Category Archives: how do insulins work

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.

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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.

Myths around diabetes


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.

 

Libre flash monitoring


The patient driven and marketed libre has arrived in south africa.

R990 for a reader once off which is a meter for both glucose and ketones.

R990 for a sensor that lasts 2 weeks and so i.e. cost per month if worn every day is R990 x2

You scan your button and get a reading every 5 minutes. The device has functions like worked out a1c (3 month average) as well as about 100 more. See the website.

https://www.freestylelibre.co.uk/libre

You need to fill in a form, pay the amount and it gets couriered to you.

Contact me for forms

26 hilton avenue 033 343 1826

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