INSULIN DEPENDENT DIA BETES
TRUST
OCTOBER
2008 NEWSLETTER
Justification for IDDT’s position on synthetic
insulins
·
IDDT has
always argued that animal insulins must remain available for people who are
unable to tolerate synthetic insulins – both human and analogue insulins.
·
IDDT has
always expressed concerns that the long-term safety of insulin analogues has
never been established.
·
IDDT has
openly criticised Novo Nordisk for their stated intention to discontinue all
their other types of insulin and only supply insulins analogues.
NEW warnings about NovoRapid justify all IDDT’s
concerns!
Warnings
in the
NovoRapid (insulin aspart) and called NovoLog in
the
On
On
The evidence used by the FD
FD
Is the
The Summary of Products Characteristics (SPC)
documents for all synthetic GM insulins have always had warned about
anaphylactic reactions:
“Symptoms of generalised hypersensitivity may include generalised skin
rash, itching, sweating, gastrointestinal upset, angioneurotic oedema,
difficulties in breathing, palpitation and reduction in blood pressure.
Generalised hypersensitivity reactions are potentially life threatening.”
In the SPC for NovoRapid these reactions are
classed as ‘very rare’ and by the standard SPC definition, ‘very rare’ means
these adverse reactions occur in about 1 in 10,000 people. However, the
evidence from controlled trials used by the FD
IDDT has asked questions of the
·
Is the MHR
·
Is the list of
adverse reactions to NovoRapid going to be revised so that allergic reactions
are moved from ‘very rare’ to ‘uncommon’? If not, why not?
GOVERNMENT REPORT – STILL
Many readers will remember that in 2003 the
National Service Framework for Diabetes [NSF] set targets for standards of care
for people with diabetes which all have to be achieved by 2013. The idea behind
the NSF is to ensure that everyone with diabetes should receive the same
standard of care, no matter where they live. Local Primary Care Trusts [PCTs]
are responsible for making sure that these targets are met.
Five years later, the Government has issued a report on the progress of
meeting the NSF targets.
·
Just half of
patients are receiving the standard treatment.
·
Improvements are
being made to reach all 12 NSF targets. The target that everyone with diabetes
should receive screening for retinopathy [eye disease] by 2008 has not been
achieved in all parts of the country. Progress is being made with the treatment
of other complications but there is still a long way to go in terms of
prevention.
·
There is a need
to increase the number of diabetes specialists.
·
The report
praised the work being done on involving people in their own care.
·
More needs to be
done to improve the management of medical emergencies, specifically
hypoglycaemia.
·
The access to
specialist care for children with diabetes and pregnant women with diabetes is
very variable and needs to be improved.
·
The NHS has
improved its record of early diagnosis of people who were unaware that they had
Type 2 diabetes – over 600,000 have been diagnosed over the last 5 years.
However the report adds that there are still a further 500,000 people
undiagosed.
Still a long way to go
No doubt there have been improvements and we know
from our members that some areas of the country provide excellent care but what
about the rest? There is certainly no room for complacency as we still receive
many calls from people who are certainly not receiving the care they should and
many people, especially those with Type 2 diabetes, don’t seem to have received
very much education about their condition, the food they should eat or
generally how to manage it.
Was setting the NSF targets putting the cart before the horse?
The report comments on the increasing number of
people with diabetes, Type 2 in particular, but this cannot be used as a reason
[or excuse] for not meeting the targets as this increase has been predicted for
many years.
The principle of setting targets of standards of
care to be achieved by Primary Care Trusts has many advantages. However, there
was a shortage of specialist staff and education programmes etc prior to
setting the NSF targets, so as the NSF also included diagnosing the
undiagnosed, can the targets ever be met? Was setting targets without the
necessary staff putting the cart before the horse? IDDT raised this question at
the time.
What’s the state of play now with staffing levels?
From figures published in Clinical Medicine
2008;8,4:377-380
·
the number of
diabetes consultants has increased but the time they spend on diabetes has
fallen from 40% in 2000 to 26% in 2007. 75% of their job plans are spent on
non-diabetes related activities.
·
94% of diabetes
consultants are spending more time in acute-general medicine which means less
time spent for training juniors in diabetes.
·
There is less
time for developing community services with GPs and only 12.8% of consultants
involved in diabetes community clinics.
·
only 38% of
Primary Care Trusts [PCTs] provided psychological support for adults with
diabetes compared with 64% in 2006. For children only 51% provided this care
compared with 69% in 2006.
·
There is still a
shortage of paediatric diabetes specialist nurses and in 41% of PCTs their case
load has increased with an improvement in only 7%.
With figures like this, can the NSF targets be met?
Greater investment in diabetes care is necessary but this seems unlikely.
