INSULIN
DEPENDENT DIA BETES TRUST
July
2008 NEWSLETTER
Self-monitoring
in Type 2 Diabetes
Offer self-monitoring of plasma glucose to a
person newly diagnosed with type 2 diabetes only as an integral part of his or
her self-management education. Discuss its purpose and agree how it should be
interpreted and acted upon.
NICE Guidelines for Type 2 diabetes, May 2008
The NICE
Guidelines recommend human insulin, not analogues as first line treatment for
people with Type 2 diabetes
Preferably begin with human NPH
[intermediate-acting] insulin taken at bedtime or twice daily according to
need.
·
the person requires assistance to administer
insulin injections
·
his or her lifestyle is significantly restricted
by recurrent symptomatic
hypoglycaemic episodes
·
twice daily basal insulin injections plus oral
glucose lowering medications would
otherwise be needed.
Offer a trial of long-acting insulin analogue
[glargine /Lantus] if NPH insulin causes significant nocturnal hypoglycaemia.
Consider twice-daily bi-phasic human insulin
[pre-mixed] regimens, particularly where Hb
Consider pre-mixed insulin analogue preparations
rather than human insulin
preparations when:
·
immediate injection before a meal is preferred
·
or hypoglycaemia is a problem
·
or there are marked postprandial blood glucose
excursions.
Review use of sulphonylurea if hypoglycaemia
occurs with insulin plus sulfonylurea.
NICE Guidelines for Type 2 diabetes, May 2008
What is Patient
centred care?
Treatment
should take into account patients’ individual needs and preferences. Good
communication is essential, supported by evidence-based
NICE Guidelines for Type 2 diabetes, May 2008
L
The front page of this Newsletter covers three key
statements from the recently published NICE Guidance for Type 2 diabetes
[National Institute for Health and Clinical Excellence]. We highlight these 3
statements because they recommend what IDDT and many people with diabetes have
been saying for a long time, even though what is happening at the ‘sharp end’ –
where people are treated, can be quite different.
Firstly NICE is not saying that people with Type 2
should be refused blood glucose test strips but that they should be offered
blood glucose testing alongside education in how and when to carrying it out
and how to interpret and act on the results. So in future people who are denied
test strips can quote NICE guidelines!
Secondly, first line insulin treatment is not
with insulin analogues but with human insulin supporting the view that
analogues have not been shown to be superior and of course, they are significantly
more expensive, so we assume that NICE is not advocating wasting valuable
resources on them, except under certain circumstances. It is worth noting that
Levemir is not mentioned in these guidelines – it is still being assessed as a
‘new agent’ by NICE.
Thirdly, it is good to see that NICE favours
addressing individual needs and preferences and that patients should make
informed decisions about their care on evidence-based information.
NICE Guidance for Type 2 diabetes [May 2008]
Here is the summary of the key NICE recommendations
for the treatment of people with Type 2 diabetes for implementation by health
professionals:
Patient education
·
Offer structured education to every person and/or
their carer at and around the time of diagnosis – this can be in group sessions
run by people who have been specially trained to do this.
·
Provide individualised and ongoing nutritional
advice from a healthcare professional with specific expertise and competencies
in nutrition.
Setting a target Hb
·
Involve the person in decisions about their
individual Hb
·
Encourage the person to maintain their individual
target unless the resulting side effects [including hypoglycaemia] or their
efforts to achieve this impair their quality of life.
·
Offer therapy [lifestyle and medication] to help
achieve and maintain the Hb
·
Inform a person with higher Hb
·
Self-monitoring
·
Offer self-monitoring of plasma glucose to a person
newly diagnosed with type 2 diabetes only as an integral part of his or her
self-management education. Discuss its purpose and agree how it should be
interpreted and acted upon.
