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.
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.
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 😉
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 😉
Dr Lee is moving to The Ellenbird in hilton – 2 Quarry road, New phone number : 0832898351, we are relinquishing telkom. We have to pay them 30k to go away. And trust me this is the “cheap” option. IN a nutshell, don’t sign a contract with telkom.
Fran Steart, Michele Albets, Fiona McRimmon and Elze Scheepers will join us at the Ellen Bird. Fran and Michele are dieticians specialising in diabetes and eating disorders. Fiona is a life coach and Elze is a laser and PRP practitioner.
Pop in – coffee at the coffee shop, gifts and the gift shop and medical help including speech therapy etc all available.
AN idea of the feeling you get at our new practice :
November is diabetes month – awareness around what it is and treatment etc. There is actually quite a lot of strange information that circulates, “fake-news” so to speak regarding diabetes at large.
So let’s dispel some myths.
1.) Diabetes is caused by poor diet : firstly type 1 has nothing to do with diet and is bad luck essentially. It seems to be an auto-immune disease and essentially destroys the b cells of the pancreas creating an absolute lack of insulin.
Type 2 diabetes is a lifestyle related as well as genetic disease and even more complex in nature.
Insulin resistance is a condition more and more prevalent due to lifestyle as well as stress – a big factor. More about this another time.
2.) IF you eat properly you will get better : well firstly type 1 diabetes, without insulin – you die, children in the era before 1921 died. Only since 1921 and Banting and Best’s discovery do type 1 ‘s survive with normal life expectancies.
Concerning type 2 diet is critical and important (as it is with type 1) carbs are key and obviously healthy eating and exercising are key but eating 100% correctly will unfortunately not bring back b cells that have died.
3.) Type 1 diabetics should never eat carbs : whilst one should be mindful of the type and quantity of carb and dose the insulin accordingly it is by no means advised that type 1’s exclude all carbs. This is a tricky one and best discussed in consultation with a dietician.