Diabetes transplant jab passes road test

Thousands with Type 1 disease could get driving licences back. Picture: Greg Macvean

Dr Shareen Forbes, head of Scotland’s Islet Transplantation Programme, said as many as 3,000 people with diabetes in Scotland may be helped by an infusion of cells from a donor pancreas to help them produce insulin again.

In the past two years the centre has carried out more procedures than any of the other six in the UK which provide the transplants.

So far 23 transplants have been carried out in Scotland in 15 patients since the first procedure in February 2011.

Forbes said the treatment has proven so successful that patients with severe diabetes who have been forced off the road due to their debilitating condition could soon get their driving licences back.

However, she called for increased awareness of the procedure among doctors and the public and more organ donations to help others regain their independence.

The transplant involves cells known as islets being extracted from a deceased donor’s pancreas. These insulin-producing cells are then prepared in the laboratory before they are injected into the diabetic patient’s liver in a simple, minimally invasive procedure.

Once in the body, they help the patient produce insulin again, reducing the need for injections. In some cases, patients have stopped using insulin all together.

The transplants have been shown to be an effective treatment for people with Type 1 diabetes who have problems recognising when their blood sugar becomes dangerously low.

This can cause them to suffer a hypoglycaemic attack, with symptoms ranging from dizziness and fatigue to blurred vision and loss of consciousness. In the most severe cases, such an attack may lead to convulsions and coma.

Those patients with low awareness of their hypoglycaemia are unable to take action to increase their blood sugar levels before the problem becomes too severe and can put themselves at risk in situations such as driving a car.

This means they have to surrender their driving licences, most fearing they will never be able to drive again. But since the islet transplant programme was launched, many are now in a position to reapply for their licences.

Forbes said: “Some of the patients had horrendous stories of becoming unconscious at the wheel and driving into a lamppost.

“We have had a series of patients who fortunately haven’t killed themselves or anyone else.

“One patient said he went round and round a roundabout about 20 times before the police intervened.

“We had another who was driving, fell unconscious and another driver called the police and then tried to push his vehicle into the hard shoulder.

“There was another who crashed a car. These are recurrent stories.”

Many patients, having been made more aware of when their blood sugar levels are falling, are now in the process of getting their licences back. Many have also become able to return to full-time work, which was previously impossible due to their debilitating attacks.

“The benefits are for the partners as well,” Forbes said. “It puts a huge amount of strain on a marriage and it has been very difficult for a lot of the partners.

“Now with the islet transplants a lot of them just feel a huge amount of independence and feel they have more quality of life back.”

Simon O’Neill, from campaigning charity Diabetes UK, said: “It’s very welcome news that these patients can finally get their licences back.

“Obviously, if they are still taking any insulin even in small doses then they should follow the same recommendations as anyone else, which means if they have not had two serious hypoglycaemic attacks in the past 12 months then they should be fine to drive.”

A DVLA spokesman said: “Drivers with diabetes treated with insulin or any medication which carries a hypoglycaemia risk must not have impaired awareness of hypoglycaemia, not have had more than one severe hypoglycaemic episode in the past year and must also undertake appropriate blood glucose monitoring.”

Around 16 people are on the waiting list for the procedure, but Forbes believes many more could benefit.

“I am sure this is just the tip of the iceberg,” she said. “There are about 30,000 people with Type 1 diabetes in Scotland. Probably about 10 per cent of them have severely impaired awareness of hypoglycaemia which is the main indication for islet transplantation.

“So that is 3,000 people probably who may potentially benefit from islet transplantation.”

Forbes said there may still be low awareness of the transplant as a treatment option among both doctors and patients in some areas, which meant more were not put forward for treatment. But she said even if they were on the list, more donor organs would be needed to help deal with demand.

Last week the Scottish Government announced plans to try to increase donation and transplant numbers, but ruled out any immediate move to introduce presumed consent for donation.

Doctors and health campaigners have backed such a system – as planned for Wales by 2015 – where people would be assumed to be willing to donate if they died unless they had opted out, rather than the usual opt-in system which applies in the UK at present.

Twitter: @LyndsayBuckland

Case study: ‘Now I am able to do things with confidence’

Diagnosed with Type 1 diabetes at the age of eight, Paul Orr gradually saw his condition deteriorate, depriving him of his independence.

“It got to the point where I was having half a dozen hypos a day, which I could not feel coming on,” the 41-year-old said. “I was totally unaware they were going to happen. So this left me stuck at home and not able to do an awful lot.”

Two-and-a-half years ago, the father of four had to hand in his driving licence as his attacks made his condition more unpredictable, even though he had driven while suffering low blood sugar without having an accident.

“It came to the point where I thought enough is enough and the doctor said you’ll have to hand your licence in,” he said.

Orr, from Greenock, also has mobility problems due to complications caused by his diabetes and a previous accident, so was left dependent on other people to get around. But after two successful islet transplants, last week he was told by the DVLA that they were satisfied his condition had improved and he could reapply for his licence.

He said the transplants had changed his life, he was now aware when his blood sugar dropped and only had to use small amounts of insulin. “When you are as ill as I was you don’t have a life, you are just living. Now I have got a life back. I am able to do things with confidence.”