Starting insulin therapy
When starting insulin therapy, use a structured
education programme that includes:
·
continuing telephone support and support from an
appropriately trained and experienced healthcare professional
·
frequent self-monitoring
·
dose titration to target [how to adjust insulin
doses]
·
dietary understanding
·
management of hypoglycaemia – how to avoid it and
treat it
·
management of acute changes in glucose control.
The type of insulins that NICE recommends is covered on the front page.
Other recent NICE guidelines
Pregnancy and diabetes [
New NICE guidelines on pregnancy and diabetes have
been issued and they recommend that:
·
women with diabetes should be able to access
specialist services before they become pregnant.
·
They should aim for a fasting blood glucose of 3.9
to 5.9mmol/l and one hour post-prandial [after meals] blood glucose below
7.8mmol/l if planning to become pregnant and during pregnancy.
·
Women should be directed to take folic acid
supplements and given lifestyle advice.
·
They should be told of the importance of
maintaining vitamin D levels during pregnancy and while breast feeding and if
required, they should be offered Vitamin D supplements.
·
Health professionals should advise on good
glycaemic control to reduce the risk of miscarriage, malformation at birth,
still birth and neonatal death.
·
GPs must tell women who are pregnant and those
planning to conceive to avoid alcohol because it can increase the risk of
miscarriage in the first trimester.
·
Women with gestational diabetes should be offered
advice on diet and exercise and offered a fasting plasma glucose test at the
6-week postnatal check and yearly after that.
Transplanting donated pancreatic islet cells for patients with Type 1
diabetes [
NICE has issued an ‘interventional procedures
guidance’ on islet cell transplantation and this advises the NHS on when and
how new procedures can be used in clinical practice. It is also to help people
who have been offered islet transplantation to decide whether to agree to it
[consent], or not. In brief NICE says:
·
Pancreatic islet cell transplantation is safe
enough and works well enough for use in NHS hospitals with experience of the
procedure. So it can be offered routinely as a treatment option for Type 1
diabetes provided that doctors are sure that [i] the patient understands what
is involved and consents and [ii] the results are monitored.
·
Before the patient agrees [or doesn’t agree] to the
procedure, doctors should make sure that extra steps are taken to explain the
potential risks of the procedure and the uncertainty about how well it works in
the long-term.
·
·
NICE has decided that more information is needed
about how islet transplantations affect quality of life and how well it works
long-term.
NICE looked at 8 studies on the benefits and risks
of the procedure. The possible benefits appear to be reduction in severe hypos,
improved hypo awareness, better control, less fear of hypos. The possible risks
are bleeding into the abdomen, a blood clot in the portal vein, high blood
pressure in the liver, problems caused by the patients lowered immune system
[through using immunosuppressants for life] and the possibility of donor cells
carrying infections or cancerous cells.
NICE approves Rimonabant for obesity [March 2008]
NICE has approved the use of rimonabant [sold as
Licensed in 2006, the European drug regulator
issued a warning against using rimonabant in people with major depression.
However, the
NICE
guidance on lifestyle changes for repeat heart attacks
For
the first time NICE has issued guidance that has recommended lifestyle change,
alongside drugs, for preventing repeat heart attacks. This is in line with the
growing evidence that specific lifestyle changes reduce the risk of second
heart attacks.
The
new lifestyle section says patients should:
·
give
up smoking
·
be
physically active for 20-30 minutes a day
·
eat
a Mediterranean-style diet
·
eat
more oily fish or be prescribed certain preparations of omega 3 fatty acids.
Research
has found that one specific omega 3 supplement called Omacor, cut the risk of a
patient dying suddenly by up to 45%. Omacor is currently the only omega 3
supplement with a licence for post heart attack treatment. NICE estimate that
the cost to the NHS of using it might be quite high as around 260,000 people
have a first heart attack every year and 20% of them might need supplements
because they are intolerant to oily fish. NICE estimates that the cost could be
£7million.
