It’s a brand new year and great excitement after a really good rest and break.
I started using ryzodeg as it hit the shelf (I had been anxiously awaiting its arrival for months). I have reviewed most of the patients started on it now and wow!! incredible results. Even more incredible when combined with a libra pro sensor!!
This is cost-effective, accurate and well tolerated treatment for type 1. Most patients have stopped having hypos and certainly all have stopped having bad hypos. All of the patients average sugars have dropped significantly and variability come back to a much more acceptable range. Patients are happier, have better quality of life and generally walk in with a smile on their dial.!! Yay!! Yay yay!!!
I could not ask for a better way to start the year 🙂
This is a video link of how the new long-acting insulin works: on youtube: Tresiba® (insulin degludec injection 200 Units/mL) Pharmacology
Ryzodeg (avail in SA) is part (1/3) short acting (novorapid) and part long-acting (48hour half life) degludec as in the video.
Are you matching your carb intake to your insulin intake? What is your specific and individual insulin sensitivity and carb ratio – do you know?
If you are injecting insulin either long or short acting or both these “numbers” are important to know.
What complicates things further is that sometimes they are different for different times of the day as well as different states of health.
Injecting insulin is a very tricky business if you are aiming for “perfect” control – i.e. glucose between 5-9 mmol/l (this is my personal goal post). Overshooting and under dosing happens most days.
In order to try and get it right most of the time it helps a lot to KNOW your body and your numbers. So what is carb ratio ? This is the amount of insulin you specifically need to cover 15 g of carbs – that is roughly one slice of bread. Most patients are in the region of 1-2 u units per 15 g/one slice bread. Children/babies however are more usually 1 u for 30g or more and in terms of sensitivity 1 u dropping sugars by 10 mmol/l (vs adults usually 1 unit dropping sugars by 2-3 mmol/l).
This information/calculation needs to be worked out by yourself, your doctor as well as your dietician. It is really important to understand and apply this in order to get better control.
Then bear in mind that on sick days you usually need a bit more. When exercising hard a little less (sometimes a lot less). And so it goes : hot weather, cold weather, different foods, stress, etc all influence the sugars and how they react to insulin.
Don’t be caught high or low this festive season – stay jolly and even.
Ok so what is available currently in South Africa for continuos monitoring – and what is that any way? Continuous monitoring is the single most effective tool in controlling sugar in my practice.
Instead of 4-6 finger pricks a day to see where you are at for a sugar level continuous monitoring is essentially a device that resides subcutaneously (under the skin) for a period of time and “reads” the sugar on a 5 min or 15 min interval and gives a reading on a graph format of the sugars.
It is a life changing and diabetes management miracle. I find that with just this one intervention we can stabilise the sugars.
So in SA we have from cost-effective to expensive : libre-pro, guardian-connect, dexcom G5 and soon to be G6 as well as medtronic’s continuous monitoring that accompanies their pump.
For those needing a cost effective yet accurate solution the libra-pro is the way to go. Please do be aware that the device in SA is DIFFERENT to the one overseas.
Guardian connect is about to launch, it is a great CGMS that is both accurate and affordable. This device has a “monitor” on which the graph of the glucose readings appears.
Dexcom is an expensive but amazing CGMS, the G5 now communicates primarily with an iPhone and soon to be android. This means carrying less devices around. It is supremely accurate and easy to use.
The CGMS that accompanies the medtronic pump is getting more accurate but only available with the pump.
Any queries will happily be answered : shoot your questions : firstname.lastname@example.org
I was privileged to attend the launch of the dexcom G5 which is a first and a world leader in terms of continuous monitoring. I so value companies that will only put out a product of excellence and quality. The MARD of the G5 is 9% what this means in layman terms is that it is the most accurate sensor on the market worldwide. MARD is a way to measure accuracy. For interest sake the MARD of the glucometers at large is around this mark and slightly lower. However some other continuous monitoring can go up to 15% or higher. The value of continuous monitoring is in its accuracy.
Why would you use a continuous monitor that is not as accurate as possible?
Most patients “react” to the number on the screen, however only the G5 has registration to “allow” patients to do this, without checking with a finger prick. In other words the number on the screen in context of the graph on the screen as well as the arrows going up down or staying constant allow you as a patient to “do” something before you are very low or very high – allow you so to speak to “stay in range”.
