Category Archives: continous monitoring

Gut microbiom and diabetes – of cats, kefir and insulin :)


I have a patient who is a type 1 diabetic and that patient has a cat who is also type 1. Needless to say they are both on insulin. Now if you thought that is it hard to dose a human try dosing a cat or a dog with insulin. It’s so hard and the margin for error is SO big.

These 2 patients have cut their insulin dose by half and halved their hypos by having kefir three times a day.

Then I came across an article in the Journal of Diabetes (South africa) about the gut bugs and diabetes. It mentions how important gut bugs are in terms of metabolic functioning – normal functioning as well as disease. It concludes by saying that “gut microbiota represents an exciting field with novel therapeutic potential”.

I say you have nothing to lose. Give it a try.kefir.jpg

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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.

Your sugars and your holidays


holidaysHow does one approach glucose control during the holidays?

Holidays are generally a time where we relax and let our hair down a bit more than at other times. Included in this are dietary relaxations like consuming more refined sugar than normal as well as alcohol in slightly greater amounts and strengths, depending on your preference and age. Also for some it may include more than normal outdoor activity and exercise.

All of these have repercussions for glucose levels.

So, obviously each person has an entirely unique set of circumstances as well as metabolism but roughly speaking here are some basic holiday guidelines.

If you are a type 1 and injecting insulins and testing :

1.) Consider testing your sugar more often if you are exercising more and possibly feeling hypo.

2.) Consider adjusting your insulin dose at meals with more carbs and simple carbs than you are used to (perhaps go through your dietician and doctor re this).

3.) Understand that if you drink a lot and sleep in the next morning this is dangerous and alcohol will at first raise your sugars and then after about 10-12 hours drop your sugars, so watch out for a “missed” hypo and make sure you tag a mate to check on you at least.

4.) If you are snacking and the carb count is more than 10-15 g of carbs you may need to bolus for this kind of snack in order to keep your sugars stable but it really depends on a number of factors other than just this.

5.) the weather plays a bigger role than you think, some people will go either high or low depending on very hot or very cold conditions so try to understand your body and rather pre-empt the rise or fall or at least be vigilant and test more often.

6.) consider wearing a type of medic alert bracelet in case of unconsciousness – it may save your life.

For type 2 diabetics on oral agents only or have additional insulin injections

1.) Most importantly holidays can mean massive weight gain, and this is very bad and hard to get rid of in the long run. Pre-empt this by seeing a dietician who could give you guidelines on how to cheat without too much weight gain. Also see it as a challenge to maintain your weight rather than a punishment and reward yourself with things other than the wrong food on the holidays. Set incentives and be kind to yourself with spoilers that blow your hair back and don’t put weight on.

2.) Make sure that you have enough medication and testing strips for the time that you are away as well as some back-up diabetes supplies.

3.) Know what carbs are and how they affect your sugars and plan accordingly.

4.) Know the carb content of the alcohol you are drinking and factor it into the daily calculation of insulin (if injecting) as well as the total effect of the alcohol and your activities (physical) or not.

5.) Try to see the holiday as an opportunity for increased movement -exercise in many different forms and find one that works for you, start the routine on holiday.

6.) Experiment with different healthy food and take mental note of how you feel and what it does to your sugars.

We all need a break, a re-set and a proper unwind. So most of all give yourself the mental  “space” and time you need to do just this. Planning for your holiday around your diabetes will aid in enjoying this time more and taking stress out of certain situations.

There are always healthcare professionals on duty, know the nearest casualty location and telephone numbers as well as ambulance and other emergency numbers before leaving home.

Mental health, impossible tasks and other musings


Why is it that when we are ill either physically or mentally and it comes to support for the person it is hard to find. In fact a very common reaction is for people by and large is to withdraw. Leaving an already vulnerable person more vulnerable and more likely to become sicker. Why do we do this as a society?

It seems we are quite cruel.

Much like being a type 1 diabetic. Once diagnosed your life depends on testing sugars and injecting insulin. People are wary, they hide, they run they disappear from your life entirely. Schools refuse to admit children with it. Kids don’t want to have them at their party. And why ?

Yes it’s different. Yes it’s a disease that requires things that some humans are uncomfortable with. But, can you not dig a little deep and conquer that fear, reach out and be a friendly face, hand , eye?

We are actually all connected and our reactions have repercussions. We have choices to make daily.

I challenge you today to not run and hide. To be present, even when it is uncomfortable. To be present. Really there. In the flesh and the mind. Present. That’s all. To be there.

Pushing past impossible is something that is actually possible.

And you know that we all – collectively benefit from that.

And the world at large can be a better place.

 

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 😉