INJECTION ISSUES
Mixing up your insulins
In IDDT’s
Simple yet innovative solution for illiterate or non-English speaking
people using insulin
Carole Malloch, Diabetes Nurse Specialist
slow-acting insulin can cause a severe
hypoglycaemic attack during the night which can lead to fitting and
unconsciousness or, worse case scenario, brain damage.
I have therefore, devised stickers to apply to the
insulin pen devices.
Day-time
– at meal times 
Night-time 
Copyright © 2008 by Royal Berkshire NHS Foundation Trust all rights reserved.
Can’t remember whether I’ve injected or not
Not difficult for this to happen, once you wonder
whether you have injected you can’t remember whether it was this morning or
yesterday morning!
·
One of our members on two injections a day, has
countered this by putting out 2 needles for the day then all he has to do is
look at the number of needles to know whether or not he has injected.
·
Lilly has introduced the Lilly HumaPen Memoir, the
first pen with a digital memory for use with Humalog and Humulin insulin
cartridges. It enables people to check the time, date and amount of the last 16
doses taken. The Memoir also has a dialling system that enables users to set
the dose by turning a knob. The correct dose appears in a display window and
any dosing error can be corrected without wasting insulin. For more details
visit www.lilly.co.uk
HYPOGLYC
Reduced awareness of hypoglycaemia still high
Research to date into impaired hypo unawareness
[loss or reduced warnings of low blood sugars] has not been very good but there
has been a general acceptance that about 25% of people with Type 1 diabetes
have reduced warnings of hypos.
·
significantly older
·
had a longer duration of diabetes
·
had a 6 fold higher increase in severe hypos in the
previous year. In the group with normal awareness the prevalence of severe
hypoglycaemia was 20.1% but was 50.5% in those with impaired hypo awareness.
·
There were no differences in control as measured by
the Hb
The researchers concluded that significant
proportion of people with Type 1 diabetes (19.5%) continue to have impaired
hypo awareness ‘despite the introduction of novel therapies’. This is an
interesting comment because the land mark DCCT study in the early 1990s showed
that there was a 3 times greater risk of severe hypos with intensified insulin treatment
so as more and more people are on intensive treatment and/or targeted to have
near normal blood glucose levels, we can hardly expect hypo unawareness to
improve!
On a daily basis hypoglycaemia and loss of warnings
are the greatest concern to people with diabetes. This study demonstrates that
despite introduction of new insulins, multiple injection regimes and increased
blood glucose testing, over 20 years there has been no improvements in the
issue that has always mattered most to people with Type 1 diabetes.
Ref 1 Diab Med,
Road traffic accidents and insulin use
People with diabetes treated with insulin are
restricted from driving group 2 and class C1 and D1 vehicles based on an
assumption, rather than evidence, that an increased risk of hypos will cause
traffic accidents.
Results showed:
·
the estimated overall annual accident rate for the
non-diabetic population was 1469 per 100,000 and for the diabetic population
856 per 100,000. Less accidents in people with diabetes is an unexpected result
and could be due to age differences.
·
When looking at insulin treated people by age,
there was no significant difference in the accident rate compared to the
non-diabetic population.
There are factors that may influence these results:
[i] within the diet/tablet treated group of people
with diabetes over 90% were over 45 years old whereas in the non-diabetic
population 40% were in the younger age group who tend to have more accidents.
[ii] people with diabetes may be less likely to
report accidents for fear of losing their licences and
[iii] some people with diabetes who have
problematic hypos may voluntarily give up driving.
The researchers concluded that insulin-treated
people as a group do not pose an increased
risk to road safety but emphasised the need for individual risk-based
assessment when considering driving restrictions. This supports the present DVL
DVL
The information leaflet issued by the DVL
The DVL
·
not to drive if blood glucose levels fall below
4mmol/l
·
not to resume driving for 45 minutes after the
levels have returned to normal
·
to take a snack before driving if the levels are
5mmol/l or lower.