Prelimary studies show that the combination of either MDI (multiple daily injections) or CSI (continuous subcutaneous insulin infusion) with continuous monitoring (accurate) gets patients to a better A1c than without continuous monitoring. The point is that the number in context of your life and where you have come from and are headed to allow you to make decisions that previously were made in an almost russian roulette fashion.
Knowledge is power and technology can change lives. Living with type 1 diabetes is no joke and having your organs damaged by high sugars is a real danger. This tool not only gives you your life back but prevents end organ damage in a big way.
Thanks Dexcom for your dedication to excellence, to accuracy and to most of all to changing the lives of our diabetic community at large.
Knowing your number in context is not only educational but life and quality of life saving.
What does the A1 c mean?
Definition : 3 month average of sugar, i.e. it totals up all the blood sugars over a 3 month period and gives and average value. Little more complex than that it is a blood test that piggy back off the “metabolism” so to speak of the red blood cell.
The more well controlled the A1c the more the post prandial is contributing. The higher the A1c in other words more out of control the more the fasting is contributing.
There is a big difference between fasting sugars and post-prandial (after a meal) sugars and how they affect things. Also think about this if you consistently go very low and very high you may well have a beautiful A1c and think you are great when actually you are not!
Glycemic variability is a BIG problem.
I would far rather my patients ran an a1c slightly higher with less variability.
So is it worth doing? I honestly feel that the A1c gives us some information, however for myself I feel the download is far more useful in type 1 diabetics and that I am able to tweak therapy far more accurately with a download or a CGMS.
For type 2’s it is a good test to follow, i.e. a trend. Is it going up or is it coming down or is it stable so to speak.
What is A1c – it’s an average and it has its uses but context is everything and for type 1’s glycemic variability is the difference between health and illness.
I just can not put into real words how passionate I am about insulin pump therapy. I mean why not? Don’t you (as a physician) always want what is closest to human physiology (when that is what is gone)? Don’t you always want the absolute best available treatment on the market for someone whose organ has stopped functioning? Don’t we do heart and kidney transplants for those whose hearts and kidneys have failed??
Do we really think that 4 injections a day can even vaguely “mimic” a very very complex physiology? Really???
Shoo ! If we do then I think we have put our brains to sleep.
My little often says to me – “how did God make the flowers mommy? “, ” how did God make the cars?” ” How did God make humans?” How did God make trees? ” I think you can see where this is going, it sure is complex.
And then we have the audacity to say that 4 injections can match eating, exercising, being, sleeping, illness, need I go on??
I am sorry but as a thinking human I beg to differ.
It is complex.
For this simple reason I shall continue to be almost militaristic in pursuit of the best case scenario for my patients and in type 1 diabetes pumps are it for the moment, (Until we get the artificial pancreas or the implantable one).
Simple really. Life is really too short to be on old-fashioned treatment when you have a disease like diabetes. Quality of life is king 🙂 Add to this a genteel tester – painless pricking and you are on a very good wicket.
As I wipe the sleep dust from my eyes it is the end of the year. It feels like yesterday that I did the very same thing and it was January 2015. I am feeling that it is the end of the year in terms of that horrid fatigue and not much inspiration left kind of feeling. It has been a busy crazy jam packed year.
I have learnt a lot! I have grown and grown up. The year kicked off with some time out and joyous time spent with friends and family and very soon got into the hum drum of practice. Early in Feb (just after the horrid Charlie de Suis story) I have the great privilege of going to Paris for ATTD. It was especially special in that I got to spend time with my sister who lives in England. The people I met and interacted with were a wonderful blessing to me and it was certainly a highlight of my career thus far. I love diabetes for the people it has introduced me to as well as the amazing opportunities it has afforded me.
Life has happened as my husband would put it with the usual trials and tribulations including a broken arm and trip to the hospital with one of my littlies.
I had the extraordinary pleasure of a diabetic update in Capetown and was hugely treated to table mountain views, divine food and wine and company in August this year.
November opened itself with a super special opportunity to do cataract surgery at Zithulele – a great great joy. My littlies accompanied me and I can honestly say loved every second of the “missionary” life.
And here we are one week away from Christmas, how did we get here?
Blessed and precious times to all and may South africa go from strength to strength in 2016.