So what can you do in the meantime? Don’t accept poor care, don’t accept delayed or no retinopathy screening,
complain to your local Primary Care Trust as they are responsible for funding
services in your area.
PORK INSULIN
IDDT receives a number of calls from people
interested in using pork insulin in an insulin pump. We are gathering
So we interested in making contact with people who
are using pork insulin in pumps, people who would like to use an insulin pump
with pork insulin and those who have talked to their health care team about
doing so. We would like to know more about their views and experiences and what
their diabetes health care team think about this as an option.
We believe that most people using animal insulin in
pumps are using pork insulin but if you are using beef insulin, do get in touch
as we would love to hear from you too.
If you fit into any of these categories and are
prepared to help us by filling in a short questionnaire, please contact Jenny
at IDDT on 01604 622837 or e-mail jenny@iddtinternational.org
We would very much appreciate your help.
INTRODUCING M
Hi Everyone,
My memories of growing up with a sister with
diabetes are very mixed, some very happy, others not so happy, but that’s just
the same as anybody isn’t it? I don’t really remember the conversation I must
have had with Mum and Dad, when I was told that my sister had been diagnosed
but I do remember spending what seemed to be hours sitting outside the
children’s ward at the hospital. I suppose I used to feel a bit jealous of the
attention that she was getting but found it difficult to say this because I
knew she was ill and that was selfish and then I’d feel guilty. I think I was a
bit confused to say the least.
That said there was an upside – all this
fascinating new stuff that came into the house, metal and glass syringes with
screw on needles, urine testing kits with fizzing tablets, test tubes and
colour charts. My sister and I discovered that if you put enough of these
tablets in a test tube with some water then they could get so hot that the tube
would crack – a bit like Mum’s temper when she found out what we had been
doing!
Like any brother and sister we also used to argue
and sometimes these were because she was hypo and thus bad tempered but what
then used to happen was that she would have something to eat and wonder what
the fuss was about and why I was still cross. These days I’ve just realised
that she doesn’t have to be hypo - sometimes she is just plain bad tempered.
Things have certainly changed since my sister was
diagnosed. I can remember Mum fundraising for the local branch of then British
Diabetic
Coming back into the loop, starting to work for
IDDT has made me realise how much there is to know and how mind-boggling the
choice of treatments can be, so even though I have quite a lot of experience of
living with someone with diabetes I can only start to imagine what it is like
to be someone who is newly diagnosed or a member of their family.
Martin is employed to help to both raise funds and raise the profile of
IDDT but he has the added ‘advantage’ of having a sister with Type 1 diabetes!
Sometimes parents are worried about how their children without diabetes are
feeling, so if you would like to talk to
IDDT NEWS
Thanks to
IDDT’s
The
To
Ruth
contacted IDDT because she wants to help children and young people with
diabetes in developing countries. Ruth put the idea of sponsoring a child with
Type 1 diabetes in
IDDT
would like to say her huge thank you to Ruth and her year group for helping
To Jackie Banks for fighting
the DVL
Nationwide Community and
Heritage
IDDT’s
Co-Chairman, Jenny was a winner in the Community – Individual category of the
To Brenda Smith and The Greene King Summer
Charity Darts League
We must thank Brenda Smith
and her family for choosing to hold their Summer Charity Darts League in aid of
IDDT. Over £1400 was raised and a presentation made at the finals at the Tally
Ho public house in Lewes. Brenda’s friend and IDDT member,
W
Byetta [exenatide] is a relatively new injectable
drug for the treatment of Type 2 diabetes.
In the UK acute pancreatitis associated with taking
Byetta is not listed as an adverse reaction but the
In October 2007 the US FD
In
Regranex [becaplermin] – is a
prescription gel made by Johnson & Johnson used to treat diabetic leg and
foot ulcers caused by neuropathy.
In the
Champix [Varenicline] – it has been
known for some time that this non-nicotine, anti-smoking drug can have adverse
effects. In the
DISCRIMIN
In our July 2008 Newsletter we discussed
discrimination at work and that although we don’t generally consider diabetes
to be a ‘disability’, it does come under the Disability Discrimination
I was booked in to a B&B in Combe
On the second day, I had lunch, went for a wander on the beach and then
went back to the B&B about
The owners of the B&B were in and out of the room, when the wife said I
would have to leave "as they were not running a care home". I was so
angry I wanted to leave there and then but had to wait until the next
morning.
The next morning I woke up and asked if the owner would help me with my boxes
of dialysis fluid because they were too heavy for me to carry to the car. They
said they could not do this until after breakfast.
When Christine rang IDDT about this, words failed
us! Here is someone maintaining her independence, unfortunate enough to have a
hypo while on holiday. It can happen to anyone with Type 1 diabetes but to be
treated with such ignorance is unbelievable!
