For the 130,000 Australians living with type 1 diabetes, a condition that destroys the pancreas leaving sufferers unable to produce insulin, regular hypoglycaemic events can be a dangerous side-effect.
Commonly known as hypos, they are caused by low blood sugar levels, with symptoms including palpitations, tremors and sweating. Patients must adhere to a strict diet, test their blood sugar levels with multiple finger pricks each day and rely on injections to give their body the insulin it needs to function normally.
‘Some patients develop ‘hypoglycaemic unawareness’,’ says transplant physician and nephrologist Associate Professor David Goodman. ‘Their body can quickly progress to unconsciousness, risking coma or even death.
‘You never know when a hypo will come on and there is no way to test for it. As a consequence, many patients with type 1 diabetes require someone with them around the clock.’
For Elaine Robinson, it was getting to the point where she was experiencing multiple hypo episodes a day. Her husband Geoff thought he may have to retire in his early 50s to take care of her.
‘I could never be late anywhere or everyone would just assume that I had collapsed somewhere,’ Elaine says. ‘My friends and family were only trying to help, but I totally lost my independence.’
Elaine’s life changed dramatically in December 2007, when she was the first Victorian to undergo a life-changing islet cell transplant treatment at St Vincent’s. The procedure involves transplanting islet cells from a donor pancreas into the patient’s liver, where they begin to produce insulin.
Elaine was given two transplants at three months apart and monitored closely for signs of insulin production. Two weeks after the second transplant, Elaine was off insulin.
Ten years on, the procedure is now part of clinical practice. 50 transplants have been performed across the country, 14 of them at St Vincent’s.
‘50 per cent of patients are still off insulin up to five years after their procedure,’ says A/Prof Goodman.
St Vincent’s now has a purpose-built islet isolation facility where a team of scientists conduct the painstaking work of extracting islets from donor organs.
‘It takes scientists eight hours to isolate the islets and examine them carefully. They are extracted the same day as the organ is donated and transplanted within 24–48 hours,’ A/Prof Goodman says.
Elaine experienced four years off insulin, before complications from rheumatoid arthritis took their toll on the islets. However the lasting positive effects of the procedure remain.
‘I’ve got my hypo awareness back – I can correct my blood sugars in time. I feel like I’ve gained some freedom.’
Elaine is open to the possibility of undergoing a new transplant, but for the time being she is waiting for the right moment and focusing on controlling her hypos.
‘I’ve tried to have the same routine and eat all the same things at the same time, and I still have wildly different readings,’ Elaine says. ‘All you can do is find a good endocrinologist who you trust, and be rigid and not skip anything. Even then, you don’t always get it right.’