Category Archives: type 1 diabetes

Medical aids and the future?


In my opinion which some may argue is not humble. I argue it is.

Medical aids restrict care for patients as well as shoot themselves in the foot when it comes to downstream costs.

Particularly in an environment like south africa where we have this tsunami wave of a diabetes epidemic. Approaching things holistically (as CDE which originated in Joburg and is now all over RSA) is the only way to manage the finances we have. Yet the push back from some medical aids is interesting to use a word so as not to offend.

I am merely a GP – general practitioner. I have made it my mission to stay up to date (as well as the most qualified I can be) regarding diabetes at large. I am passionate about it. I am even more passionate about the best care for my patients. This largely could translate to the best money spent for medical aids but alas it does not turn out that way 9 times out of 10.

There are medical aids who are open minded and practice preventative care like Discovery and medications and appliances are provided with insight and good application.

I wish this were across the board. Alas not in our beautiful country.

Patients vote with where they pay their money.  The next few years are critical as to both the direction of medical aids and whether the money will be spent effectively saving downstream costs or whether the whole thing just implodes. Every day another massive wave of patients are added to this problem. It is soon to hit that critical mass where devastation occurs.

We have to become more preventative, we have to manage what we have to the best of our abilities with what we have.  That is best done with more brains. Team is key. Technology is key and unfortunately not everyone is on this boat.

Think before you drink before you drive, think before you eat that cake and you don’t survive.

 

Advertisements

Carb counting and cooking demo


cooking demo.jpgWe have a few spots left, book asap – the dietician consult is claimable from medical aid and a very fun way to do your yearly dietetics consult 🙂

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

Diabetes do-able, delicous


Super exciting news emanating from 26 Hilton avenue is a brand new concept of multi-disciplinary and holistic care for the spectrum of diabetes : pre-diabetes, type 2 and type 1 s.

We are starting with a “master” class in diabetology understanding and cooking and the best bonus of all is that you will sit down to a meal with the delectable delicious meal that you have just learnt how to replicate at home. You will go home with the recipe in detail as well as have our dietician carb count and drill down into the nitty gritty yet easy way to “see” carbs and “react” to them.

As a team, the innate Hilton professionals are rolling out the full range of services for diabetics and we will keep you posted.

For enquiries re the “master” class : Shirvone 033 343 2243

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

Dexcom spaghetti


How does one unravel the download of dexcom spaghetti? I find continous monitoring is HUGELY beneficial to the patient on a literally minute to minute basis and in terms of the “knowing” what their sugars are and in terms of littlies the mom or dad “knowing” minute to minute “where” things are at.

For the health care professional however there is a lot of spaghetti to wade through.

My personal favourite is the graph that averages everything out and plots one average on a 24 hour day. For me I can USE this information to adjust settings and give advice. NO two days are quite the same, diabetes remains a learning game, but if you use your trends you will always win, just a little rhyme for a bit of fun.

Diabetes is a challenge, an obstacle, a learning game. I learnt recently from a very inspirational type 1 diabetic that one needs to dance with the obstacle. I am learning myself (as a health care provider) to dance with the obstacles I have in caring for diabetics.

how to unravel

how to unravel

Diabetes ketoacidosis ABC


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

blood ketones vs urine ketones