When Allma Johnson was diagnosed with Type 1 diabetes at 15, she knew her life would be forever changed.
An active high school student involved in marching and concert band, Johnson had to begin daily insulin injections. For years, the injections were all she needed to manage her disease. In her 30s, she transitioned to an insulin pump, along with a continuous glucose monitor. A few years later, she returned to daily injections and routine blood sugar checks. Together with a healthy diet, they kept her diabetes in check.
But in early 2015, when she was 43, Johnson began to experience troubling symptoms.
“I started noticing swelling in my ankles that slowly progressed to my calves,” Johnson said.
Those symptoms signaled the beginning of a downward spiral in Johnson's condition that took a serious toll on her heart and kidneys. Her need for specialized care led Johnson to Mayo Clinic, where she eventually received a kidney and pancreas transplant that restored her health and allowed her to bid goodbye to her diabetes for good.
Johnson's leg swelling in 2015 landed her in a hospital emergency department in Las Vegas, where she lives. The news wasn't good. "They removed eight to 10 pounds of fluid from my body, and told me I had congestive heart failure," she says.
As a result of that diagnosis, Johnson started receiving care from a local cardiologist. But two months later, while at work one day, she began having serious breathing problems and ended up back in the emergency department, where she received more bad news. She had stage 3 kidney failure.
Johnson was referred to a local nephrologist for treatment. She began taking medications to improve her kidney function, and she followed a strict diet that limited her salt and water intake, as well as phosphorus, protein and potassium. But those measures didn't work. Within two months, Johnson's kidney failure progressed to stage 4.
"The doctor told me I needed to prepare for dialysis. I was just in shock," Johnson says. Then, in the summer of 2016, Johnson learned she would need a kidney and pancreas transplant.
"About one-third of patients with Type 1 diabetes develop kidney disease and eventually kidney failure," Dr. Hasan Khamash said. "These patients are typically prime candidates for a kidney and pancreas transplant."
Based on her kidney function, she fit the criteria for a transplant. But Johnson's poor heart function stood in the way. During her first meeting with Khamash, Johnson learned her heart's ejection fraction – a measure of the percentage of blood the heart squeezes out with each beat — had been as low as 30 percent. Khamash told her it had to be at least 45 percent to have the transplant.
"Kidney failure and diabetes can affect heart function," Khamash said. "With kidney failure, you have a buildup of fluid and toxins in the body, which reduces the ejection fraction of the heart."
Over the next several months, they worked to improve Johnson's ejection fraction. By February 2017, it was high enough for her to qualify for a transplant, and Johnson's name was place on the transplant waiting list.
Knowing it could be several years before a kidney and pancreas became available to her for transplant, Johnson maintained her hope and faith with the knowledge that a new beginning was coming. To help her cope with the wait, she made sure to be well-prepared.
"I was concerned because I didn't know what was going to happen," Johnson says. "I kept my phone in my hand and a few personal items ready. I knew I had to be ready to go whenever I got the call that organs were available."
As Johnson waited, more challenges cropped up. She became severely anemic and had to take medication to help her bone marrow produce red blood cells. She also had weekly iron infusions.
"I kept getting worse every day and felt so fatigued. I could barely perform daily tasks like brushing my teeth," Johnson says. "I pushed hard because I needed to have a sense of normalcy. I refused to let what was happening get the best of me."
In June 2017, Johnson began dialysis. A month later, her ejection fraction dipped to 28 percent. Because of that, she was inactivated on the transplant list. She could no longer work and retired from her position with the U.S. Postal Service. "I felt like I was just dying," Johnson said. "I made my funeral arrangements and wrote my obituary."
In August 2017, Johnson spoke with Dr. Brian Hardaway, a Mayo Clinic cardiologist, who told her that better dialysis and fluid removal could improve her heart function. The new treatment plan made a difference. In March 2018, Johnson went in for a follow-up visit with her local cardiologist. Her heart function finally was normal. She was reevaluated for a transplant at Mayo. On June 28, 2018, she was cleared to be put back on the transplant waiting list.
Three days later – and 31 years to the day after being diagnosed with diabetes – Johnson got the call that would save her life. There was a kidney and pancreas available for her.
On Aug. 1, 2018, Johnson received a kidney and pancreas during a nine-hour surgery. She was discharged from the hospital a week later. She stayed in Phoenix for two-and-a-half months to receive follow-up care and then returned home to Las Vegas, free from all her previous medical concerns.
"It was the first time that I was able to say that I feel good. I never knew what the experience of feeling good was like," Johnson said. "I can't begin to explain the joy I have every morning I awake and don't need an insulin injection or to undergo dialysis."