Monthly Archives: September 2015

How does insulin work?

There are quite a few different types of insulin on the market and a whole bunch of brand new ones arriving soon.

The basic broad classification is long vs short acting. As their name implies they are long or short acting. What does that mean? When you require insulin you have both basal needs as well as prandial (meal time) needs. Your basic and ongoing metabolism needs glucose to go into the cells (all the cells in the whole body) on a minute to minute basis and hence a basal requirement of both glucose and insulin. Insulin is the key that gets the glucose in. When you eat carbohydrates you then require insulin to get the glucose load out of the blood circulation and into the cells where it can be used as fuel.

The long acting insulins cover basal requirements and act for a long time – 6 – 24 hours and some new long actings with a duration of about 48 hours.

The short acting insulins act for a short period of time, starting within about half an hour of injecting and then lasting for around 4 hours. There are brand new ultra short acting ones that are soon to arrive.

Insulin is a dangerous substance and the most acute danger is hypoglycaemia. In other words you inject too much insulin and the sugar plummets very low. At different levels for different people but generally below 2.5 mol/l you not only feel awful but can become unconscious and potentially no longer require a bucket list.

For this reason it is imperative that if you are injecting insulin you understand how it works, when it starts working, how long it works for, the shape of the curve of the action and also imperative to know what your number is – your blood glucose. Before injecting insulin you should ideally do a glucose test and factor this number into the equation.

action of insulins

action of insulins

how do insulins work

how do insulins work

It’s in the detail

Type 1 diabetes is a diagnosis that rocks most families and patients and affects the entire family dynamic for the rest of the patient’s life. It’s affect is minute to minute and second to second and quality of life is a very key thing that gets given a good shaking up – of all affected.

Have you ever had a drop in sugar? How did it make you feel? Can you imagine going from high to low like a rollercoaster most days? That is what some patient’s face. Hard for the patient, harder still for the parent/care-taker.

For some people the term “brittle” diabetes is a swear word and does not exist, for some people it is an excuse to run their sugars all over the show. For me the truth is somewhere inbetween.

Certainly in my experience there are definitley patients who are more sensitive to insulin and in tiny alliqots than other patients, especially children, women at different times of cycle/states of hormones etc. It becomes incredibly tricky to get the “dosing” right on 4 injections a day. The more sensitive one is to insulin the easier I find it to manage patients on an insulin pump. This will enable smaller doses, a 1/3 less of a total daily dose and easier titrations in these sensitive candidates.

Life after diagnosis is tricky and quality is key. Every minute and every second counts towards that. A roller coaster is no way to live. Rather a smoothie – nice even sugars, minimal variation and mostly at target makes for a happy patient.insulin pump

Telkom let down – business must go on

Ok so our telkom lines are down as well as our internet. WE have made a plan and you are able to get hold of us for bookings and enquiries on the following:

So ! after the power on off business over the weekend our telkom lines and internet are down. What is working : 0333432247, 0743654986, 0747502493, www.https://xandaro/drleethegp, Facebook, twitter –

online booking : www.https://xandaro/drleethegp

We are open and available and Dr Lee available on friday after the public holiday 🙂

telkom let down :(

telkom let down 😦

A 2 % drop in A1c with just one addition – I call it a “smoothie”

Recently I have started quite a few patients on dexcom and to my and their delight with this simple intervention we have achieved a 2 % drop in A1c – WITH obliteration of hypos over a 2w to one month period. Previously unheard of!

For a type 1 diabetic who has long battled with both low sugars and high averages – neither good in long or short term it is a great joy to see the “smoothing” out of a very detailed download (c/o dexcom).

Yipee Yay!!dexdowndex sensor

all in the green, no lows no highs

all in the green, no lows no highs

Mountain splendour splendour

Source: Mountain splendour splendour

Mountain splendour splendour

For our 5th wedding anniversary we galavanted to Mountain Splendour – a wonderful place in the Drakensberg mountains where one can “glamp”. Glamping is a wonderful way to camp with children. Ours are 2 and 4. The tent is set up for you with all you need, including electric blankets ! What bliss and shear luxury.

The setting is arguably one of the most breathtaking in terms of mountain splendour. Surrounded by natural beauty with mountain biking/running trails to your heart’s content. For the children there is a playground that rivels the best of them full of wonderful swings, clambering things and even a caravan to play in. My children would have slept in the playground if we had let them. Possibly the only drawback being that they just wanted to be there all the time!

We had a wonderful time and will certainly be back.

Mountain splendour, splendour!

Mountain splendour, splendour!

Scrambled egg for breakfast

The pendulum doth swing from one end to the other. At the moment eggs are in. What is a good start to the day? Especially if you are not wanting to have a carb “excursion” it bodes well to have a protein start to the day. Breakfast is a very important meal, perhaps the most important and affects metabolism for the rest of the day. There are studies that link skipping breakfast to the development of type 2 diabetes. Other studies that link general good health to eating a good healthy breakfast.

There is so much rubbish out there for breakfast including just about all the cereals on the market though some are worse than others. They are jam-packed full of sugar.

Not everyone is happy to have eggs for breakfast – there are some other options : jogurt (no sugar added kind), fish (though if not keen on eggs less likely to be keen on fish I think) and then there is a whole range of future life breakfast that needs to be dosed in the correct portion and I would suggest the no sugar added one.

But back to scrambled eggs – easy to do, easy to flavour with just about anything from a touch of salt to cheese or even more adventurous toppings. If you are diabetic and you have protein for breakfast – it is “free” and does not require a dose of insulin. Bargain.scrambled eggs

Dexcom spaghetti

How does one unravel the download of dexcom spaghetti? I find continous monitoring is HUGELY beneficial to the patient on a literally minute to minute basis and in terms of the “knowing” what their sugars are and in terms of littlies the mom or dad “knowing” minute to minute “where” things are at.

For the health care professional however there is a lot of spaghetti to wade through.

My personal favourite is the graph that averages everything out and plots one average on a 24 hour day. For me I can USE this information to adjust settings and give advice. NO two days are quite the same, diabetes remains a learning game, but if you use your trends you will always win, just a little rhyme for a bit of fun.

Diabetes is a challenge, an obstacle, a learning game. I learnt recently from a very inspirational type 1 diabetic that one needs to dance with the obstacle. I am learning myself (as a health care provider) to dance with the obstacles I have in caring for diabetics.

how to unravel

how to unravel

A “learned” response

How does one overcome adversity? I watched a brilliant little youtube clip by a guy with type 1 diabetes who has done incredible things and thanks his diabetes for his “gift” of “not being able to choose” the disease and having to learn how to cope.

What I loved most about his clip was the fact that he aims to ” have his favourite song playing” – you probably have  to watch it to understand – but to be inspired on an ongoing basis. The “success” so to speak is shortlived and a moment, but the journey is where you “perform” and get swept up and sweep others up.

He tries to impart how to “dance” with your obstacle and yield in a sense and the power that then comes from that as opposed to fighting the diagnosis/obstacle.

IT’s inspirational and worth a watch., also on YOU tube : Sebastian Sasseville

SEbastian Sasseville, an inspirational diabetic

SEbastian Sasseville, an inspirational diabetic

How could this Not be inspiring ?

How could this Not be inspiring ?;)

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