There is a new law in
Visual field loss - grim determination with the DVL
In the past the DVL
Obviously in cases where people do not meet the
required standards of vision or visual fields, then driving licences should not
be issued or renewed but some people are being denied their driving licences
even when their retinopathy has remained stable ie it has not worsened and they
have not had laser treatment for many years. In this situation we
advise people to appeal against any decision to
remove their licence and where people have already lost their licence, to apply
again.
Grim determination paid off for Pat Millar after 8 years without a
driving licence
Pat Millar lost his driving licence 8 years ago
because he had had laser treatment some years earlier.
Several other people have also received their
driving licences back but as far as we know, not after 8 years like Pat. Pat is delighted to be driving again but of
course, he is questioning whether or not the DVL
There are some messages here if the DVL
·
If you had laser treatment years ago, your
retinopathy has remained stable and think you are fit to drive, don’t just give
in if the DVL
·
The DVL
·
Don’t be intimidated by the DVL
Many older people are prescribed an aspirin a today
to prevent blood clotting in the arteries - thrombosis. Clotting is caused by
platlets in the blood joining together to form a clot or thrombosis.
[The Evaluation of Methods and Management of
We hope that this information may help
you in your choices about taking aspirin.
L
On
·
Unilet ComforTouch lancet with a
specially shaped 28-guage lancet and a recapping facility for safer disposal.
This lancet is suitable for most skin types and compatible with the majority of
finger pricker devices.
·
Unilet GP Superlite lancet is a 23-gauage
lancet suitable for people with tougher skin or those used to a thicker lancet.
It is compatible with most leading finger pricker devices.
·
Unistik 3 is an all-in-one lancing device. It is a preloaded lancet
penetrates the skin to precisely the right depth and then retracts back into
the device ensuring its safe disposal. It has the added feature of Comfort Zone
Technology and is a more comfortable way to take a blood sample. There are
three variants available:
·
Unistik 3 Comfort – suitable for most skin
types
·
Unistik 3
·
Unistik 3 Extra – suitable for tough skin
and larger blood samples required for home cholesterol testing.
For more information call: Owen Mumford
COUNTING THE CLICKS – SOME
In IDDT’s
For those who are visually impaired:
Innolet – using the Innolet which is a dial up injection
device which looks like a clock and the unit numbers are larger. You just have
to twist to the right number of units. It dials up to 50 units so the first 50
could be dialled up and injected without counting, then there is only a need to
actually count the remaining 10 units. The Innolet is made by Novo Nordisk, so
is only available with some of their insulins: Insulatard, Mixtard 30 and
Levemir.
NovoPen Magnifier – this is a little
magnifier that fits over the end of the NovoPen 3 to enlarge the numbers.
For people who are blind or have very little sight:
·
Counting the musicians way – this is hard
to explain in writing! For example, divide the 60 units up into groups of 6 so
that you only have to count up to10 each time counting as follows: 1 followed
by 1 to 10, 2 followed by 1 to 10, 3 followed by one to 10 etc up to 6 followed
by 1to 10. I hope you can follow this!
·
Perhaps easier still breaking up the 60 into 6
‘chunks’ of 10 units and putting 6 coins in a pile on a table and with each
‘chunk’ of 10 units move a coin from left to right or better still have 2 boxes
one with 6 counters and swap a counter to the other box for every 10 units.
·
If the pen dials up to say 70 units, dial up the 70
without counting and then count 10 backwards until 60 units is reached.
·
Finally after thinking about this for a whole
weekend, one member suggested that a sighted person cut a piece of card for the
exact distance that the top of the pen when it comes out to the correct dose,
and this is used to slotted in for each dose – not sure about this one!
Some answers to other frequently asked questions……..
