Category Archives: carb counting

670G medtronic – a lesson for all diabetic practioners in a very good way :):)


The new 670G medtronic pump is truely a wonderful amazing device.

What suprised me more than anything else is what an absolute pearl of a lesson it is in terms of how insulins work and the daily awful grind and variability of being a type 1.

Honestly congratulations to this development team, you have come up with a genius product. Genius!

It expertly and simply solves for so many of the dilemmas type 1’s face daily. And in a safe and perfect way.

Truely a product that answers so many of the questions that we have up to now not solved.

Thank you thank you thank you.

THe MARD was my biggest happiness on the sensor – 8.7- wow-Yay!

So many reasons that in my opinion as many type1 patients should get onto this technology in terms of cost saving in the long run for med aid schemes and longevity with quality for patients both old and young.

I nominate it for product of the year.

Problems it solves for :

1.) daily variability (automatic adjustments according to blood glucose)

2.) hypoglycemia – on a downward trend of sugar readings it keeps decreasing insulin as to prevent a low and then eventually suspending insulin so as to prevent the low from happnening, as soon as the sugar trends up it resumes insulin and keeps adjusting

3.) high sugars – on an upward trend it increases insulin (up to a preset SAFE) level with alarms and alerts so as to prevent the high sugar

4.) variability immediately improves as does TIME IN RANGE

5.) multiple layered safety catches in case of problems

 

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Continous monitoring and it’s influence on control – a huge wonderful impact


If I could pick only one thing for all my type1s and type 2 s on insulin to have in their armamentarium of goodies it would be access to continous monitoring for sooo many reasons.

1.) they learn from it and figure out which foods spike them

2.) they learn what drops them and how quickly and how to rectify this, ie how long the rescue takes to kick in so to speak

3.) they are able to see that if they inject insulin correctly at the correct time that it actually controls the sugar

4.) they can see what a “missed” dose does to the sugar

and I could honestly go on to 100 things …

REcently prices have literally plumetted on these devices making them more and more accessible.

THe next question to ask is : ? accuracy.

It is imperative that the device have the lowest MARD possible.

All this means is that the reading you see on the device is actually a TRUE reading.

Sluce. Kapish. Simple

Accurate is everyting .

So pick up something in your armementarium today for YOUR control ๐Ÿ™‚

Accuracy data from ADA 2019 hot off the press praising CGMs’s at large ๐Ÿ™‚

The data backs up the average clinician’s gut feel that seeing is the answer.

dexcom

Newer insulins


Are they any better ?

Yes, yes and yes, if I needed insulin I would only be on the newest latest of them. Are they for everyone?

I certainly believe individualisation is the key here. We now have so many tools in the armament of diabetes and to this end they require to be prescribed for the greatest benefit for the individual.

So, when it comes to what we call basal insulin – background insulin. The insulin that controls your sugar before a meal and overnight and in the back ground so to speak (out side of meals). We now have a lot to choose from : protophane, other long acting basals, analogue basals like : glargine, detemir, newer ultra-long acting like degludec.

In terms of the choice it needs to match the needs of the patient.

If a patient wishes to only inject twice a day we have an option for that.

If a patient prefers an insulin pump we have an option for that.

If a patient is wanting ultimate control above all else there are choices for that.

What is critical is aiming for an A1c of 7 with very little variability. I am always happy to sacrifice A1c for less variability and my most important criteria is no hypos! or as few as possible. They are “Kak” for both brain and patient.

Diabetes and the holidays …


So I have blogged about this before, but they are upon us now.

What should you be doing/not doing or doing differently during the holidays.

We all know that glucose control is one way in the week and quite a different way on the weekend and holidays. This is partly because we are human and life is well just not always easy and letting your hair down usually goes with a bit of alcohol (if you are old enough) and a bit of cheating (dare I say it).

So all things considered, where does this leave you with your diabetes?

Consider it. Be mindful of it. Carb count it. Accurately.

With the holidays come a little bit of time – that we don’t usually have. Choose to exercise – must be something you love. Be creative. Horse ride or bike ride or dance!

Factor the exercise in. IF you are not sure how to do this, consult someone. Even if you are on holiday – trust me most of us (health care folk) are at work : dieticians, GP’s, nurse educators etc.

Don’t just go ape on yourself. It’s so much harder to get back the lost ground.

Enjoy yourself but be fair about it. Restraint is required.

Give yourself a Christmas present of being present more often. This will carry through to the new year and be a wonderful asset.

Top sites that I feel are invaluable : http://www.fatsecret.co.za – south african ,excellent for carb counting and so much more!, pinterest has awesome pictograms of diabetes.

Feel free to share your best app, resource with me.

Merry Christmas.

Myths around diabetes


November is diabetes month – awareness around what it is and treatment etc. There is actually quite a lot of strange information that circulates, “fake-news” so to speak regarding diabetes at large.

So let’s dispel some myths.

1.) Diabetes is caused by poor diet : firstly type 1 has nothing to do with diet and is bad luck essentially. It seems to be an auto-immune disease and essentially destroys the b cells of the pancreas creating an absolute lack of insulin.

Type 2 diabetes is a lifestyle related as well as genetic disease and even more complex in nature.

Insulin resistance is a condition more and more prevalent due to lifestyle as well as stress – a big factor. More about this another time.

2.) IF you eat properly you will get better : well firstly type 1 diabetes, without insulin – you die, children in the era before 1921 died. Only since 1921 and Banting and Best’s discovery do type 1 ‘s survive with normal life expectancies.

Concerning type 2 diet is critical and important (as it is with type 1) carbs are key and obviously healthy eating and exercising are key but eating 100% correctly will unfortunately not bring back b cells that have died.

3.) Type 1 diabetics should never eat carbs : whilst one should be mindful of the type and quantity of carb and dose the insulin accordingly it is by no means advised that type 1’s exclude all carbs. This is a tricky one and best discussed in consultation with a dietician.

 

Innate


http://innatehilton.wix.com/innate

Holistic integrative medicine

Pump for me or not for me?


Report back : We had a marvellous discussion about pumps on wednesday evening. Highly enjoyable and informative, even our pump patient learnt something.

JOIn us today : On wednesday night 530 pm in Hilton Pietermaritzburg we will be holding an informal hour discussion about pumps -insulin pump therapy. What is pump therapy ? Who “qualifies”? What is the benefit. Is it for everyone who injects insulin?

Feel free to join us for free for an hour to explore the “pump market” in south africa and get first hand feedback from “pump” patients ๐Ÿ˜‰