C
eBay Weekend
What a lot of people don’t realise is that every
time they sell an item on eBay they can raise money for charity – including
IDDT.
How to donate to IDDT by selling stuff on eBay – it’s really quite
simple
1. Log on to www.e-bay.co.uk
2. Once you’re ready to sell your item, go to the Sell
hub and select ‘
3.
4.
Everyone’s a Winner!
You Win - every time you list an
item for charity, you’ll get a fee credit on your basic insertion and final
value fees equal to the percentage you donate. So if you donate 50% of your
selling price to a charity, eBay will waive 50% of your fees.
We Win – every time you sell an
item, Missionfish will collect your donation and after deducting a small fee to
cover administration, pass your donation on to IDDT.
We know it works, thanks to Jean
Jean from
IDDT’s eBay weekend, January 17th and 18th 2009
Of course you can start selling items on eBay to
donate a percentage to IDDT anytime and we are always grateful for your help.
But we are making January 17th and 18th 2009 ‘IDDT’s eBay
Weekend’ by asking everyone with internet access, to get involved. It’s a good
opportunity to sell any unwanted items, especially any Christmas presents that
maybe you don’t really want! If we all list our unwanted items, however small,
and donate a percentage to IDDT, not only can we have some fun but we can raise
a tidy sum – the old saying of look after the pennies and the pounds take care
of themselves.
Other ways to use eBay to help IDDT
If you run a business that uses eBay, you can help too!
If your business uses eBay to sell then you can
also register to donate to IDDT, again with benefits:
·
your listings
are highlighted with a yellow and blue ribbon,
·
your business is
associated with a good cause and
·
there are
significant tax benefits.
For more
Special
The final way you can help IDDT is by holding a
special auction.
·
‘money can’t
buy’, one of a kind items or experiences,
·
items with
celebrity status,
·
unique or
extraordinary items,
·
extremely
valuable or rare items.
If you need any help or have any ideas or items for
a special auction, then please contact
NICE GUID
NICE issues guidance is about the use of medicines,
devices and treatment in the NHS in
1. Pump therapy is recommended as a treatment option
for adults and children 12 years and older with Type 1 diabetes provided that:
·
attempts to
achieve target Hb
or
·
Hb
2. Pump therapy is recommended as an option for
children younger than 12 years provided
that:
·
MDI is
considered to be impractical or inappropriate, and
·
Children on
insulin pumps would be expected to undergo a trial of MDI between the ages of 12
and 18 years.
3. Pump therapy should only be started by a trained
specialist team who should provide structured education programmes and advice
on diet, lifestyle and exercise appropriate for people using pumps.
4.
5. Pump therapy is not recommended for the treatment
of Type 2 diabetes.
More
INTERESTING COMMENTS ON CONTINUOUS GLUCOSE MONITORING SYSTEMS BY
We all place high hopes on the development of
continuous glucose monitoring systems. These are now available but are only to
be used to pick up trends in blood glucose levels and cannot be relied on for
making dose adjustments.
There was an interesting letter in Diabetes Health
[
·
The readings are delayed in time and can lag behind the actual blood sugar
concentration by as much as 20 minutes. This is because they sample
interstitial fluid [fluid in the cells] which may take up to 20 minutes to
change in the same direction as blood glucose. Standard finger-prick monitors
use capillary blood which represents the current blood glucose levels. This
time lag means that they cannot reliably protect against hypoglycaemia as 20 minutes
can be too long before treating the hypo. This is not helped by the sensors
being inaccurate at both high and low blood glucose levels.
·
Both manufacturers warn that continuous monitoring
systems are not a substitute for finger-prick testing and decisions about insulin dose must be made on
the basis of finger-prick tests. So using continuous monitoring does not reduce
the number of daily finger-prick tests.
·
These devices and the sensors are very expensive costing between £400 and £500 in the
·
People using a pump need two subcutaneous
insertions and for slim people this can be a problem as the
abdomen fat they use for the pump insertion site may not be large enough for
two insertion sites. Unlike the pump infusion set, the sensor probe of the
continuous monitoring system bends more easily and therefore any area of the
body that is continuously being flexed or that bears weight is not a good
choice for the sensor probe to be inserted.
Undoubtedly continuous glucose monitoring systems
are useful for people who wish to monitor trends in their glucose levels but as
this user points out, people need to be aware of the drawbacks too –
What does research say?
Trials have mostly failed to find a significant
improvement in control with continuous glucose monitoring [CGM] compared to
finger prick tests. Several studies have shown that CGM may help to detect
night hypos and one study showed that CGM helped to motivate people with Type 2
diabetes to take more exercise.