My insulin dose is large, I have to inject with my
pen twice
The amount of insulin a pen can deliver varies with
the different brands of pens, but a frequently grumble made to IDDT by people
on high doses of insulin, is that their dose is higher than their pen will
deliver in one injection and so they have to inject twice. There is a simple
answer – use a 100unit syringe and a vial of your insulin and then you can draw
up to 100units and only inject once each time. You may prefer to use a pen when
you are out but you could use a vial and syringe at home. While pens are great,
they are not so great of you have to inject twice every time.
Yes, instead of using a pre-filled ‘disposable’
pen, you could use a non-disposable pen and just replace the cartridges. It is
interesting marketing that the insulin manufacturers never refer to pre-filled
as ‘disposable’ but they are and are not environmentally friendly. IDDT made
these points in the regulatory authority consultation when disposable pens
first appeared but to no avail - perhaps we were ahead of time as saving the
environment was not as high on the agenda. Disposable pens have a place, such as
for people who have problems with their hands, but if you want to be more
environmentally friendly, talk to your GP practice about changing to a
non-disposable pen.
DISCRIMIN
From time to time people with diabetes contact IDDT
because they are having difficulties at work. This maybe being put under
pressure to work without being given time to eat or for newly diagnosed people,
having to carrying out tasks that they do feel confident in doing because they
are still learning to manage their diabetes. This can become very stressful
which does not help diabetes control and makes going to work something to
dread.
The Disability Rights Commission is now part of the
Equality and Human Rights Commission and if you need help or advice relating to
discrimination at work or at school, you can call the Equality and Human Rights
Commission Helpline.
The details are as follows: for
MORE ON
While
there may still be some debate about the increase risks of heart attacks with
Type 2 drug,
The latest position on
Last November in the
In 2007 the European Medicines
Position in
The minutes of the February meeting of the Managed
Clinical Network for Diabetes in
The Physicians Committee for Responsible Medicine
in the US has petitioned the FD
With these mixed messages, if you are taking these drugs, we can only
recommend that you discuss your options with your doctor.
INSULIN PUMPS LINKED TO INJURIES AND DEATHS IN TEENAGERS
Between 1996 and 2005 this review of the adverse
events reported to the FD
Insulin pumps are the size of a cell phone and worn
on a belt or pocket. They send insulin into the body through a plastic tube
with a small tip that inserts under the skin and is taped in place. Users must
tell the device how much insulin to give before each meal, based on the
estimated carbohydrates in the meal. The devices also deliver a continuous low
level of insulin.
Dr John Buse, the
The authors of the study: "The
FD
The key message here is that insulin pumps must be
treated with respect and an understanding that without appropriate blood
glucose monitoring and care, pumps increase the risk of getting ill more
quickly than injections.
It is also worth remembering that just because a
younger child has accepted the extra care and attention that is required when
using a pump, as children become teenagers they can change. The reliable child you
once had can become a rebellious teenager who does not always take care of
their diabetes.
WH
Have you ever wondered who decides which research
will be funded?
We may think that researchers themselves know better
than both clinicians, patients and carers, but do they? How do they know what
is important to those living and working with diabetes everyday? Sometimes we
may wonder if researchers are more interested in ‘research’ itself, forgetting
that the only reason for doing research is to assist people who have a disease
such as diabetes. It makes sense therefore, that the people with diabetes
should be involved in driving the research agenda – setting the priorities for
research funding.
There is an additional problem nowadays.
Looking at research priorities is a complex
business perhaps especially so in diabetes. This is highlighted by the title
question, ‘what are the research
priorities for people with diabetes?’ The
question is too simplistic. To start
with there are two types of diabetes – Type 1 and Type 2 and the research
priorities for people with Type 1 diabetes may well be quite different from those
of people with Type 2. Then there is another group – the parents and partners
of those with both types of diabetes who may have different priorities for research.
We can break this down even further to see that the priorities of people who
have lived with both types of diabetes for a long time may be different from
those who are relatively newly diagnosed.
