Category Archives: insulin action

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 ??

😉

Pump for me or not for me?


Report back : We had a marvellous discussion about pumps on wednesday evening. Highly enjoyable and informative, even our pump patient learnt something.

JOIn us today : On wednesday night 530 pm in Hilton Pietermaritzburg we will be holding an informal hour discussion about pumps -insulin pump therapy. What is pump therapy ? Who “qualifies”? What is the benefit. Is it for everyone who injects insulin?

Feel free to join us for free for an hour to explore the “pump market” in south africa and get first hand feedback from “pump” patients 😉

Diabetes type 1 on the rise?


Is type 1 on the rise or is it just that we are better at diagnosing it?

Type 1 diabetes is where your pancreas or B cells are not able to produce any insulin and thus your cells are not able to get any glucose into them and literally “starve” and are forced to metabolise other substrates in order to attempt survival. This is what causes the massive weight loss associated with initial diagnosis.

The anniversary for the first successful insulin being dosed was yesterday.

1921 – Banting and Best (accredited -though there were more people involved).Ninety six years ago. So before that if you had type 1 diabetes you would not really survive.

Now however type 1 ‘s sometimes outlive non-diabetic patients.

We have come a long way.

Is type 1 hereditary ? In part so that is one reason why we do have an increase in type 1 diabetics. It is not the whole story.

However type 2 diabetes has risen out of proportion to any other chronic disease on the planet. To say it is a tsunami logarithmic disaster is to be polite about it.

Type 2 is preventable as well as treatable. And yet! we have this huge huge burden on our health economics worldwide. Does not make sense.

So a challenge for the new year – are you on a trajectory to developing type 2 ? You have the power to stop that. IF you are already type 2 there are so many things you can do to get better control as well as control  the progression and not go onto the inevitable : insulin.

For inspiration and ideas : follow Fran Steart on Facebook for wonderful recipes, get exercising (in any way that takes your fancy) and see a team of practitioners who can get you to target. 🙂

 

 

 

 

Success !


It’s a brand new year and great excitement after a really good rest and break.

I started using ryzodeg as it hit the shelf (I had been anxiously awaiting its arrival for months). I have reviewed most of the patients started on it now and wow!! incredible results. Even more incredible when combined with a libra pro sensor!!

This is cost-effective, accurate and well tolerated treatment for type 1. Most patients have stopped having hypos and certainly all have stopped having bad hypos. All of the patients average sugars have dropped significantly and variability come back to a much more acceptable range. Patients are happier, have better quality of life and generally walk in with a smile on their dial.!! Yay!! Yay yay!!!

I could not ask for a better way to start the year 🙂

This is a video link of how the new long-acting insulin works: on youtube: Tresiba® (insulin degludec injection 200 Units/mL) Pharmacology

Ryzodeg  (avail in SA) is part (1/3) short acting (novorapid) and part long-acting (48hour half life) degludec as in the video.

 

Carb : Insulin mismatch?


Are you matching your carb intake to your insulin intake? What is your specific and individual insulin sensitivity and carb ratio – do you know?

If you are injecting insulin either long or short acting or both these “numbers” are important to know.

What complicates things further is that sometimes they are different for different times of the day as well as different states of health.

Injecting insulin is a very tricky business if you are aiming for “perfect” control – i.e. glucose between 5-9 mmol/l (this is my personal goal post). Overshooting and under dosing happens most days.

In order to try and get it right most of the time it helps a lot to KNOW your body and your numbers. So what is carb ratio ? This is the amount of insulin you specifically need to cover 15 g of carbs – that is roughly one slice of bread. Most patients are in the region of 1-2 u units per 15 g/one slice bread. Children/babies however are more usually 1 u for 30g or more and in terms of sensitivity 1 u dropping sugars by 10 mmol/l (vs adults usually 1 unit dropping sugars by 2-3 mmol/l).

This information/calculation needs to be worked out by yourself, your doctor as well as your dietician. It is really important to understand and apply this in order to get better control.

Then bear in mind that on sick days you usually need a bit more. When exercising hard a little less (sometimes a lot less). And so it goes : hot weather, cold weather, different foods, stress, etc all influence the sugars and how they react to insulin.

Don’t be caught high or low this festive season – stay jolly and even.

The intricate mechanisms of a “normally” functioning body are totally taken for granted. When one “loses” your pancreas’s endocrine function one’s whole world is turned upside down and it’s very very hard to rectify to perfection.

 

 

 

 

Holistic chronic disease management


innatehilton

Chronic diseases are really common place in 2016. They respond much better to holistic treatment than to simply relying on your medicine to “treat” you.

We believe that a combination of exercise, mindfulness, whole body treatment will get you both longevity as well as quality of life.

