Regarding Issurim related to eating , if done B'Shogeig, T'shuva alone is M'chaper. If done B'Maizid, T'shuvah suspends the punishment and Yom Kippur atones for the Aveirah. If someone performs an Issur in spite of Hashem, the Rambam calls it a Chillul Hashem. For Chilul Hashem, T'Shuva plus Yom Kippur suspends the punishment and only through death does the Aveira get completely wiped out.
Since the Gid Hanashe has no taste, it can be assumed that it was eaten for spite and thus needs death to be M'Chaper completely. This is similar to the Gemara in Hariyos that says that if someone ate a mosquito, he must have eaten it in spite (since they are not appetizing enough to say that there had been a craving for it.)
The Gemara there differentiates between the eatings. The first time he eats a Davar Issur, we don't assume that it is done for spite. Rather we suppose he is curious to eat the Issur to see what it tastes like, and the eating will quench this urge. But after that first time, since he already knows what the taste of this Issur is, we assume that there is no other motive other than spite. The same reasoning applies to Gid Hanashe. The first time it is eaten, we can assume it is not being done for spite, but the second time, since there is no other possible motive that can be offered, we must suppose it was done for spite.
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