There are also the clinicians, the doctors who look
after people with diabetes in their clinics and surgeries everyday. They will
certainly have their views on priorities for research and again these may be
different from those of people with diabetes but they are just as valid. How
much influence do they have over which research is funded?
Just what do we mean by research priorities?
Perhaps for many of us who are unfamiliar with the
research world, this expression alone sounds out of our league, but it isn’t.
Research should be driven by what is important to patients, what matters most
to them, what bothers them most about living with a condition such as diabetes.
People with Type 1 and Type 2 diabetes have never
been asked in any organised way what concerns them the most about having
diabetes in order for this to influence how research money is spent. Perhaps
this is surprising as very often this is money they have raised or it has come
from the public purse! If the important issues for patients are identified, the
next step is to find out if research has already looked at these issues and if
not, then this has identified gaps in research that need to be addressed.
For people using insulin, hypoglycaemia is thought
to be their major day to day concern and fear of hypos is known to prevent
people from achieving the target blood sugars. Linked with this is that
impaired hypo warnings are a major problem for many people with Type 1
diabetes.
Here’s an unanswered question: if we avoided some hypos by raising target
blood glucose levels to 5 to 8mmol/l instead of 4 to 7, would the risk of
complications be any greater and if so, how much greater? The answer to this
question could make life a lot easier and enable people treated with insulin to
make more
But there are treatment uncertainties that we may not realise are
uncertainties!
We may think that the treatment we are receiving is
based on evidence of benefit and that it is known to be the best for us. But is
the case? Do we ask this question? Very often we don’t, we simply assume that
the treatment we are given is ‘the best’. Sometimes we may prefer not to ask
questions because the answer could be ‘I don’t know’ and some people find this
difficult to live with.
For example, it is hard to believe that once a new
insulin appears on the market, suddenly it appears that our clinic decides that
this is the best insulin for everyone – and there are group sessions of
transferring people to the new insulin, as happened with Lantus. But do we know
which groups of people are better suited to certain types of insulin? No we
don’t, because the research has not been done. So although insulin is the very
basis of treatment for Type 1 diabetes and some people with Type 2 diabetes, it
is staggering to realise that we don’t know which insulins suit which people
best. If this isn’t a treatment uncertainty, I don’t know what is!
DUETS and Diabetes
DUETs stands for ‘Database of Uncertainties about
the Effects of Treatments’ which lists treatment uncertainties which arise from
clinicians, patients and from reviews of research which highlight that more
research is needed into a particular topic. Thanks to Dr Roger Gadsby and the
team at
DI
People with diabetes are more prone to gum disease
and tooth decay than the general population, partly because glucose remains in
the saliva.
The article issues the following advice:
·
See the dentist on a regular basis and inform
him/her of any changes in your health and medications.
·
Tell the dentist about any sores, swellings,
redness or painful areas in your mouth.
·
Eat a normal meal before the dental appointment,
take all your usual medications on time, take your blood glucose monitor with
you and tell the dentist if you have hypo symptoms.
Gum disease and gestational diabetes
Recent dental research [Journal of Dental Research,
RESE
Probably the most exciting research of our time
Some time ago
Dr Faustman found that mice with a form of diabetes
similar to Type 1 diabetes in humans started to improve within days of being
injected with the BCG vaccine and eventually were free of diabetes. The vaccine
destroyed the abnormal white blood cells which were obstructing the production
of insulin in the cells of the pancreas.
Trials on humans are taking place at
The first step is to find out if the same strategy
can be of BCG vaccination can be used in humans. The research will be a long
process but it seems one of the best hopes there has ever been. The trial
information is available at www.faustmanlab.org.
Six new genes linked to Type 2 diabetes
Scientists have found six new genes that are linked
to Type 2 diabetes. Each of the genes raises the risk of developing Type 2
diabetes by a small amount but the scientists believe that the combination of
all six could be powerful. This discovery could help in the development of new
forms of prevention and treatment.