The results showed that Hb
This supports current evidence suggesting that
continuous glucose monitoring cannot be recommended to improve control in every
patient but it may be useful in selected people, especially for the
investigation of loss of hypo warnings [hypo unawareness]. [Pract Diab Int
July/
L
We frequently hear that
lack of exercise and today’s sedentary lifestyle [along with eating too much]
is a major cause of the rising level of obesity. However, recent research
carried out at the Universities of
Surprisingly they also
found that there is very little difference in the energy used by people in the
It seems that this is yet another case of
assumptions being made rather than looking at the actual evidence from
research. While it can never be denied that exercise is healthy, this latest
research suggests that governments have made recommendations about how to
combat obesity and overweight on assumptions not evidence. They have also spent
fortunes on getting a message across that appears to be anecdotal!
IT`S
The
BBC television series, Casualty 1907,
based on The London Hospital in Whitechapel, provided some dramatic and gritty
reminders about advances made in medical treatment. `The
This
new frontier in managing the disease was set out in a small book of lectures by
Dr
O Leyton, published in 1917. Dr Leyton was Physician to The London Hospital and
his lectures to colleagues and medical staff described The Treatment of Diabetes Mellitus by
Patients
suffering from severe forms of the disease were unable to utilise even the
carbohydrate portion of their protein intake. Leyton found that after
alimentary rest, patients were able to use the carbohydrate in protein and also
to oxidise some starch.
The
physician recognised that in the normal healthy individual there was a balance
between physical and chemical processes within the body, creating a stable
equilibrium. He also understood the part that emotions such as anger, fright or
stress could play by increasing the activity of the suprarenal glands, with the
result that sugar was liberated into the bloodstream.
The
new treatment consisted of starving the patient, sometimes for nine days, until
sugar had been absent from the urine for 24 hours. Then the carbohydrate
tolerance was established in a diet containing very little protein and
practically no fat.
The
success of this approach was demonstrated in treatment figures for the year
1916. Of 66 cases of severe, often comatose, diabetics admitted to `The
London`, 39 were treated with alimentary rest and, of these, 29 were recorded
as leaving the hospital sugar-free and on a diet of around 2000 calories.
One
of Dr Leyton`s patients in 1917 was a 26 year old soldier repatriated from the
Western Front. His weight was down to less than nine stones and he was passing
urine at the rate of seven pints daily. He had been diagnosed as diabetic by
army doctors after being wounded in the trenches.
On
being transferred to Dr Leyton’s care at `The London`, the soldier was given
immediate alimentary rest and after nine days his urine was sugar-free. His
response fluctuated but by the middle of 1917 he was sugar-free, had gained a
little weight and was able to undertake light work.
In
a modest preface to his book, Dr Leyton referred to the treatment of diabetic
patients `by a method yielding much better results than those obtained in the
past`. By such pioneering efforts is progress achieved. He also graciously acknowledged
the help of his fellow physicians at The London Hospital.
Dr Leyton`s
lectures were published in The Clinical Journal in 1917 and in book form the
following year by
IDDT HELPS IN
One of
IDDT’s new members is a doctor in
But as we hear on the news, the situation in
“We
don’t have much to say on the subject of choice of insulin, we don’t have a
choice as patients are happy to find any insulin at all! Having a chronic
illness in
But I
do understand your concerns and I agree that patients should be able to choose which
insulin to use – animal or ‘human’. People with diabetes are the best people to
decide what is best for them and no study can replace patient experience.
Please keep fighting for the rights of people with diabetes to choose what’s
best for them. I applaud you!”
IDDT
sent Dr Nyathi 6 unused blood glucose monitors and 600 test strips which had
been donated to IDDT by you, our supporters. He is now able to do instant blood
glucose tests on his clinic patients. Here are the thanks from Dr Nyathi:
“The blood glucose meters will go a long way in
helping the management of our patients……Even though we have a sign which says
‘Supported by IDDT’, we already have raised eyebrows with people asking why I’m
doing free blood tests [because these days nothing is for free!] This move has
made more people aware of your organisation as people are always asking who
IDDT is. Thank you for being a caring organisation.”
To our supporters
This
just shows what a help our collection of unused,
unwanted, in-date supplies is to people in other countries, so thank you to
everyone who sends in unwanted, unused supplies.
With the new warnings issued in the
IDDT has always had a keen interest in adverse
reactions because so many people have experienced them when using synthetic GM
insulins yet have not been believed by their doctors or healthcare team.
What is an adverse drug reaction?
Certain types of reactions occur only in susceptible people and these
are:
·
Drug intolerance - a low threshold to the normal pharmacological action of a drug [the
way a drug works]
·
Drug ideosyncrasy - a genetically determined abnormal reaction to a drug related to a
metabolic or enzyme deficiency
·
Drug allergy - the immune system rejects the drug and this reaction reoccurs if the
drug continues to be given
·
Pseudoallergic reaction - appears to be like an allergic reaction but is not caused by the
immune system reacting to the drug.
