Category Archives: how do insulins work

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

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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.

Diabetes – the biggest killer of women under the age of 60


Shock horror indeed!

The medical people have long been warning of this tsunami and everyone has just yawned and gone – not me. and carried on munching on that way too big carb full meal.

Not me. Not today.

Only to find out 10 years down the drag that actually yes me too.

Diabetes is a tsunami and it IS happening and best we sit up and take notice. There is so!! much that can be done and also there is much to be said about early diagnosis and best management.

Which brings me to medical aids. In their best interest for good management to happen and yet so slow on the uptake. Folk, medical aids need the ground swell pressure of the people to force them to do what is actually best for them – ironically.

And yes CGMS, continuous monitoring and good insulins and newer treatments and earlier interventions actually SAVE money in the long term BIG time and death and morbidity (that’s when you suffer but don’t actually die).

So, folk, women and men folk. Really so much to do, so little time. Go out and have a blood test, if is it negative don’t just accept that as up to 30% of people will have a “normal” fasting sugar but an abnormal post meal sugar – and you guessed it – you could STILL have diabetes.

Stop reading and get a proper test.

Diabetes non-month -we can still make folk aware ;)


Hello. Today is the first of December. November (diabetes month) officially over. “Ca dover”.

Diabetes is a growing problem. Most people do NOT choose it. More so type 1 – spontaneous destruction of all beta cells of the pancreas making you insulin dependent (like alcohol dependant only a little different (this is a little joke so don’t get too upset about this statement if you are prone to getting upset).

Type 2  can be lifestyle induced but that does not mean you should judge the person. Or that anyone has given you the power to do that. Or the right.

Insulin only comes in the injectable form. Yes that means you have to inject anywhere from one to 6 x a day. Then you also have to test your sugar – another “prick” required.

So don’t be a prick to diabetics as having dealt with so many already they can’t tolerate you too. And for that matter the moms and dads of diabetic children also fall into the category of not needing any more pricks in their lives – they are hard enough. Grow some empathy. Please? Even if just for the festive season.

So, in december, the festive season. Not everyone in this life is as blessed as you : health and wealth and mental health wise. If you only do this this festive season let it be that you are kind. To all around you. Truly kind not the falsely kind of kind.