so I missed his first day of kindergarten.

Maureen C.: Oh, I'd say for a good [crosstalk 00:09:37]

Wendy Peacock: No, but yeah, yeah. So yeah, it was definitely the plane ride there, you're full of ... I mean, I'm excited, and of course I'm scared, the unknown. I just cannot say enough great things about the team at DRI, and everyone there. One of the doctors met my cab there at the curb when I arrived, and got out at the DRI late Sunday evening. They're just so compassionate, and so dedicated. I just have to tell any of your listeners, if you're at all considering this, or someone you know ... I mean, it's obviously a huge decision ... a lot of time, and effort, and dedication, but that team is hands down, one of the best teams I've ever met.

Maureen C.: Yeah, you said-

Wendy Peacock: Their compassion motivates me.

Maureen C.: No, that's really a wonderful ... And you had said in the article that we had interviewed you for last year, about how you walked into the room, and I guess didn't realize until that point, how many people were working so hard to have this procedure made available, right? Maybe was it the operating room? Not the operating room, I guess, the office where you were meeting them? Tell us a little bit about that.

Wendy Peacock: Right, yeah. That was probably about a week or two weeks after my transplant. Obviously I stayed in Miami for approximately four weeks after my transplant. There was a lot of followups. I went in approximately every two to three days for lab work, just to make sure everything was going okay. As part of that process, they weaned me off of insulin very slowly, so again, monitoring everything.

One of the doctors carries a phone with him, still now, I call it the DRI 24 Hour Phone. If I ever have a question, I can immediately contact them. But anyway, to get back to your original question, I remained in Miami, so about the second week after my transplant, Dr. Ricordi in fact, invited me to one of their meetings. He said, "Would you like to attend it with our weekly staff meeting?" I said, "Oh, absolutely, I would love to come."

When they opened the door for me to walk in, I was expecting maybe six or eight people at a staff meeting, and it was just this room of people, sitting around this huge conference table, and chairs up against the wall. These are all the people that worked towards a cure for Type 1 Diabetes. It just stopped me in my tracks. I was like, "Wow." Some of these people have been at the institute for 20 plus years. Obviously Dr. Ricordi being one of them.

It's just amazing to see their dedication. Some of the staff members themselves are Type 1, researching, looking for a cure. They have so many things going on, not just islet cell transplants. They have research that they're doing for newly diagnosed Type 1 diabetics, so there's so much going on there, and I really encourage your listeners to visit their website. There's so many things that they're looking at right now.

Maureen C.: Yeah, and then just going back then, to the actual day of the surgery, you land in Miami, and like you said, there was one of the doctors there to greet you, which I think is just wonderful. You get prepped, right? So a couple days later, you're going into the OR. I guess the anti-rejection drugs come after, but give us a little bit of detail around how this all went down, and how long the procedure was, and how invasive it was.

Wendy Peacock: Sure. I checked into the hospital on a Sunday evening, and so I was in the hospital until ... Well, the surgery was on Tuesday, it was Tuesday evening. The surgery itself lasted, oh, maybe an hour and 15 minutes, the actual procedure. Not an in-depth procedure, and I had two tiny little incisions, on either side of ... Let's see, the lower ... on either side of the naval, the belly button. Very minuscule.

I found out after the fact, yeah, that they think they can actually do away with one of the incisions, so now when they do it again in the future, it will probably just be one incision. So anyway, it's very minor procedure, really. It took place about 6:30, I woke up in recovery probably by 8:00, and I was released from the hospital that Friday.

Maureen C.: And it was general anesthesia, or ...

Wendy Peacock: Yes, it was, yes. It was completely, all the way under.

Maureen C.: Yeah, I guess for that length of time, nobody wants to be awake, hearing what's happening.

Wendy Peacock: Right, right, but again, the recovery was minimal.

Maureen C.: So yeah, I mean, that's just mind blowing in a way.

Wendy Peacock: Mm-hmm (affirmative).

Maureen C.: What about your insulin? You wake up, and they're saying, "Okay, let's give you a little insulin, see how you do." How do they figure all ... what you needed?

