Kathy Keller got so confused she pulled her car over, just blocks from home.

Julie Seaton nearly drowned in her pool.

Dan Quigley killed a man in a traffic crash.

Diabetes patients with a severe form of the disease, they have frequently faced life-threatening episodes of low blood sugar. But at UW Hospital, they received islet-cell transplants that have greatly improved their conditions. Doctors infused insulin-producing cells from donor pancreases into their livers.

"It has totally changed my life," said Keller, 51, of Edgerton. In April, she became the 10th person to receive an islet-cell transplant at UW Hospital since Wisconsin's only program to offer the procedures started in 2002.

The transplants, given to patients whose diabetes regularly slips out of control despite careful monitoring, have allowed Keller and most of the others to eliminate or reduce their need for insulin shots. The procedures also have kept their blood sugar levels from dropping to dangerous, seizure-causing lows.

But some patients have needed more than one of the expensive transplants, and three had to restart insulin shots. The procedure is still considered risky enough that only a small fraction of diabetics qualify. Locally and nationally, the hope that the transplants might soon cure legions of people with diabetes has dimmed, though research continues toward that goal.

"There has been a bit of dampening of enthusiasm," said Dr. Jon Odorico, an islet-cell transplant specialist at UW Hospital. "But still, a lot of progress has been made."

A new technique

The mixed picture is part of an alluring concept in transplant medicine: that patients with organ damage don't necessarily need entire new organs but can make do with certain cells that power those organs.

Scientists are also trying to develop cell replacement therapies for heart disease, kidney disease, neurological disorders and other conditions, often through the use of stem cells.

Islet-cell transplants are for people with Type 1 diabetes. In the disease, a person's islet cells don't produce insulin, the hormone needed to process sugar. More than 1 million Americans have this form of diabetes, which requires daily insulin therapy.

About 22 million others have Type 2 diabetes, in which insulin is produced but not used properly, often because of inactivity or obesity. Some of them take insulin shots but many rely on medications to control their blood sugar.

Both forms of the disease can cause complications, including kidney failure, stroke, blindness and the need for leg amputation.

Some patients with Type 1 diabetes receive pancreas transplants. But the procedures require major surgery and are usually performed on patients who also need a kidney.

In islet-cell transplants, the cells, which make up about 2 percent of the pancreas, are isolated from a deceased donor's organ (sometimes organs from two donors are required to get enough cells). Then the cells are infused through a catheter into the portal vein to the liver, in the operating room under general anesthesia or in a radiology suite with local anesthesia.

The procedures, first tried in the 1970s, long had little success. But in 2000, researchers in Edmonton, Canada, reported surprising results with a new approach. They used different enzymes to process the islet cells and different immune suppressant drugs to prevent the patient from rejecting the transplant.

All seven patients who initially received the new technique, followed for up to a year, were able to go off insulin. Transplant centers around the country, including the one at UW Hospital, promptly adopted the "Edmonton protocol."

Quality of life

But long-term results haven't been as stellar. In 2006, the doctors in Edmonton and at other centers said that just five of 36 islet-cell transplant patients, or 14 percent, remained insulin-free after two years.

In a federal report last year on nearly 300 patients, almost three-fourths of those who had been transplanted two years earlier had gone off insulin for at least two weeks — but more than half of them had to restart insulin shots. Many of the patients received two or three transplants.

"The problem is that the islets seem to lose function after a while," said Joan Chamberlain, a spokeswoman for the National Institute of Diabetes and Digestive and Kidney Diseases, which published the federal report.

UW Hospital's program has had a similar experience, Odorico said. Of its 10 patients, he said, seven became insulin independent for at least a month — but three of them have had to return to insulin. One has been insulin-free for three months, and three have been off insulin for more than two years.

Still, locally and nationally, most patients who have had to restart insulin require much less of it than before, doctors say.

Perhaps more importantly, episodes of dangerously low blood sugar, frequent in most patients before the transplants, have been greatly reduced. People with Type 1 diabetes generally wrestle with blood sugar levels that are too high, but their insulin boosts can sometimes be too great or their bodies can react to them oddly, causing the problematic lows, sometimes called "insulin shock."

"These transplants have significantly improved the quality of life for these patients," said Dr. Luis Fernandez, another islet-cell specialist at UW Hospital.

For now, Fernandez said, patients must have severe diabetes to qualify because the transplants require them to be on anti-rejection drugs, which carry risks for infections and other problems.

Cost is another hurdle, Odorico said. The university covers a significant portion of the transplants, which cost between $120,000 and $160,000, but patients must pay $40,000, he said.

Insurance doesn't cover the experimental procedures, but a national study UW Hospital might join would provide coverage through Medicare, Odorico said.

No more episodes

For patients, the transplants can be well worth the risks and the cost.

Quigley, who was UW Hospital's first islet-cell transplant recipient in 2002, was able to stop insulin shots after his third transplant in 2004.

A low blood sugar episode in 1999 caused Quigley, who lived in Door County at the time, to lose control of his car in Sister Bay and kill a 45-year-old father of four, authorities said.

UW Hospital hasn't been able to contact Quigley for several months, but last doctors knew he was healthy and still off insulin, Odorico said. The Wisconsin State Journal also was unable to reach him.

Seaton — from Muskego, near Milwaukee — had two islet-cell transplants in 2005. She remains insulin-free and has had none of the disorienting dips in her blood sugar that scared her before.

She once had a seizure while floating in her pool. Her daughter pulled her out and called 911.

"The paramedics all knew me by name," said Seaton, 45, a mother of five who breeds and shows Australian terriers.

Keller, diagnosed with diabetes at age 6, had taken insulin shots four times a day for nearly 40 years before her transplant.

The procedure has allowed her to cut back to one insulin shot a day. She is on the list for a second transplant, which she hopes will let her fully discard her needles.

A recipient of a kidney transplant from her sister a decade ago, Keller is used to a daily regimen of anti-rejection drugs. Now with the islet-cell transplant, she takes 29 medications, some two or three times a day.

But she no longer slips into trances on the kitchen floor or thrashes in bed from her low blood sugar states — from which her husband, Chuck, has repeatedly had to rescue her.

Keller also hasn't gone into a daze while driving like she did last year while returning to Edgerton from Janesville.

"I don't remember driving home at all that day," said Keller, who pulled over near her house and was taken in an ambulance to the hospital.

"That's the best part," she said. "No more of those episodes."