Frequently Asked Questions

We will never 'push' someone into a TPIAT procedure. This is a major surgery. During the evaluation we will determine if, based on our experience and data, we think you might benefit from surgery and would be a candidate. Even if the team decides you are a candidate for surgery, it is up to you (and your family) to decide if and when this is the right step for you.  

Yes! 100% of individuals have some diabetes after surgery, at least for a while. Individuals who have mild diabetes before TPIAT will always need insulin after TPIAT. Individuals who have pre-diabetes before TPIAT usually need to stay on some insulin after TPIAT.  Individuals who have no diabetes before surgery have about a 30% chance to come all the way off insulin (3 out of 10) but that means that 70% (7 out of 10) will still need some insulin. In these cases, most patients have some function of the iselts, but it is just not enough to come all the way off insulin. Having some islets still makes diabetes easier to control, and some individuals on insulin get to the point where they only need one injection a day of long-acting insulin to keep blood sugars well managed. 

Even patients who come off insulin will need to eventually restart insulin. Most people off insulin are off for 3-5 years, but sometimes it is shorter, and sometimes much longer (even 10-20 years). However, because we know patients will need to restart insulin some day, we ask our patients to monitor blood sugars at least 6-8 times per week (2x/day, 3-4 days per week) when off insulin. 

Yes! You will be exhausted after surgery. Some days will be good days and some not so good. You will be on tube feeds and have many medications early after surgery, including pain medications and insulin. For your safety, we require everyone who has TPIAT to have a care provider with them for the duration that they are in Minnesota. This does not need to be the same person, but everyone who is there should have basic knowledge of how to administer medications, insulin and tube feeds. 

At minimum, you will need a primary care provider, gastroenterologist, and endocrinologist at home. Often we will also recommend a health psychologist, and sometimes a pain management provider to help with pain management long-term. Your team can provide specific recommendations.  

Most patients have a primary doctor and gastroenterologist, but most do not have an endocrinologist. Determine who this will be be (or at least where) before you have surgery. You can set up an appointment for a new diabetes consult with that local diabetes team at 2-3 months after surgery. Scheduling in advance can help make sure you have that team lined up at home. 

Our team may recommend weight loss before surgery. Even though chronic pancreatitis can cause some individuals to lose weight due to malabsorption, others will struggle with weight gain from reduced physical activity and a low fat but high carbohydrate diet. There are several reasons for this. A body mass index (BMI) >30 kg/m2 has been published as one of the major risk factors for not being able to remove all the pancreas tissue successfully. We also know that obesity is strongly associated with fatty liver disease, which can be unhealthy for both the islets and the liver after transplant and will increase diabetes risks. 

We recommend everyone with pancreatitis to avoid smoking and alcohol since they can both contribute to progression of disease. In addition, both can contribute to complications with surgery. Alcohol can irritate the liver. Smoking interferes with small blood vessel growth that is needed for healing of the intestinal reconstruction and engraftment of the islets. We recommend never smoking after TPIAT-- it can cause complications like ulcers and also greatly increases risk of vascular complications from diabetes. After you are 6-12 months out from surgery, small amounts of alcohol, like an occasional glass of wine or beer, is probably fine, but heavy drinking that could injure the liver should be avoided.