Diabetes is a chronic disease affecting (according to International Diabetes Federation) over 400 million people worldwide. It is possible to reduce the risk of this type of disease by improving lifestyle. Type 1 diabetes, that accounts for 7-12% of cases, is not currently preventable (1). Regardless of type, diabetes is associated with a number of micro and macrovascular complications that affect life expectancy. In order to maintain normoglycemia and consequently avoid complications novel therapeutic strategies are pursued. Unfortunately type 1 diabetes can only be managed with the delivery of insulin either by subcutaneous injections or by insulin pump. Among all available treatment options only pancreas transplantation enables insulin independency, eliminates acute complications and stabilizes long-term renal and neural complications, thereby improving quality of life. It should be considered in patients with type 1 diabetes in whom glucose control is difficult to achieve resulting in frequent, acute and severe complications (hypoglycaemia, marked hyperglycaemia, ketoacidosis) that require medical attention. Clinical and emotional problems associated with exogenous insulin administration may also be significant indication for a transplantation (2). Patients with type 2 diabetes account for about 7% of the recipients with similar indications as mentioned before (3). It should be emphasized that this treatment option involves contraindications such as severe uncorrectable cardiac disease, malignant neoplasm, ongoing or recurrent infections, high insulin resistance, preserved insulin secretion, persistent substance abuse, unresolvable psychological problems and inability to adhere to posttransplant immunosuppressive regimen (4).

However, the procedure of transplantation itself is connected with possible complications (acute rejection, thrombosis, pancreatitis, infections, intra-abdominal haemorrhage, exocrine pancreatic duct leaks), additionally the patients require lifelong immunosuppression, which often involves many side effects. Therefore, patients qualified for pancreas transplantation should undergo objective multidisciplinary evaluation including psychological assessment. We present below a case of a young women with type 1 diabetes qualified for pancreas transplantation.

A 24-year-old woman (psychology student) with an 8-year history of type 1 diabetes was admitted to the department of diabetology because of poor control of the disease. The main problem included frequent episodes of hyperglycaemia over 400 mg/dl and severe hypoglycaemia (even 20 mg/dl with loss of consciousness) irrespective of maintenance of appropriate diet. In addition she presented with dysuria. Because of neuropathy the patient was receiving oxycodone and lidocaine through an intravenous catheter. She was also treated for hypertension with candesartan, hydrochlorothiazide, amlodipine, clonidine and metoprolol achieving good blood pressure control. The other comorbidities included neurogenic bladder, recurrent urinary tract infections, urolithiasis, celiac disease, peptic ulcer disease, iron-deficiency anaemia, polycystic ovary syndrome, simple breast cyst, vitamin D deficiency.

She was treated with insulin pump, receiving over 100 U/day. She was hospitalized in our department 5 times in one year in order to optimize the treatment and, because of failure to do that, a process of a qualification for pancreas transplantation was eventually started.