So as only a percentage of people have adverse reactions to GM insulins,
is there a group of people with diabetes who are particularly susceptible to GM
insulins?
Risk factors for adverse drug reactions
·
Genetic factors may be important. For instance, the HL
·
The drugs themselves can also be risk factors and these include macromolecular size ie large
molecules, which may be complete antigens eg insulin.
·
The method of administration of the drug may also be a risk factor and adverse
reactions occur least often with drugs that are taken by mouth and most often
with those given intravenously. [What
about those given subcutaneously like insulin?]
When do adverse drug reactions occur?
They can occur at any time throughout a drugs life
– immediately after taking, within weeks, months or even years after taking a
drug. IDDT has always advised people to read the Patient Information Leaflets
[PILs] inside the packaging of drugs and this is true for drugs or insulins
that you have been taking for some time. Why? The warnings may change as new
adverse reactions are found. The clinical trials carried out to gain marketing
approval of a new drug are relatively small using selected people so the
adverse effects may only show up over time with greater use in the wider
population. Insulin is no exception to this advice as the recent new warnings
in the
We know little about a drug when it first hits the market
For example, pre-licensing trials for a new insulin
may and often do use people with diabetes who are not the very old, not the
very young and have no complications, so at the end of the trials all we know
is whether the drug is safe in this particular, healthy group of people and
what adverse drug reactions they experienced. When that very same new insulin
reaches the market, it will be used thousands or millions of people with
diabetes many of whom may have quite different health situations from the
pre-marketing trial participants. It is estimated that 50% of people with
diabetes have some forms of complications – how will they be affected by the new
insulin? Some people have had diabetes much longer than others – will the new
insulin affect them differently? Some people will be taking other drugs for
other medical conditions – will the new insulin affect them differently?
We simply do not know the answers to any of these,
and many more questions when a drug or insulin first reaches the market. What
we do know is that drug companies issue press releases that sing the praises of
their new ‘wonder’ drug and it is easy to be misled by press reports that rarely
mention known or unknown side effects!
Understanding the risk of adverse reactions
In making a choice about whether or not to take a
drug or insulin, one of the things that we consider is any possible adverse
reactions to a drug or insulin. It is important that we don’t get the risks of
them occurring out of perspective. For instance, if we are told that an adverse
reaction is common, we probably all have different views of what this means.
Those who overestimate the meaning of common may be put off using a drug that
would be useful to them.
On drug
·
very common: >1/10 which means the adverse reactions affect more than 1 in 10
people.
·
common: >1/100,<1/10, the adverse reactions affect between 1 in 10 and 1
in 100 people
·
uncommon: >1/1000,<1/100, they affect between 1 in 100 and 1 in 1,000
people.
·
rare:
>1/10,000, <1/1,000, they occur in more than 1 in 10,000 people but not
as many as 1 in 1000
·
very rare: <1/10,000, they affect less than 1 in 10,000 people.
How does this relate to insulins?
The UK SPC for NovoRapid classes the
allergic reactions to NovoRapid as ‘very rare’ but the clinical trial results
that prompted the FD
These same trials showed that the
allergic reactions to human insulin occurred in 3 of 735 people also making them ‘uncommon’. Interestingly, the SPCs
class the allergic reactions to
Note:
The importance of reporting adverse drug reactions
One of the major ways that the safety and efficacy
of drugs are monitored is through the system of reporting adverse reactions –
in the
The collection of adverse reaction reports about a
drug gives indications or trends that a drug may cause problems that were not
detected in the pre-marketing trials. It is these trends that result in further
investigations into a drug and perhaps the issuing of new warnings or even the
removal of a drug from the market. For example, this reporting system in the
It is estimated that there is a 90% under-reporting
of adverse reactions but nevertheless, the system gathers
It is estimated that the cost to the NHS
of adverse reactions to prescribed drugs is £2 billion – and this figure could
be higher if it included adverse reactions that occur with drugs that are
prescribed to people while they are actually in hospital!
·
6.5% of total hospital admissions in
the
The sums are simple, it is only the
numbers that are large! In 2006 the total number of hospital admissions was
16,000,000 so 6.5% of this is 1,040,000. The calculated cost of a day in
hospital is £228 and on average people admitted with adverse drug reactions
stay in hospital for 8 days. Thus the total cost to the NHS for adverse drug
reactions could be as much as £1,896,960,000 for hospital admissions alone. [
These are just hard facts and figures
but we must not forget that 1,040,000 hospital admissions are real people who
have been made unnecessarily ill as a result of a prescribed drug.
·
Jon Trickett MP has asked Parliamentary
Questions about the numbers and costs of adverse drug reactions. Compass has launched an
investigation into the role of the pharmaceutical industry and public health
which will explore key issues including:
·
The relationship between the pharmaceutical industry and public health
·
The current system of drug regulation
·
The safety and efficacy of drugs
·
Whether it is in the public interest for drug companies to be represented
by the Department of Health.
