From there, Selig went directly to Sydney’s Prince of Wales Hospital and was told he had diabetes. This was news to him and he remained at the hospital for a week, until fit enough to go home.
Having just turned 18, he was facing a lifetime with diabetes type 1. As far as he knew, it came out of the blue.
Life changed forever
Although perfect sight returned, Selig’s life had changed. No longer could he spontaneously dash out to dinner with friends, to swim at Bondi or to play tennis.
He had to check his sugar, make sure he was hydrated, that he had his insulin pump, and his little black bag with his monitor and jelly beans.
But these were minor inconveniences compared to the constant background concern that was now part of his life.
“What takes the most time is the consideration around every move your make and everything you eat. And there is the anxiety about the long-term consequences, the shortened lifespan, vision loss.”
Selig decided to become a peer volunteer for the Juvenile Diabetes Research Foundation and, for about four years, took time to talk honestly to young people diagnosed with diabetes type 1 and, often, to their families too.
“I wanted to be an open and solid bridge between the diagnosis and helping people understand diabetes and what it means for them,” he says.
Today Selig, 26, is a lawyer at Clayton Utz in Sydney. He says diabetes can be managed without affecting work performance, but time and consideration are needed.
“Small things that others don’t think about, like an extra coffee or cookie, require planning and consideration. People with diabetes have to think about what is in the food item and how much insulin to administer, and then check their blood sugars before eating.”
“Having a biologically functioning pancreas gives others the freedom of not needing to plan ahead, but for diabetics the technology is not fool-proof.”
Although the management of diabetes is becoming increasingly sophisticated, the technology still requires human input.
“Administering insulin to yourself is not a finite art and you can give yourself too much or too little. When I go into a meeting, I have to think ‘have I got my blood sugar right, am I going to be OK?’ “
If it’s not right, cognitive function, mood and vision can be affected. It can also result in palpitations and make a diabetic feel hungry or lethargic.
Even if these effects are marginal, they are still important. He is hopeful that leaps in technology will free him from this background concern.
Australia in the race
An intense international race to achieve this is under way. Australia is among the top 10 competitors. In scientific terms, it is towards the front of this leading group but in terms of funding, it is towards the back.
That these players all take bits and pieces from other countries might look like collaboration, but this is really pure competition.
The prize is to find a way to enable a person with diabetes type 1 to receive a graft that will last for five or more years without the need to inject or infuse insulin and with perfect control.
Such a person would have no need for anti-rejection drugs, which increase the risk of infection and cancer.
In Australia, this could benefit almost 500,000 people. While about 120,000 have diabetes type 1, it could also be helpful for about 300,000 Australians who use insulin for diabetes type 2.
Several research centres in Australia are pushing the boundaries but none have cracked the problem of transplanting cells without the need for anti-rejection drugs.
Professor Bernie Tuch, an endocrinologist and scientist, has been working with diabetes for more than 40 years.
He is a director of the Australian Foundation for Diabetes Research and is part of an Australian consortium that has bio-engineered an implantable device to deliver insulin. The IP belongs to the foundation.
Such is his passion for this, he sees patients two days a week and works, pro bono, on the device the rest of his time.
Rather than a sprint, Tuch says this race is a step-by-tiny-step journey towards the goal. And at 68, he is watching the clock.
“Given the average Australian lives to 82, I reckon I just might have 14 years to get there. I need to remain very focused and open to change, should the path become blocked.”
Whenever his patients ask about progress, the optimistic Tuch, an honorary professor at Sydney University and an adjunct professor at Monash University, replies “in my lifetime”.
One unusual aspect of his device is it delivers insulin produced by tissues derived from human embryonic stem cells.
Another is the way it protects these cells from attack by the immune system, thus reducing the need for anti-rejection drugs.
Over decades, Tuch has drawn help widely, including from the CSIRO. He says there is a lot of sharing of expertise at the level of basic science but it dries up towards the pointy end, where there’s competition to make a commercially viable therapeutic.
To the naked eye, his device looks like a small piece of gauze. Made at the Queensland University of Technology, it is a polymer scaffold designed to hold micro-bubbles filled with insulin.
While these bubbles are made of seaweed harvested in South America and processed in Scandinavia, the insulin is made by tissues derived from embryonic stem cells in Israel by Kadimastem Ltd.
The device is assembled in Sydney and will initially be placed under the skin, on the back or chest.
So far, a smaller version of the gauze has been used in diabetic mice and Tuch says it normalised their blood sugar levels for three months.
The next step is to use human cells in mice. These mice have to be immuno-deficient to reduce cross-species problems.
Human cell tests
“We are about to launch this study. Human cells are scarce but our Israeli colleagues have some and are prepared to have them tested in our device.”
Tuch’s team is about to receive its second batch of human cells and if these work in trials, both in Sydney and Israel, the research will proceed to human trials.
He has done work in humans before. A decade ago, he encapsulated insulin-producing cells from human donors in seaweed. These were then implanted into the abdominal cavity of four patients.
Small amounts of insulin were produced in recipients for up to four weeks following implantation.
These were insufficient to make any difference to the amount of insulin the patients needed to inject but proved the concept worked and was safe.
The pores in the seaweed were too small for immune cells to squeeze through and cause problems with rejection.
Removing anti-rejection drugs
But Tuch says the pores may prove big enough to allow some immune molecules to shimmy through. Should this occur, nanotechnology might be used to put a protective coat on the seaweed.
Removing the need for anti-rejection drugs is a key issue and while a number of groups around the world have created cells containing insulin, none have been tolerated without these drugs.
The other key issue is regulation. While normal insulin-producing cells are self-regulating, so are those developed from stem cells.
But human insulin-producing cells obtained from donor pancreases are in short supply.
Tuch, former director of the Diabetes Transplantation Unit at Sydney’s Prince of Wales Hospital, says only 50 pancreases become available each year in Australia following the death of otherwise healthy people.
The problem is that between one and four pancreases may be needed to get enough insulin-producing cells for one recipient.
Regarding the competitors in the race, he says there is a lot of patent protection and only limited information is available.
“As far as I know, no one has micro-bubbles inside 3D scaffolds but others overseas are beginning to use tissue derived from human embryonic stem cells in clinical trials.”
If all goes well, he says the team’s device could be available in five to 10 years.
“It will mean people who administer insulin three or four times a day will no longer need to do this. Those who use insulin pumps to smooth the way the insulin is delivered will no longer need to do this. People like British Prime Minister Theresa May, who wear a patch for continuous glucose monitoring, will no longer need it.”
Selig, who knows Tuch as an endocrinologist and family friend, will watch the development keenly. “In theory, this technology is the ‘holy grail’ of diabetes treatment. Having this technology self-regulate blood sugars would remove a whole layer of planning and anxiety from my life and the lives of all diabetics.”
If it goes well, it could bring considerable savings in the present annual cost of $733 million for diabetes type 1 in Australia and make a dent in the cost of supporting those with diabetes type 2 who inject insulin.
Jill Margo is an adjunct associate professor at the University of NSW.