Category Archives: how do insulins work

“hybrid” Closing the loop …how divine :)


If you have an intact pancreas you already have a closed loop. That is to say you eat food and your pancreas automatically releases the perfect amount of insulin to “match” the carbohydrate you have just eaten so that the glucose molecule can travel easily into the cell, all cells require glucose for metabolism.

However if you are reading this and you are a type 1 diabetic you do not have B cells that are functioning and this is great news for you – a closed loop. It is in essence : an artificial intelligent pancreas.

It is here and for that we rejoice. It is not the full monty but at this stage each step is a win and this is a big big win. The algorithms get more and more accurate and detailed as time and data increase.

From march 2019 the alogrythms to close the loop will be available to all and anyone in the world.

For more info : 0832898351 Romae for a booking

It’s here and that is awesome. It’s hybrid and it’s not at its full potential as yet however it it more than we have had up to now and for that we rejoice.

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The Diabetic Educator …for a friday read :):)


What does an educator do? Diabetes is a multisystem disease affecting most organs in the body. Managing diabetes holistically in a team means each member focuses on their area of expertise.

For the educator this is explaining how insulins work, how the different oral meds work, what sugars should and could be at different times of the day, dangers of hypos and highs, how to inject, how to test etc in the newly diagnosed.

One very important aspect is setting goals around targets like A1c as well as variability, post meal values etc as well as any other goals regarding diabetes like exercise, staving off burn out and depression and a whole host of possible goals.

The educator in many respects is a co-ordinator or conductor of the processes and aids very much with direction and the trajectory of the diabetic path.

This critical role actually can make the difference in getting to target as well as staying at target which translates to less health expenditure downstream as well as healthier functioning patients with quality of life.

Educators are core to diabetes management top of the range.

Diabetes type 1 is no one’s fault, don’t be ignorant


Daily I hear very interesting “lies” about diabetes. I heard a classic last week. Someone’s mom who had had a stroke was told her mom has the kind of diabetes that CAN NOT be controlled. God’s truth!!!

Another common lie is that this is a disease “you do to yourself” i.e. you behave/eat in a certain way and your “punishment” is diabetes. Well I am afraid that is NOT TRUE.

Especially in type 1 diabetes. This scourge has been with us for a long time. However up until the 1920’s there was no “cure” or “treatment” so to speak i.e. you generally died from it. And the consequence being the “genes” or genetic inheritance died with that. Since the 1920 s we have had insulin and now one can live very “normally” yes ~I said normally with type 1 diabetes. Yes it involves checking sugars and injecting insulin but other than that you can eat mostly what you would like to and get on with life as you would like to.

So to the diabetes that can not be cured I say : Lord have mercy. There is so much lack of knowledge especially in public sector about diabetes. That added to the corruption. Ie meters, strips, insulin being sold on the black market meant for the poorest of the poor free as part of a the dismal service being provided is a scourge.

Any form of diabetes can be treated and controlled. Is it easy ? No but is it do-able even for the poorest of the poor. YES!!!

There is so much corruption in this country and it always affects the poor more. Let’s at grass roots level tackle this with the power of words, peace, and the truth. Join us to contribute to both awareness and funds for shap shap doing this very task daily excellently : roarin 20s party 27 oct 2018 …see Facebook drleethegp and shap shap

Type 1 managed at home from the start


Outside of a patient arriving in a DKA (diabetic ketoacidosis) one can actually manage them at home from the offset. Yes this may well be a bit controversial, however, in my opinion subjecting a whole family to hospital admission of 10 days at the start of such a huge ordeal is controversial too.

There are many arguments for both sets of management.

My personal feeling is that a hospital is a very traumatic place to be. To subject an entire family to 10 days in an institution with bad food and light far away from home is akin to a concentration camp.

Trauma is also about how it is managed and the calmer, better slept “managed” parents and children do better I believe.

Type 1 diabetes is an absolute lack of insulin. There need to be multiple mind shifts that occur and this requires calmness and astuteness. It is very easy to manage in this day and age what with excellent new insulins as well as cheaper CGM availability.

We currently have an epidemic of type 1 diagnoses. If I learnt anything from Larry Distiller (guru and endocrinologist) it was step back, take a deep breath and apply the knowledge you have calmly. This is the dictum I follow with great success.

type1diagram

Diabetes college …


Should we open up a college to teach folk about diabetes. The diabetes man. Yeah.

A touch of sugar, my doctor says I have a little bit of sugar.

So much of confusion out there. Yes diabetes is here in a big way. Yes it’s logarithmically growing. Yes is perfectly preventable (type2). Yes there are massively big differences between being insulin dependant (type 1) and insulin deficient (varying degrees) type 2.

So yes maybe we need diabetes night school or even day school to tutor folk.

Yes you can not stuff endless amounts of carbs in your mouth. Yes that includes beer. It’s a carb. Yes it is.

Whiskey and water is better but in the quantity of one drink.

Yes fruit is full of carbs – sugar. Yes it is. No it is not great for diabetics. Does that mean you can’t eat fruit at all? No but the quantity and the type count.

Can a dietician help you ? Yes very much so.

Will exercise help ? Indeed, at least one hour though and a few times a week.

Do you have to run ? No, walking is actually better exercise.

Bottom line when your sugar goes above 10 in the blood stream things stick together. A Sticky mess.

Toujeo or not to jeo?


Yes folks we have a new insulin and the best best news is that it is priced affordable – R590 SEP for a long acting insulin that almost guarantees NO hypos!!!

What great great news !!!

I can barely contain my excitement as I scribble out scripts for gazillions of patients for whom this means a huge leap up in quality of life living with type 1 diabetes or diabetes that requires insulin injection.

What is it? Toujeo – or insulin glargine U300 – lots to figure out. In a nutshell it is the same as lantus/optisulin BUT squashed smaller. What does that mean?

Science is “fucking” wonderful – sorry I had to – I LOVE !!! science. When you make a molecule smaller you decrease the surface area and thus slow the absorption rate right down. So now you have a more concentrated molecule (U300 vs U100) that is “dissolving” or releasing much more slowly and predictably and yes you guessed it all you insulin boffins out there – no stacking of insulin, which means no HYPOS !!

Simple yet brilliant, don’t you think – or am I just a proper nerd.

Once daily dosing – truly once daily.

No hypos, predictable.

Need I say more

Toujeo or not to je o ??

😉

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.