Wendy Peacock: Right, yeah, they monitored that very closely. Even throughout the surgery, monitored my blood sugar. They started weaning me off insulin, let's see, the surgery was on a Tuesday ... they started decreasing the insulin probably within about a day and a half, to two days, and just started bringing it down little by little. Within two and a half weeks post-surgery, I was completely off of insulin. So yeah, they monitored it very closely, but yeah, [crosstalk 00:15:32].

Maureen C.: How many years did you need insulin?

Wendy Peacock: I had been injecting insulin for 26 years.

Maureen C.: 26 years, and how many times a day?

Wendy Peacock: I injected, oh, anywhere from probably three to four times a day.

Maureen C.: Okay, so how are you feeling at this point? Is your mind going, "Wait a second, I can't even ..." Are you freaked out, or are you just kind of like ...?

Wendy Peacock: Oh, yeah, it was very surreal, those first couple weeks. Well, and even sometimes now. It's still I'm like ... I'll catch myself. Not as much anymore, but especially the first few months after surgery. As any Type 1 diabetic knows, and especially for me, I lived on such a schedule. Everything was, "What time is it? I have to inject at this time, check my blood sugar. I have to eat this and that." Just very regimented, in order to control as best I could my blood sugar.

For me, I always had to plan, and it was very difficult to just get up and do something very quickly without planning. You always have to have your supplies, and blood sugar glucose tablets, make sure you have stuff you can eat. Even traveling. Usually as a Type 1 diabetic, you need to be able to at least get to a grocery store, and have food that you can get, and keep in your room, those types of things, which may sound kind of simple to a non-Type 1, but for a Type 1 diabetic, those are crucial. You know, just things like that.

Maureen C.: It's like this new found freedom, that a lot of people probably don't think about, right?

Wendy Peacock: Exactly, yeah.

Maureen C.: How about being with your son, what kind of freedom do you feel there, reassurance about ...?

Wendy Peacock: Oh, yeah, that's one of the biggest things. He was actually my biggest motivator for getting involved with this research, is my whole family. Because it does, it affects the whole family, obviously not just the person who has Type 1 Diabetes. I think it affects, for me, it affected my family more. But yeah, being able to lay down at night ... That's been my biggest, and my greatest reward, and benefit, and blessing all wrapped up in one, is laying down at night, and not worrying that my blood sugar is going to go low.
That was the hardest thing for me, with dealing with my Type 1 Diabetes, was I always had the low blood sugar, and not being able to sense it anymore. It's called hypoglycemic unawareness. I'd had diabetes for so long. It doesn't happen to every Type 1, but it did to me, that I was no longer able to sense when my blood sugar was going low. It's actually danger, very dangerous. I don't have that anymore, which is great, especially being the mom of an active six year old boy.

Maureen C.: Yeah, gosh, right? I have three boys myself, so I know what it takes to keep up with even one boy.

Wendy Peacock: Yeah, exactly.

Maureen C.: Physically, how did you feel after the surgery, other than the obvious? You said you were up and around, and feeling pretty normal?

Wendy Peacock: Yeah, I definitely was. I had to, I think, limit my exercise somewhat, because they were small incisions, but they were still ... So I couldn't go work out like crazy, I had to limit my exercise for about three to four weeks. Other than that, no physical limitations.

Maureen C.: Okay. Do you have to take anti-rejection medication?

Wendy Peacock: I do. That is the ... I guess the negative. For me, it's not a negative, and it's something that every patient would have to weigh. I have been very fortunate, I haven't had side effects from the immunosuppressants, and knock on wood, knock on something, I have not been sick. Obviously if you're on immunosuppressants, your immune system is very depressed, is I guess the term they say. I have been very blessed to not ... I have not gotten sick since I've been taking immunosuppressants now for more than a year.
I'm very careful, I wash my hands like crazy. I did before, but now I wash my hands like crazy, and always make sure I have my flu shot, and try to avoid places where there's ... Like in work, if someone is sick, maybe I'll work from home for a couple days while the person is sick. Then of course with my son, he's six years old, he brings home a lot of stuff, but there again, so far, I've been very blessed.

Maureen C.: Wow, that's amazing. Will you have to take these drugs for the rest of your life?