It will also review the
progress made since the 2005 Health Committee report, ‘The Influence of the Pharmaceutical Industry’, to which IDDT gave
evidence of our concerns about the power and influence of industry in diabetes
treatment and research.
Zoe Gannon is leading the research and
has made some important points.
·
The
lack of effective regulation of the pharmaceutical industry is costing the tax
payer, and in some cases is also causing unnecessary suffering.
·
The
pharmaceutical industry has an important role to play in the economy but
companies are making huge profit margins in excess of 14.3% against a normal
business average of 4.6%!
·
The
pharmaceutical industry is always promising the latest miracle drug but too
often fails to deliver. The number of truly new drugs is decreasing yet tax
payers’ money is funding questionable research and development expenditure.
Readers may remember that
the Health Committee report recommended that the pharmaceutical industry should
be regulated by the Dept of Trade and Industry, as are other industries, and
all health matters, such as drug regulations, should be handled quite
separately by the Dept of Health. This still seems the most effective way of
taking at least some control over the pharmaceutical industry and would result
in greater transparency and less suspicion of conflicts of interest.
How to report adverse drug reactions through the Yellow Card Scheme
For many years, only doctors could report adverse
reactions but the system has been expanded so that patients and other health
professionals can now make reports. You can report any suspected adverse reactions you experience. You only have to suspect, not prove, that adverse effects
are caused by a drug.
·
If you have access to the internet: go to www.yellowcard.gov.uk
and CLICK on submit a Yellow Card report. On this site you can also check the
adverse reactions reports already made.
·
If you prefer to use a paper Yellow Card reporting
form: telephone the MHR
You can also check on adverse reactions already
reported
If you
are considering a choice of treatment/ insulin or you think that you are
experiencing an adverse drug reaction to insulin, it can be useful to look at
the adverse reactions that have already been reported by doctors and patients.
However, as the reports are of suspected adverse
drug reactions, it does not necessarily mean that the drug actually caused
them, just that it may have.
You can
look at the reports by going to the same website: www.yellowcard.gov.uk
This
website has had a major upgrade and so it gives a lot more
DIET – H
Different types of sugar
We know that there are
different fats but an article in the New Scientist [
In research at the
·
in people given fructose there was an increase in the intra-abdominal fat
[fat that wraps round internal organs] causing increases waist measurements
which has been linked to increased risks of Type 2 diabetes and cardiovascular
disease. This did not happen in the group who ate glucose instead of fructose
even though both groups put on the same amount of weight.
·
The people who ate fructose also had raised triglycerides which are
deposited as abdominal fat and cholesterol.
This study only looked at
pure fructose and not high fructose corn syrup or sucrose so it is not yet
clear whether these substances can be blamed for the increase in obesity and
Type 2 diabetes but the researchers are planning a long-term study to find out.
However they do say that it is not too soon for people with metabolic syndrome,
the group of conditions that increase the risk of Type 2 diabetes and
cardiovascular disease, to avoid drinking too many drinks containing fructose.
Looking into fruit and leafy
vegetables also showed concerns about fructose
Is it time for a re-think in
the five a day recommendations?
By the way………….
The traditional
Mediterranean diet is rich in olive
oil, vegetables, fruits, nuts, cereals, legumes and fish but relatively low in
meat and dairy products. There are also
studies showing that people with diabetes also do better on this diet. This
sort of evidence has been around for many years so why do we have dietary
recommendations for high carbohydrates?
WE’RE COMING UP TO WINTER
Recent research [Diab Care,
The risk of pneumonia was greater with longer
duration of diabetes and with longer duration with poor glucose control but
even in people with ‘good’ control there was an increased risk of 22% compared
with people without diabetes.
Just food for thought………
FROM OUR OWN CORRESPONDENTS
My experience of ‘The Pill’
Dear Jenny,
I thought your readers may be interested in my
experiences of taking the contraceptive pill.
J.K.B.
Changing to pork insulin in
Dear Jenny,
I was worried that changing to pork insulin and that
the suppliers,
So far so good and thanks to everyone for being so
supportive.
Terry, by e-mail
Note: Terry thought his positive
experiences might be of help to other people in
Gluco Tabs in
‘bulk’
Dear
Jenny,
We
discovered that Gluco Tabs are much easier to carry about because they are in a
plastic case but they are so much more expensive than ‘Dextrose’ tablets that
we didn’t feel we could justify the expense as a family. Well, now Boots are
selling ‘bulk’ packs of Gluco Tabs with a refill bottle of 200 of Gluco Tabs
and so we are much happier to buy them.
