Category Archives: diabetes

New insulins


Is it not a joy and a delight to be able to know that these days we can prescribe an insulin that is far more predictable and sticks to the rules than ever before.

If you are not a type 1 diabetic or parent of one you will never understand how easy it is to either over or under dose on this medication. Add to the fact that sometimes 10 u behaves a certain way and other days it behaves in another way.

So to have both Toujeo and Tresiba – true long acting analogues with SMOOTH delivery available in SA at a price that is competitive fills my whole being with delight. I can prescribe knowing that what I am hoping the insulin to do will ACTUALLY happen 🙂

By the way this lovely awesome cellist is also a type1 – no-one can deny his talent and poise. Just saying ! Type 1’s ROCK!!!!

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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

Children with type2 diabetes


In the last month I have diagnosed 2 children with type 2 diabetes. This is a first for me and greatly concerning. The prediction was there but I guess I hoped I would never see it.

What does this mean?

Type 2 diabetes is where you “run out” of b cells – the ones that make insulin and run high sugars due to a bad match between carbs (too many) and insulin (too little).

This was previously only seen in adults really towards the age of 40. To see this in children is a wake-up call.

We have an epidemic of logarithmic proportions and it needs to be tackled in a multifaceted way. By governments – providing funding and facilities as well as knowledge sharing. By health practitioners – early diagnosis and implementation of turning the tide for both individuals and population groups. By society – recognition of poor eating and not enough exercise – ditch the device across the board. Go outside more often/daily for physical activity. By you and by you, yes you.

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 death rate a shocker


Following on from yesterday, there is so much we can do.

One of those things is : better insulins.

Arriving on the scene shortly in SA and already there all you first world folk, is degludec. Why is this an extraordinary insulin.

Well long have we hoped for these properties : less hypos, more even delivery, longer acting (thus forgiving if a dose is skipped), safe in the context of double dosing !!!

Yes yes and yes.

So why the tardiness in terms of medical aid re-imbursement?

Good question as I tell my 4 year old when she asks a good question.

Degludec in SA marketed as Tresiba – a wonderful new arrival on our market, folk I need the groundswell to convince the funders that this will SAVE them money and YOU your life and quality thereof. I can not do it by mine self 😉

 

Diabetes – the biggest killer of women under the age of 60


Shock horror indeed!

The medical people have long been warning of this tsunami and everyone has just yawned and gone – not me. and carried on munching on that way too big carb full meal.

Not me. Not today.

Only to find out 10 years down the drag that actually yes me too.

Diabetes is a tsunami and it IS happening and best we sit up and take notice. There is so!! much that can be done and also there is much to be said about early diagnosis and best management.

Which brings me to medical aids. In their best interest for good management to happen and yet so slow on the uptake. Folk, medical aids need the ground swell pressure of the people to force them to do what is actually best for them – ironically.

And yes CGMS, continuous monitoring and good insulins and newer treatments and earlier interventions actually SAVE money in the long term BIG time and death and morbidity (that’s when you suffer but don’t actually die).

So, folk, women and men folk. Really so much to do, so little time. Go out and have a blood test, if is it negative don’t just accept that as up to 30% of people will have a “normal” fasting sugar but an abnormal post meal sugar – and you guessed it – you could STILL have diabetes.

Stop reading and get a proper test.

T-slim in south africa ???


I came across a product called T slim – insulin pump that “talks” to dexcom …now wouldn’t it be nice to have this product here in RSA.

Insulin pumps deliver a set rate (hourly) subcutaneously as well as a “bolus” for meals without having to “inject”/jauva. It’s also so much more “physiological” and results in less low sugars less very high sugars, less variability, better A1c, better quality of life.

Just saying 😉