Category Archives: Uncategorized

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 ??

😉

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Gut microbiom and diabetes – of cats, kefir and insulin :)


I have a patient who is a type 1 diabetic and that patient has a cat who is also type 1. Needless to say they are both on insulin. Now if you thought that is it hard to dose a human try dosing a cat or a dog with insulin. It’s so hard and the margin for error is SO big.

These 2 patients have cut their insulin dose by half and halved their hypos by having kefir three times a day.

Then I came across an article in the Journal of Diabetes (South africa) about the gut bugs and diabetes. It mentions how important gut bugs are in terms of metabolic functioning – normal functioning as well as disease. It concludes by saying that “gut microbiota represents an exciting field with novel therapeutic potential”.

I say you have nothing to lose. Give it a try.kefir.jpg

A peace poem


some times frogs boil

some times minds foil

sticks and stones can not hurt nearly as much as words, ever

some times I wish I lived in the land of never never

hearts beat strong

lives live long

and actually sometimes there is even a king kong

world’s collide

sometimes divide

the crashing waves of hurt subside

and peace can become the normal tide

life is a pulse

a heart beat or two

so simple yet so complex

rather not be constantly vexed

peace is a path

chosen

on purpose

our lives a tapestry recorded and finite

choices all ours and have an impact into eternity

weird to think

sometimes a heart sink

and yet a choice

let peace be your choice

 

 

Children with type2 diabetes


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.

The drakensberg …


What a privilege to spend easter with divine friends in the pristine drakensberg mountains at Cobham near Underberg.

“Die heuwels fantasties”.

Easter camping on the riverside breathing in the fresh air up there, diving into streams of clear fresh water. Children playing, friending new friendies. Braais and “braai-pie” – thanks Suzette – watched your you tube clip and was indeed a crowd pleaser and so easy.

What a privilege.

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.

Life – a translation


Day after day, the same rythym beats a drone

The hours feel full and yet I am so alone

but under your gaze my fears depart

sun saffire – life caught fire

long lost joy streams in to my being

animated! I live

Designed to pursue love

to fly on wings of friendship

blissfully unaware of tomorrow

understanding once again how to dream and the essence of peace

the peace of being fully present

and that I am here for a reason (that my life has meaning)

Questions, like shadows inside me

but through your laugh the answers find me

I see the sunshine stories

in your eyes new languages

and I read a brand new beginning

I Live

Designed to pursue love

to fly on wings of friendship

without a care of what tomorrow might bring

translated into afrikaans because this song is so inspirational …

Annelie Van Rooyen