Category Archives: diabetes

Baricitinib :), yay

Hot off the press, studies from Australia have great great hope for BAricitinib. THis is a “medication” (anti-autoimmuneantibody) “drug” that aims to reverse early onset type 1 diabetes as well as I presume LADA.

What happens with type 1 diabetes is the body attacks itself and destroys the pancreas.

What happens with baricitinib is it stops that process.

This is really really great great news for anyone that is early in the process. And, we hope will point us in the right direction for somehow “reversing” damage in some cases. What is sad though is that fully blown type 1 is still likely a long way off being “cured” sadly.

But, this is hope and we are progressing faster than ever before.


GLP-1 once weekly – Trulicity – truely a great piece of good news #trulicity

We now, even in south africa, have a once weekly GLP-1 injectable. That is to say you can inject once a week and get both good glucose control, positive effects on kidneys and heart as well as less risk of hypos. To clarify it is NOT insulin, it is an GLP-1 incretin mimetic.

It is still really quite cost limited and medical aids are not yet really coming to the party broadly.

However perhaps in the future it may be more affordable and also it may be more accessible re the med aids. This would be good news.

What is a GLP-1? An incretin mimetic. That is to say it is a drug that helps your bodies own physiology in terms of countering both high sugars as well as the poor glucagon response in diabetics.

Which ever way you too look at this – this is a great great bit of news for diabetics especially type 2 diabetics that are deteriorating- worsening sugars with poor effects on organs like kidneys and heart. If you have had type 2 diabetes for a long time and the high sugars have taken a toll on your organs – diabetes is a mulit-systemic train smash, then there is really really great benefit to be gotten. From my point of view why not use it early on and stay ahead of the train smash??? -just my 5 c worth 🙂

Diabetes is a massive problem. A massive problem. Arguably one of our biggest public health dilemmas. So yes a great piece of good news.


Just a caveat : type 2 diabetes (broadly) is very very preventable and turn-aroundable if caught early and major lifestyle changes implemented, we specialise in this :


We heal wounds …bioflex laser

No need for scalpels, amputations. Key is control sugar, bioflex laser, biweekly dressing with the correct dressing 🙂

0832898351 : book for Michelle bioflex laser 🙂

Glucagon – can save your life if you have type1 diabetes :)

What is a hormone? Essentially a messenger/transmitter. We have many of them. In terms of the glucose metabolism we have insulin and glucagon which do opposite type of functions in the body. Insulin takes glucose into the cell to be used for aerobic cell respiration and glucagon makes glucose available to the body for use in emergency type settings.

This is a simplified version of what they do at cellular level but nonetheless a start to understanding.

If you are a type 1 diabetic, you do not have enough insulin and many times your body seems confused on a glucagon level too.

If you are unconscious from a hypo- a very low sugar (usually a value below 2 mmol/l) and a care-giver or companion injects glucagon it may save your life. At the correct injunction of time glucagon SC/IMI – subcutaneously or Intra-muscularly is life saving.

It is for this reason that a type 1 patient or a patient injecting insulin should have a glucagon pen on their person at all times. In an ideal world.

So, if you fit into this category of patient and you do not have a glucagon pen, make a telephonic, virtual or in the flesh visit to your GP/diabetologist or endocrinologist to get a script so that you have this little gem with you – in the fridge or a cooler preferably.

#glucagonexplained #lifesaving #diabetesglucagon

2020 – a new year for diabetes -perhaps a cure???

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.

Libre flash monitoring – “freeing” you up to live life (technology permitting )

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

November is BLUE #diabetesawareness

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 rangenovemberblue.jpeg

NHI and what is to come…because it IS coming!

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.

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 🙂

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.


The battles we face daily …diabetes and the funders :) yeeha!

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.


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