I really like the sound of 2020 and we are at the cusp of really exciting things especially for type 1 diabetes and closed loop technology. Eventually.
Yes it has taken quite long to get here partly because it is a really big and honourus challenge going closed loop. But seeing as 2020 has 2 loops that’s double the looping chance of looping becoming more sustainable.
That thought also makes me super happy. Mainly so that patients who previously had to prick fingers 6-10 x a day and inject 4-6 times a day can now really focus on what the rest of us focus on – living life unencumbered.
So let it be the year of accurate CGMS and flawless looping.
What is flash monitoring ? Well it’s a button you wear on your upper arm (under normal sleeves) and use your phone (many compatible android and iphones) to swipe across the button and voila- a sugar reading. It then records on a graph on your phone.
We have come a long way since 1922 when without insulin type 1 patients essentially died. Crass but the truth sadly. And here we are in 2019 and we do not even have to rely on finger pricks. Yay! Progress and science and so much of happiness all around.
Flash monitoring does have a lag, and that is quite individual. Safe to say the “real time” sugar is ahead ie the flash is behind real time but the trend remains the same – I hope that makes sense. The beauty is being able to see where you have come from and are headed towards. So, if you are heading down you can snack or watch and wait depending on the circumstances : ie food, exercise, illness and same for heading up. And you can flash in 5 minutes to see.
So I very much advise against knee-jerk reaction to the blood sugar on flash monitoring but rather watching and waiting and “learning” from experiences of exercise and cake eating etc. As for adjustments in insulin doses and timing of insulin and what does what. For example stress affects certain people in one way and others in another and the beauty of the flash is that you get to learn what your body does and adjust to that.
In the UK this device is now relatively largely widespread and with great great results of way better control, time in range and very importantly better quality of life for type 1 patients. It is being funded by the NHS at large thanks to the Diabetes warrior doctors who have literally “gone to war” to get this funded.
In south africa we battle “the funders” to do what actually benefits them downstream but happy to say that I do feel that progress is being made in this arena too. Our “war” also slowly slowly being won for the betterment of both funder and patients.
Flash monitoring – glucose readings regularly not requiring finger sticks/pricks – accurate, timeous and life changing – allowing patients to live full lives rather than survive.
#abbottlibreflash a multitasking device that adds value at every level
Sugars are sticky
Sugars are icky when low or high
november is blue but we are not blue
because there is a solution for many of the problems
sugars …SOLVE them make them stay tight in range
The NHI will certainly be coming whether or not it is yet another train smash as we have experienced with every state run institution or not. Will it be a better south africa ? That remains to be seen.
What is unequivocal is that it is coming and it WILL be implemented. Does that make me want to run away. Yes, yes and yes. Am I going to ? No, no and no. I have personal reasons for staying but I do believe that we also need better health care for the majority and NHI may well aid in a small way to some kind of “fairness” when in the past there has been gaping holes of “unfairness”.
I would like to start a new movement of positivity and seeing the opportunities in south africa.
Face it, there is no perfect place in the world. People are the problem. And they are everywhere. However there are also unique wonderful people who are everywhere.
Also in this place we call home with wide aching gaps there are opportunities for both financial prosperity as well as kindness prosperity – which is all we go to the grave with.
So will NHI be a challenge. Yes it will. Does it mean the end of health care for the wealthy or relatively wealthy (bear in mind there are folk who survive out here each month on R1000 a month). No, I hope not. Is there opportunity to assess this situation and find a new way regarding the epic challenges that face us like diabetes, hypertension and the complications thereof ? Yes. I believe necessity is the mother of invention and as health care practioners it is yet another to re-evaluate and use our God given brains to come up with a palatable solution.
Kindness is one of the few things we take with us. And death is a certain guarantee.
So let’s start there and move outward as the ripples on the sea when a stone skips over the surface. South african’s are adaptable at large and we are able to see and do the positive, come with me.
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 🙂
Accuracy data from ADA 2019 hot off the press praising CGMs’s at large 🙂
The data backs up the average clinician’s gut feel that seeing is the answer.
So we all know we are currently experiencing an epidemic that is about to “tidal wave” africa in terms of diabetes. And we know that world wide despite logarythmic increases over at least the last 10 years there is no stopping the tide. We love food and no exercise too much.
So we also know that the more this happens the less health wealth and happiness for society and the more sick folk get the more it costs the medical aids – so then with tears in my eyes and a brain between my ears why is it that we have a daily fight with funders to do what is right for patients and saves them hugely downstream costs ?????
To me it’s a no-brainer. I dont know.
I have been accused of being a dilly woman and yes I am a woman doctor – that does not bode well to start in the patriachy. And yes my dress sense is a bit quirky. And yes my mouth she speaks way too easily for the patriachy once again. BUT, really all I want is the best for my patients short term, long term, longevity with quality wise which adds up to a societal knock on downstream. So whilst quirky all I am actually fighting for is the greater good ????
The funders and generally brushed with a giant sweep of a brush at large seem to slowly be waking up to the multiple facts staring them down like a gun barrel as this is a very large challenge to them to. How does one solve these dilemmas as still stay top 5 profitable in south africa ??;) 😉 😉 ah em …
Just saying, there are better ways to tackle this tsunami…
I met an amazing academic yet pracitical medical advisor the other day, and my suggestion is that other medical aids follow suite – yes have your acturial scientists who make you the top JSE company when a med aid is supposed to be a med aid not a top achiever, but combine it with some sense so that you can stay there cos right now your tactic aint going to work for you on the long game.
When you overload a cart the horses take strain. Much the same with the human body. Each cell requires a few things : amino acids, glucose molecules, and a whole host of other complicated yet simple molecules.
Each cell in the body essentially respirates, breathes in so to speak glucose and oxygen and breathes out ATP and CO2 in order to function, much like the lungs and the opposite of what trees do.
Simple yet complex.
If you overload the system with glucose molecules they will simply be stored as fat for a rainy day and also overwhelm and flood the system with stickiness.
That is what diabetes is in the type 2 sense of the word, flooding the system and causing a sticky mess.
Type 1 however is an initial lack of the key that takes the glucose into the cell and forcing the cell to respirate anaerobically which leads to death without the rescue molecule insulin.
Starving in a sea of plenty is type 1.
Drowning in a sticky mess is type 2.
The ebb and flow of the cell works in harmony if the correct diet is maintained and goes horribly out of whack with an overload or under-dose of glucose molecule flow to the cell.