The cost comes down enough to justify having the reassurance that we
won’t find a stack of hard, moulded-together tablets at the bottom of the bag,
because the wrapper isn’t hardy enough. They’re also available in
M.E,
By e-mail
Your article on
Dear Jenny,
Following the article on aspirin in the July
Newsletter, I would like to pass on my experiences. During the past few years
I’ve had laser surgery for retinopathy several times. Two years ago my eye
consultant said he couldn’t understand why I kept having retinal bleeding which
required laser surgery and said, “You’re not taking aspirin on a regular basis,
are you?” When I said yes on the instructions of my diabetic clinic, he
contacted them immediately so that they could instruct my GP to discontinue
prescribing it.
Within weeks that retinal bleeds stopped and I
haven’t had any since. Perhaps though this Newsletter you could suggest that
your members check with their eye specialists before taking aspirin regularly.
I very much appreciate your Newsletter, it’s the
only thing that keeps me
Mrs C.E.
Responses to pumps and animal insulin
Dear Jenny,
I am one of the people who uses animal insulin in a
pump – I used Novo Nordisk pork insulin and now Wockhardt Hypurin Porcine
Neutral with no problems at all. In fact, when I used ‘human’ and analogue
insulins in my pump, I used to get blocked tubing quite often but this has
never happened with pork insulin.
In cases where people have who doctors are unhappy
to allow them to use animal insulin in pumps, I wonder if they would get if
they could refer their consultant to talk to another consultant who already has
experience of patients using animal insulins and a pump?
L.B.
By e-mail
Dear Jenny,
The result of this has been a slow but
steady decrease in his insulin requirements (down to about 50% less than when
he was using injections), an improvement in his Hb
Glad to see IDDT continues to go from
strength to strength!
Massage therapy
has made a big difference
Dear Jenny,
I find your
Mr G.J
By e-mail
‘MODERN’ INSULINS - F
I
know I’ve mentioned this before but I’m like a dog with a bone! I’m fascinated
to know why Novo Nordisk always seem use the term ‘modern’ insulins when
referring to their analogue insulins and never actually call them ‘analogues’.
I have heard ‘modern insulins’ used by representatives of Novo Nordisk , seen
it their press releases and looking at their financial report for the half of
2008, yes, there it is again: “Sales of
modern insulins increased by 30% (21% in Danish kroner).” The report referred to their other products by
name eg NovoSeven® , so why not refer to analogue insulins by name?
Then
on September 9th, the very day I was about to send this Newsletter
to the printers, Novo Nordisk issued a press release and how did it describe
NovoMix 30?
“NovoMix® 30
(biphasic insulin aspart) is a premixed, dual-acting modern insulin, indicated
for the treatment of diabetes mellitus, which contains both rapid-acting
insulin (30%) and intermediate-acting insulin (70%).”
Nowhere
does it tell readers that NovoMix 30 is an insulin analogue!
The word ‘modern’ means little – is it modern as opposed to ancient, as in history? English grammar fanatics would say that it is an adjective that describes the word ‘insulin’ but when used for a insulin, it tells us nothing and you can’t even look it up to see what it is! Other insulin manufacturers have no difficulty using the word analogue, so why is it a problem for Novo Nordisk to use it? By not referring to NovoMix 30, NovoRapid and Levemir as analogues, are they trying to disassociate themselves from insulin analogues, when very justifiable questions are raised about their long-term safety? A re they preparing us for the time they remove all other insulins so that insulin is just insulin and the fact that is analogue made by GM technology gets forgotten? I have no idea, but it all seems strange and there must be a purpose as they are so studiously avoiding using the words analogue insulin! A nd what will they call the next generation of new insulins – ultra modern?
NEWS FROM
Type 1 diabetes is still on the increase in
·
6,000 new cases
in children aged 0 to 14 years between 2000 and 2006, the equivalent of more
than two new cases every day.
·
The rate of new
cases of Type 1 diabetes was highest in children aged 10 to 14 years, the rates
for 15 to 24 year olds remained fairly stable but for people over 25, the rates
fell.
·
There were
nearly 9,000 new cases of Type 1 diabetes in people aged 15 or over with males
over 15 years almost twice as likely to be diagnosed as females of the same
age.
Opinion formers in
Based in
While
Websites revamped
Diabetes
Funded by the
Protecting Women’s health in
The Bridges Research Grant Programme is managed by
the International Diabetes Federation [IDF] and funded by pharmaceutical
company, Eli Lilly. BRIDGES supports worldwide diabetes research that bridges
the gap between science and people with diabetes. The first round of funding
has been completed and one of the projects being funded is in
SUPPORT FOR C
Nearly
six million people act as carers for relatives and this includes some family
carers of people with diabetes. Complications of diabetes or total loss pf hypo
warnings can make a carer essential. But sometimes, 24 hour caring can just get
people down and they need a break.
