Celebrating 15 Years of Success

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Although it is not an unfamiliar disease to most Canadians, Type 1 diabetes is often understood as being only about food and insulin. The reality is that Type 1 diabetes is much more complicated and difficult to manage. Outside factors like infection, stress and exercise influence blood glucose levels in ways that are nearly impossible for someone with the disease to predict. Recent achievements in kidney and pancreas transplantation at Toronto General Hospital offers hope for people suffering from Type 1 diabetes and end stage renal failure.

There are numerous complications associated with the fluctuation of blood glucose levels. As the disease progresses, high blood glucose levels can cause complications such as blindness, heart disease, kidney problems, poor wound healing, nerve damage and amputations. Low blood glucose levels are equally dangerous. Normally, a person with Type 1 diabetes will feel warning signs of low blood sugar including feeling disoriented and irritable, slurring speech and having cool and clammy skin. Over time, some patients will lose their ability to sense when their blood sugar is low. This condition is known as hypoglycemic unawareness which can lead to seizures, coma and, if not treated, severe hypoglycemia can be fatal.

In addition to these complications, there is a stigma that accompanies a person with diabetes, says Andrea Norgate, kidney and pancreas transplant coordinator at Toronto General Hospital. “Type 1 diabetes is one of the only diseases that takes away your identity,” Andrea says. “After diagnosis, you are referred to as a ‘diabetic’ rather than as a person with diabetes. Very few diseases actually have that kind of power.”

Because this disease is so debilitating, there have been many attempts world-wide to develop lasting therapies and treatments. Over the past 15 years, ground-breaking advances in transplantation at Toronto General Hospital have improved the lives of nearly 300 patients through the Toronto Pancreas Transplant Program. The transplant procedure can mean the return of a normal life to those who have been suffering for years.

“A successful pancreas transplant restores normal insulin production and blood glucose control,” says Dr. Mark Cattral, Director of the Toronto Pancreas Transplant Program at Toronto General Hospital. “It has an enormous impact on the quality of life of patients by eliminating the need for insulin therapy, blood glucose monitoring, and dietary restrictions.” At the one year mark following a kidney-pancreas transplant, there is a greater than 90 per cent chance that a patient will no longer need insulin or dialysis.

The Toronto Pancreas Transplant Program performs three types of transplantation. Simultaneous pancreas-kidney transplant (SPK); pancreas-after-kidney transplant (PAK) when the pancreas transplant is performed after a previous kidney transplant; and pancreas transplant alone (PTA) for patients with Type 1 diabetes suffering from severe, hypoglycemic unawareness, but with adequate kidney function. For a major surgery, the recovery period is surprisingly short. After the procedure, transplant recipients spend an average of only seven to 10 days in hospital. A pancreas transplant can also help stabilize diabetic complications and remarkably, most patients are able to return to work within three months. Post-surgery, transplant recipients generally feel better, spend less time in hospital and enjoy a normal diet.

Since reaching the 15 year milestone, the program is working hard to raise awareness about its success and its impact on the lives of patients. The Toronto Pancreas Transplant Program will launch an awareness campaign including a series of presentations for dialysis centres and diabetes clinics across Ontario. “The road show is designed to educate and inform nurses and physicians about the life-saving impact of transplantation,” explains Andrea. “We encourage our fellow health-care providers to recognize patients who might qualify.”