Diabetes can cause amputations, need for dialysis, blindness as well as severe and debilitating nerve damage – pins and needles/nerve pain in the hands and feet.

If you visit “the team” regularly this will NOT happen to you.

Your medical aid pays for all of the members of the team – so no excuse.

Don’t do it for me or the next person – do it for YOU and your family.

Rizodeg about to “arise”


Yes yes yes ! I am hoping (praying ) that Rizodeg will be scriptable by monday – you heard me this coming monday!

The insulin we have been waiting for : no stacking (NO stacking) nil to no hypos, steady release, long half life, a short acting component for meals -breakfast and supper – you can either eat NO carbs for lunch or do an extra short acting dose.

Essentially a BD – twice daily dose with far far better CONTROL – i.e. staying in the happy zone of 5-9 constantly – what joy!!!!

WE have been waiting and waiting for a product like this and it is about to arrive and arise!

Diabetics on insulin up to now have swung from high to low and low to high and had very little control over this, so many factors and “not at all predicable” absorption.

This new insulin solves many of our issues and we can not wait!!

Sadly probably not re-imbursed by med aids – but which diabetic would not gladly rather have quality of life?

Rather save on some other things and make sure the diabetic in your life has quality and quantity of life 🙂ryzodegabsorption

Dreams become reality


Yesterday something that I have dreamed about came true. Integrative, holistic, healthy, delicious, diabetology in motion.

We had our very first collaborative cooking class with Tanya Nicolson (The cookhouse) and Fran Steart (dietician). Food is a part of daily life. For many diabetics it becomes a bone of contention for so many reasons. Controlling the glucose is key to a long healthy happy life and yet so much of what we eat does the opposite to the blood sugar. Does that mean diabetics have to eat awful, tasteless “diabetic” food? NO!! No no no.

Enter our team with a meal created and crafted especially for this first occasion (and more to follow), “tested” in situ by real diabetics who tested both sugars and the actual experience of the class.

We are so excited to offer this concept to not only diabetics (though this is our starting point) but also for weight loss, general fatigue as well as other applications going forward. Eating is also about socialising, experiencing different things, tastes and emotions.

Thanks so so much to Tanya for all your research and perfecting (and I mean perfecting) this divine meal that has allowed minds and taste buds to open. Thanks to Fran for succinctly detailing information about carbohydrates and improving the process of understanding on a daily basis that is able to transform glucose levels and lives.cookingclass

Diabetology in practice “treat” your pancreas today


You are invited to our very first unique demonstration/interactive cooking “master” class. It will be held on wednesday the 20 th of January 2016 at 12 pm – 230 pm.

“Class” includes interactive demo of exactly how to cook a delicious meal that you then can easily replicate at home (including very detailed recipes) as well as “tasters” from a known range of meals available and diabetic friendly. You then get to eat the heavenly spoils whilst our dietician goes through the basics of carbohydrate dos/don’ts whats and what not too”s” etc, the nitty gritty of carbs for type 2 diabetics. You will get to test your sugar before and after and “see” the effect on your blood sugar.

Just a note for couples, as this is a first we are allowing couples to “share” lunch and pay for one instead of 2. This policy may not be feasible to continue but please make use of it whilst we are offering it.

Booking is essential : 033 343 2243

The following week’s “class” will focus on type 1 diabetics, carb counting as well as working out the exactly correct “dose” of insulin for that meal.food2

How does insulin work?


There are quite a few different types of insulin on the market and a whole bunch of brand new ones arriving soon.

The basic broad classification is long vs short acting. As their name implies they are long or short acting. What does that mean? When you require insulin you have both basal needs as well as prandial (meal time) needs. Your basic and ongoing metabolism needs glucose to go into the cells (all the cells in the whole body) on a minute to minute basis and hence a basal requirement of both glucose and insulin. Insulin is the key that gets the glucose in. When you eat carbohydrates you then require insulin to get the glucose load out of the blood circulation and into the cells where it can be used as fuel.

The long acting insulins cover basal requirements and act for a long time – 6 – 24 hours and some new long actings with a duration of about 48 hours.

The short acting insulins act for a short period of time, starting within about half an hour of injecting and then lasting for around 4 hours. There are brand new ultra short acting ones that are soon to arrive.

Insulin is a dangerous substance and the most acute danger is hypoglycaemia. In other words you inject too much insulin and the sugar plummets very low. At different levels for different people but generally below 2.5 mol/l you not only feel awful but can become unconscious and potentially no longer require a bucket list.

For this reason it is imperative that if you are injecting insulin you understand how it works, when it starts working, how long it works for, the shape of the curve of the action and also imperative to know what your number is – your blood glucose. Before injecting insulin you should ideally do a glucose test and factor this number into the equation.

action of insulins

action of insulins

how do insulins work

how do insulins work

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