The
government has now recognised this and is to double the amount of respite care
available for family carers of the elderly and disabled.
·
£38 million will go towards supporting carers in
the job market, encouraging flexible working hours and job training. It is
already the right of carers to request flexible working although only 7% of
carers are aware of this.
·
Young carers who care for sick parents and
relatives will be granted an extra £6 million to go towards increasing
protection from "inappropriate" caring for young people.
·
·
There will be training for GPs so they are better
able to advise on the pressures of being a carer.
NEWS FROM THE PH
New
pre-mixed insulin analogue - Novo Nordisk has
received approval in the
EC approves
Novo Nordisk wins design award for safe needle device
In the
FOR THE MEN
Testosterone deficiency in men with Type 1
and Type 2 diabetes
It has
been known for some time that men with Type 2 diabetes are more likely to have
a deficiency of the male hormone, testosterone, but recent research has shown
that the same is true for men with Type 1 diabetes. Testosterone plays an
important role in men’s health and deficiency
of it can contribute to impaired performance, mood,
and libido, as well as having an adverse impact on cardiovascular risk. The
findings of a recent study suggest that this is a significant and unrecognised
problem among men with diabetes and the authors suggest that it requires
greater attention from clinicians and scientists. They stopped short of
recommending testosterone replacement therapy as the risks and benefits require
much more study. .[Journal of Clinical Endocrinology & Metabolism,
Testosterone supplements for older men –
are they any good?
Research looks at testosterone gel
Studies
in the
The
study showed that in the group treated with testosterone there were significant
improvements in insulin sensitivity which may help to improve cardiovascular
and other diabetes complications. There was a significant improvement in
erectile dysfunction after 6 and 12 months. Skin reactions were the most
commonly reported adverse effects in both groups. The authors recommend a
screening programme particularly for men with Type 2 diabetes. [The study was
sponsored by the manufacturers of the gel.]
Erectile dysfunction drugs linked to risk for hearing loss
The FD
Diabetes may be
damaging men's fertility
Research
[Human Reproduction, May 2007] compared DN
This
small study at Queen's University in
The
non-diabetic volunteers in the study were all men seeking fertility treatment
who may also have more sperm damage than the average man so the differences
demonstrated in this study could be even greater if compared to non-diabetic
men without fertility problems. Further research is recommended.
FOR THE L
Leading up to
menopause
We hear a lot from women who talk
about how their diabetes control goes adrift when they are in the menopause but
little seems to be written about the time leading up to the menopause. This is
usually gradual and can last for 3 to 6 years during which time a woman can
experience mild to severe symptoms including:
·
hormone
and mood swings
·
weight
changes
·
fluid
retention
·
headaches
·
memory
problems.
Hormonal changes may cause symptoms
that are similar to those of hypos – rapid heart beat, flushed skin, so instead
of assuming it is a hypo, it is sensible to do a test before eating/drinking
something sugary.
Pregnancy
- it is also important to remember that you can still become pregnant during
this time and as we know it is much healthier for women with diabetes, and for
babies, to have planned pregnancies. If you have stopped menstruating for
several months your period can still reappear. Most books say that you should
go an entire year without menstruating before you can assume that an unplanned
pregnancy will not occur.
Post menopause health risks – when menstruation has stopped completely, the risk of
heart disease increases, there is a reduction in the amount of calcium in bones
and an increased risk of vaginal infections. So it is important to talk to your
doctor about these effects to help you to reduce these health risks to a
minimum.
Good advice seems to be: don’t
despair, all women have to go through this but eat well, be physically active
and adjust your diabetes regime as necessary.
SNIPPETS
The Olympic Games - how many people in
It
is estimated that there are 35million Chinese with diabetes. It is predicted
that this number will grow as the Chinese become financially better off. Novo
Nordisk expect the number of insulin users to grow by 30 to 35% a year. They
have invested $200 million in
Reheating spag bol may be good for you!
Have you noticed that spaghetti bolognese often
tastes better re-heated on the second day?
Well scientists have now found that reheating increases the health
benefits of the tomatoes in the sauce. Tomatoes contain lycopene, a powerful
antioxidant that can help to combat heart disease and diabetes.
Using ears to best advantage
New research suggests that declarations of love,
jokes or anger are remembered best when they are heard through the left ear.
However, instructions, directions and non-emotional messages are better heard
in the right ear. It is all to do with the two halves of the brain having
specialised functions – the left side is more dominant and logic-based and the
right side the more imaginative side.
Frog’s skin boosts production of insulin
Researchers have discovered that a substance on the
skin of a South
In sporting circles Viagra is known as Vitamin V
indicating that it is commonly used by athletes to boost performance – athletic
performance that is!
More people having cosmetic and weight reduction surgery than ever
before!
Recent