Wendy Peacock: Yes. In order to keep the islet cells functioning, I will have to remain on the drugs for the rest of my life. For me, the trade off is worth it. That is what the next phase of the research that they are looking at, at the DRI, is to be ... Now, I can't give you all the technical ways of how they will do it, but that's one of the things that they're looking at, is to be able to have this transplant without the patient having to take immunosuppressants.

Maureen C.: Wow.

Wendy Peacock: Yeah. That will truly be, I guess, the cure of [inaudible 00:21:09] when you have to take the immunosuppressants. Then again, I haven't had a lot of [inaudible 00:21:13].

Maureen C.: Right, because then you're kind of done.

Wendy Peacock: Yeah, exactly.

Maureen C.: Are you aware of any other patients that they're planning to have undergo the procedure? Have they done some already?

Wendy Peacock: They won't really send information, because obviously, it's patient privacy. They have talked about probably that they plan to do ... I want to say the goal is a total of six, for the transplant that I had, the transplanting islets of [inaudible 00:21:46]. I'm pretty sure it's six is their goal. I'm not positive, but I know it's definitely more than one.

It'll be the same thing, they have to have a match. As soon as they have a match for the next one, they'll do the next one. There may be some differences that they learned from mine, that the next one will be even better. That's the goal though, to definitely have more than just me.

Maureen C.: Yeah. Did they share any details about the organ donor? Is that something that you ...

Wendy Peacock: Yeah, and that is private. They did with me, but that's information that I can't share. But yeah, just an amazing story. There again, the fact that we have people, and they're willing to do that, I mean, it just gets research that much farther. We so need everyone to be willing to be an organ donor.

Maureen C.: Yeah, that's an excellent point.

Wendy Peacock: Amazing, yeah.

Maureen C.: Without sharing confidentiality, because I respect that this needs to be kept private, but in terms of how you felt about this person, what are your thoughts?

Wendy Peacock: Oh, just when they shared the story, I was already touched, but when I heard the story, it's just again, I felt so blessed, and so honored to be the recipient.

Maureen C.: Are there family members aware? Like the donor's family members aware of what the donor was able to do for you?

Wendy Peacock: Yes, yeah, absolutely. That makes it even more meaningful, yeah.

Maureen C.: I would think so, that's a beautiful thing. Just to kind of wrap things up here, other than the obvious, which is like, "Oh my god, I don't have to use insulin anymore," I guess, they expect that this will be life-long, right? I would hope that your body continues to do what you've been doing so wonderfully.

Wendy Peacock: Yeah, I hope so.
Maureen C.: What would you say the most exciting thing to come out of this for you, just to sum it up, I guess?

Wendy Peacock: Well, I have been able to, for me ... Well, first of all, the people that I've met at the DRI, it's like my second family now. They're just amazing. If I could share one thing with your listeners, if they're Type 1s, or they have a loved one who's Type 1, it's just to hope. Don't give up. I've talked to quite a few Type 1s and shared that with them, that there's a team of people, brilliant research scientists, surgeons, doctors, that are dedicated to finding a cure for Type 1 Diabetes.

Yeah, we all want better tools to manage, and I know that's important, but we need a cure, because this needs to end. These people are just dedicated, and they put so much compassion into it, it's not just a job. It's their life's focus. If I could share anything, it's that, hold on to that hope. Maybe you aren't interested in participating in research, but you can still know that there are people that are working to find a cure. I think that was probably the biggest takeaway for me, is that wow, I believe they're going to do it. They're going to be able to do it without immunosuppressants. I have complete faith in that team.

Maureen C.: Yeah, well, you're a great testament to the possibility, so thank you so much for being here today, and I think-

Wendy Peacock: Absolutely.

Maureen C.: We're just going to have to do maybe an annual check in with Wendy.

Wendy Peacock: Oh, that would be great, yeah. Yeah, August is now my favorite month of the year, when I had my transplant.

Maureen C.: Yeah, I'm sure you toast, celebrate, right?

Wendy Peacock: Yes, I absolutely do.

Maureen C.: Well, for listeners here, you can also go to DiabeticLifestyle.com, to read the article that we did a year ago, that talked about the surgery in more detail. Once again, Wendy, thank you so much for being here and be well, and we'll talk soon.

Wendy Peacock: Thank you.

Maureen C.: Okay, take care.

Wendy Peacock: Okay, great, thank you. Goodbye.

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