Category Archives: ease of use

670G medtronic – a lesson for all diabetic practioners in a very good way :)


The new 670G medtronic pump is truely a wonderful amazing device.

What suprised me more than anything else is what an absolute pearl of a lesson it is in terms of how insulins work and the daily awful grind and variability of being a type 1.

Honestly congratulations to this development team, you have come up with a genius product. Genius!

It expertly and simply solves for so many of the dilemmas type 1’s face daily. And in a safe and perfect way.

Truely a product that answers so many of the questions that we have up to now not solved.

Thank you thank you thank you.

THe MARD was my biggest happiness on the sensor – 8.7- wow-Yay!

So many reasons that in my opinion as many type1 patients should get onto this technology in terms of cost saving in the long run for med aid schemes and longevity with quality for patients both old and young.

I nominate it for product of the year.

Problems it solves for :

1.) daily variability (automatic adjustments according to blood glucose)

2.) hypoglycemia – on a downward trend of sugar readings it keeps decreasing insulin as to prevent a low and then eventually suspending insulin so as to prevent the low from happnening, as soon as the sugar trends up it resumes insulin and keeps adjusting

3.) high sugars – on an upward trend it increases insulin (up to a preset SAFE) level with alarms and alerts so as to prevent the high sugar

4.) variability immediately improves as does TIME IN RANGE

5.) multiple layered safety catches in case of problems

 

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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 πŸ™‚

Accuracy data from ADA 2019 hot off the press praising CGMs’s at large πŸ™‚

The data backs up the average clinician’s gut feel that seeing is the answer.

dexcom

“Soul”it ude …https://www.solitude.org.za


This last weekend I had the joy and priveledge of going to a creative retreat at solitude in the dargle near Howick. What a soul re-juvenation πŸ™‚

One’s own journey is a precious thing, one’s own creative journey in my opinion even more precious, like precious on steroids πŸ™‚

What I discovered on my very excited to share return was that one’s personal journey is not as relevatory to others as it was to one’s self.

Lesson learnt πŸ™‚

For me it was cathartic, connecting to myself, releasing in a high release way as well as calming, coo-ing almost in the best way possible, rocking in a hammock kind of gentleness, presence and preciousness.

We did all sorts of “arty” things not for creation sake but more for the journey sake and connecting to one’s inner child. The wisdom that was downloaded to each of us was profound, gentle and powerful. Sometimes the simple in life is the key. And happiness is an elusive gift just within our reach.

solitude

 

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 πŸ™‚

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!!!! Honestly sometimes diabetes type 1 can actually be the spur that spurs you on. This phenomenal talent (recognised by Megan Markle -now the princess) rocks my world!!

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

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 πŸ˜‰