Some of the disease variants are in 10% of the
population and the one that's increasing the risk is the majority version which
is in 90%. Inheriting a disease variant of any of the genes from either parent
could increase a person's risk of developing Type 2 diabetes by 10%-15%.
In the study 90 researchers from more than 40
European and US centres pooled genetic data gathered from more than 90,000
people. The researchers comment that none of the new genes were previously
suspected of having a role in diabetes, so there is still a lot more research
needed to work out what the genes are responsible for. Nearly all the genes
found so far seem to be affecting the ability of the pancreas beta cells to
compensate for insulin resistance.
Why some people may be more prone to complications
I am sure many readers will have come across some
people who don’t seem to take a great deal of care of their diabetes but don’t
develop complications and yet others who try really hard, do. There may now be
an explanation.
Researchers at
The
IDDT BUSINESS
If you are an internet user you can help IDDT to raise money every time
you search the web.
Everyclick.com is a great new search engine. It
works just like other major search engines but it also generates cash for
charities and it doesn’t cost you or us a penny so it is a great way to help
IDDT. You can make Everyclick.com your homepage or every time you search the
web, simply use http://www.everyclick.com/IDDT
IDDT receives a few pence every time you use it, so
ask your friends to do the same or set your e-mails to automatically add the
following at the end:
Search the web and raise money for IDDT - http://www.everyclick.com/IDDT
Don’t forget IDDT’s
Going on holiday? IDDT has a ‘Holiday
Information Pack’ with
Can anyone
help?
One
of our members would like to know if anyone has spare copies of a video of a
programme called Same Difference on Channel 4 about 1990 and another on BBC
Watchdog covering the human insulin debate. If so, please let Jenny know on
01604 622837 or e-mail enquiries@iddtinternational.org
INSULINS – THERE’S STILL CONFUSION!
Pork insulin
·
Hyprurin Porcine Neutral [short-acting]
·
Hypurin Porcine Isophane [intermediate-acting]
·
Hypurin Porcine 30/70 Mix
·
Hypurin bovine insulins continue to be available as
before.
Human insulin
There is also confusion about which human insulins
are available. People who have had adverse effects from analogue insulins and
want to change back to their original human insulin have been told that these
are no longer available. In some cases, only insulin in certain delivery
systems has been discontinued so the insulin type is still available but not
necessarily for the same delivery system. For example, Novo Nordisk
discontinued Insulatard in pre-filled pens but it is available in cartridges
for pens as well as vials and pre-filled dosers. If you have always used
pre-filled disposable pens, using cartridges instead simply means using
replacing the empty cartridge in the pen with a new one and not throwing the
pen away each time – some would say more environmentally friendly!
So the commonly used Novo Nordisk human insulins and their delivery systems
still available are:
|
Name of insulin |
Source |
Delivery system |
|
|
Human |
Vial |
|
Insulatard [Intermediate] |
Human |
Vial, cartridge, pre-filled doser |
|
Mixtard 30 |
Human |
Vial, cartridge, pre-filled doser |
Important option – change brands!
People who want to use
If we have learned anything from the misinformation
that has been flying about pork insulin availability, it is that we, as
patients, cannot always assume that the information we are given is accurate so
we have to ask questions and if necessary, do our own research on what insulins
are available. Or just give IDDT a call on 01604 622837 or e-mail enquiries@iddtinternational.org
THE END FOR INH
Cases of cancer with Exubera
On
The warning states that all patients who developed lung cancer had a prior
history of smoking, but there were too few cases to know whether the development
of lung cancer was related to the use of Exubera.
Then on
But if it should ever reach
the market, who’s going to prescribe it and who’s going to use it?
Lung function research
Part of a study known as the
The unknown risk of long-term lung damage has been
one of the concerns about inhaled insulin but one of the arguments in its
favour was its advantages for people with Type 2 diabetes because of their
fears of injections. In the light of this new research, the decision to
discontinue inhaled insulin seems the safest one!
