So common theme – child faints at school and the staff ask did you eat breakfast. Why?
Because hypoglycemia is common. Common things happen commonly. Kids especially have brains that “chow” sugar. In other words a child’s brain is glucose hungry and thus the need to feed food that keeps blood glucose levels constant, not spiking and dipping, but a constant availability of glucose for all cells but brain hungry cells especially.
How much more so is the problem in a type 1 diabetic whose “automatic” controls and back up systems have failed altogether.
Hypos -ARE BAD!
Hypoglycmia – low sugar is really bad for you and for this reason the bodies alarm bells go off properly when your sugars are dropping or go very low and the possible end result is loss of consciousness or death.
So when I write motivation after motivation as if my words have magic power and attempt to explain to a fellow colleague who should know these things and have to re-explain why multiples hypos are BAD. That’s what I mean they are bad in so many ways but the death way really pertinent.
The only real way to get good “time in range” in type 1 diabetes is with a pump and an accurate CGMS – continuous glucose monitoring.
In my opinion this should be standard care. Before the funders have apoplexy. It saves lives, it saves complications and many downstream costs. But that’s just my opinion.
But mostly if I had a type 1 child I would not be able to rest easy without such a system. Finish and klaar.
I don’t know, call me crazy, but death is a bit off-putting as a side-effect, in my opinion the best way to prevent hypos is the best surely? And by best I mean detecting them before they happen and only an accurate CGM can do this. #CGMS
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 ??
In the last month I have diagnosed 2 children with type 2 diabetes. This is a first for me and greatly concerning. The prediction was there but I guess I hoped I would never see it.
What does this mean?
Type 2 diabetes is where you “run out” of b cells – the ones that make insulin and run high sugars due to a bad match between carbs (too many) and insulin (too little).
This was previously only seen in adults really towards the age of 40. To see this in children is a wake-up call.
We have an epidemic of logarithmic proportions and it needs to be tackled in a multifaceted way. By governments – providing funding and facilities as well as knowledge sharing. By health practitioners – early diagnosis and implementation of turning the tide for both individuals and population groups. By society – recognition of poor eating and not enough exercise – ditch the device across the board. Go outside more often/daily for physical activity. By you and by you, yes you.
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 😉
There are various teams around the world – dedicated scientists and enthusiastic people working on all aspects of diabetes – trying to find prevention, cure, treatments – better, onwards and upwards. The diabetic scientific community at large strive for better quality of life.
There are also many snake juice paddlers as there are fake news folk. Do not be duped or sucked into some scam.
It’s a pity that in the light of such a huge and devastating epidemic there would be folk peddling snake juice and basically lying to a vulnerable subset of people. But that is life and ours the task to engage the brain and always question.
New treatments, closed loop technology and cures are on the horizon and I salute the many people working around the clock to accomplish that. Please the internet if FULL of rubbish – surf wisely.
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. 🙂
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.
I have blogged about DKA before.
DKA – diabetes keto acidosis. Starving in the sea of plenty. Too much sugar – way too much in the blood stream and not enough insulin to get it – the glucose into the cell. Did you ever do those experiments at school about osmosis, where water moves through a membrane to where it is being drawn? In this case the cells, so to speak, dehydrate and start to die and the vascular system is “loaded” with glucose. The cells are dry dry dry and have no way of doing what they need to do – metabolism – without which the human whose cells they are die.
A process begins and catapults quickly and rapidly into a serious life threatening environment which is hostile in the nth degree. Acidosis – pH below 7.4 is very unkind and unfriendly to human life.
The by-products of this deranged metabolism – which is by the way the bodies way of desperately trying to stay alive – are called ketones – these one can measure.
NOW, a 100 years ago we did not know about ketones, about 50 years ago we discovered a way to measure them in the URINE – major breakthrough. About 20!! years ago we learnt how to measure them in the BLOOD – this is FAR more accurate – far far more accurate, in terms of being related to the timing of what is actually happening in the body as well as giving an accurate quantitative measure of the ketones. In other words one can more accurately monitor and wash them out if you are checking the blood ketones.
Generally speaking if a doctor uses urine ketones to monitor and treat you it will take up to 10 days to get rid of the ketones. IF the doctor uses blood ketones you can see that they disappear (if of course you are doing the fluids correctly and the insulin infusion) within 12-24 hours at the most 48. Not you tell me, patient, medical aid and family which would YOU prefer? Ahospital stay of 2 days or 10 days, one in ICU or one in a well run ward?
Is there a good reason to use urine ketones over blood ketones? No I really don’t think so, it is like using a horse drawn cart to drive to work.
Sorry but I just can not take it any more. Surely it is indelibly printed on your inside if you are a doctor that you wish to do NO harm and wish to HELP your patient to the best of your ability? The best of our ability at this point in time when it comes to DKA is using blood ketones (not urine ketones and yes the occasional blood gas does help but it is a painful investigation and one can very easily and safely manage with new techology).
blood ketones vs urine ketones
I am so glad and so grateful for the partnership between Roche accu-chek combo and Dexcom (ethitech) for bringing together effective algorythyms for delivery of insulin with really accurate continous glucose monitoring. It is making the biggest difference in stable sugars since I have started helping diabetic type 1 patients a good many years ago.
For the first time in their lives my 5 patients on dexcom/accu-check combo pump have a tool that helps minute to minute but essentially prevents hypos and high excursion in blood sugar. The result more stable moods, more energy, I guess in short better quality of life due to not “recovering” from a high or a low. Better adjustments on the pump because of quality information that actaully makes a difference.
Life as a type 1 for both patient and all the family and friends of that patient is tricky. This is making it far less tricky and changing quality of life as well as long-term health translating into less complications downstream. (Note to funders : this will cost you less in the long run – less heart attacks, amputations, dialysis, etc)
So I have 5 patients on Dexcom – continuous monitoring for diabetes. They are all type 1 patients (but type 2s could use this device too). It has made the hugest difference in terms of almost NO hypos ! Why? Because you see it dropping and you react !
Seems obvious but if you are diabetic you know how @@$$%% awful a low is. And being able to prevent is like a magic trick.
Also a lot less high excursions – you see the trend of it going up and you can exercise, run a temp basal or if really high like >15 do a correction bolus (aiming for not too aggressive otherwise you induce a see-saw pattern we are trying to avoid).
Delighted I am for them as well as all the other patients in the future that is it going to help.
The technology is simply one that works – an amazing little filament with embedded sensor that detects change that is fed into an algoryhtm. It is accurate, hard working, simply a wonderful armentarium in the diabetes tools.
Can I ask anyone out there to give feedback on their dexcom tips?