Diabetes affects more than 220 million people worldwide, with the greatest number of cases in India, China and the United States. It can lead to life-threatening complications, but a double organ transplant can give some diabetics a new lease on life.
It's 5:30 a.m. in an operating room at Barnes-Jewish Hospital in St. Louis. Surgeon Jason Wellen points to his patient's open abdominal cavity, and her newly transplanted pancreas.
"Here's the vein where the blood flows out, that we made a connection - you see the sutures right there?"
A light blue surgical sheet covers the rest of the patient's body and blocks the surgeon's view of her face. Her name is Tiffany Buchta. She has type 1 diabetes.
Before the surgery, Buchta - an administrator at a local community center - continued to work fulltime even when she was on dialysis.
She was diagnosed at 15. Formerly known as juvenile diabetes, the type 1 form develops when the body's immune system turns on itself, destroying the insulin-producing cells in the pancreas. About 10 percent of diabetics have this form of the disease.
The exact cause of type 1 diabetes isn't known, but researchers believe a combination of genetics and environmental factors are to blame.
As a teenager, Buchta was an athlete, playing basketball for her high school. But after her diagnosis, life got a lot more complicated.
"Having a more strict schedule on when you eat, and taking your medicine, and weighing out your foods, and things like that," says Buchta. "It was kind of difficult at the beginning, but you just get used to it."
Unlike type 2 diabetics, who can often control their disease with diet, exercise, and oral medication, people with type 1 diabetes need daily insulin injections to survive. The disease can be particularly tough on the kidneys.
"Probably about three years ago, four years ago, I found out that my kidneys were like 45 percent functioning, and didn't realize that it could happen so quick."
That was when she was in her early 30s. By October of last year, Buchta's kidneys had pretty much stopped working. Three times a week, she had to go to a local clinic. There, she spent three and a half hours hooked up to a dialysis machine. It filtered the waste products out of her blood, doing the job her kidneys no longer could.
Then Buchta was offered the possibility of a transplant: not just a new kidney, but a pancreas, too.
"If I was to just give a type 1 diabetic a kidney transplant, over time their diabetes is going to attack that kidney, just like it did their own kidneys," says Dr. Wellen. "So when you offer them a kidney and a pancreas transplant from the same donor, not only do you drastically improve their quality of life - so their sugar's completely normal, no longer need for insulin - but it makes that kidney last longer."
Buchta's transplanted pancreas and kidney are attached to blood vessels in her lower abdomen, leaving her own pancreas and kidneys in place. Her original pancreas still produces digestive enzymes, while her new pancreas makes the insulin she needs.
Her newly transplanted kidney will filter her blood and produce urine.
With careful control of their blood glucose, cholesterol, and blood pressure, many type 1 diabetics can avoid serious complications. But for those who do develop renal failure, Wellen says a kidney-pancreas transplant can be life-saving.
"If she did not get this transplant, Tiffany would have a 30 percent chance of living five years."
With the pancreas and kidney of her donor - a 23-year-old car crash victim - Buchta is likely to live longer.
"This operation should give her a five year survival hopefully in the 85 percent range," says Wellen. "So you're going from a 30 percent chance of living five years to an 85 percent chance. I mean that's a big difference."
Instead of insulin, Buchta will now need to take medications that suppress her immune system, to keep her body from rejecting her new organs. The drugs will also make her more vulnerable to infections and disease.
But it's all worth it to Buchta. One month after the surgery, she's just happy to be off dialysis.
"I mean I have so much more energy," she says. "And even with, you know, starting back to work, I was kind of scared on how, how much that would wear me out, but it really hasn't."
And as Buchta puts it, it's just nice to have her life back.