FROM OUR OWN CORRESPONDENTS
Dear Jenny,
The article on statins in the
Mrs J.P.
Sexual dysfunction
Dear Jenny,
Thank you for the excellent publication on sexual
dysfunction in men and women which was most informative. I would like to
comment of the limits on how many tablets, such as Viagra, that can be
prescribed on an NHS prescription. In my case this is 4 tablets per month on
the NHS an any extras cost £40 for 4 tablets. The tablets come in 3 strengths,
25mg, 50mg and 100mg. I asked my doctor to prescribe 100mg tablets and I then
cut them to the required size with a serrated knife which is easily done while
they are still in the packaging.
Name
withheld
Jenny’s comment: When Viagra first became
available IDDT and many other organisations raised objections when the Dept of
Health placed a limit of 4 tablets a month for the treatment of impotence. It
was, and is, grossly unfair and has caused people to resort to these measures.
I’m appalled!
Dear Jenny,
I was flabbergasted to read in the
Thank you for all the good work you do for all of
us.
D.P.
South
East
Dear Jenny,
Thank you very much for the information and IDDT
Newsletters you have sent me. I appreciate this very much. I have had Type 1
diabetes since 1961 when I started on beef insulin and have been on it ever since.
I have worked hard to remain free from all the severe diabetes complications.
I have received my beef insulin from CP
Pharmaceuticals since 2001 and my diabetes is well-controlled. When I tried
so-called ‘Human’ insulin in 1998 I had terrible low blood sugars everyday
followed by highs – it was a living hell.
Thanking you for helping and for listening to all
of us who still need animal insulins to survive. In the
Name supplied,
Jenny’s comments:
Pumps and animal insulin
Dear Jenny,
I would like to use an insulin infusion pump but as
I have adverse reactions to all synthetic insulins and to pork insulin, I can
only use beef insulin. My hospital clinic has told me that I cannot use pork or
beef insulin in a pump. You did tell me that some IDDT members successfully use
pork insulin in pumps and at least one uses beef insulin but still my clinic
said that it was not possible.
I contacted the manufacturers of beef insulin and if
any of your readers are in a similar position they will find this information
useful. “Hypurin Bovine Neutral
insulin,is a soluble, short-acting insulin which contains a phosphate buffer
and is suitable for use in subcutaneous pumps. In the
By e-mail
Note: Hypurin Porcine Neutral also contains a phosphate
buffer and therefore on the basis of the above statement from the
manufacturers, is suitable for use in pumps.
The change worked for me
Dear Jenny,
If
any of your members are worried about the discontinuation of certain pork
insulins my experience may help. I am now 60 and have been diabetic since
1979.I have been on pork Insulatard and Hypurin Porcine Neutral for many years
and was very worried about changing to a new insulin but last October I saw a
new diabetic nurse and she prescribed the GM insulin analogue, Levemir in Flexpens.
Since then I have not had a single hypo, whereas before they were a regular
occurrence, and now my general health and moods have greatly
improved. The diabetic clinic doctors never offered me this new insulin
regime and I cannot thank my diabetic nurse enough. My wife says I am a
lot easier to live with now!!
Mr G.D.
By e-mail
Note: This is great news
for Mr G.D. but what works for one person does not necessarily work for another
so it is vital that the choice of natural animal, human and analogue insulins
remains available.
STR
Many older people like me, will remember life when
we ate fats without thinking about whether they was good or bad for our hearts
and plenty of butter on our toast was a treat. Of course life was different
then and we all got a lot more exercise but I don’t remember when saturated
fats became bad for us.
However, according to an article in MSNBC Dec 2007,
the first and influential condemnation of saturated fats was made in 1953 by Dr
This all sounds good enough to have the impact it
has had – to change the thinking so that recommended healthy diets were low in
fats [and high in carbohydrates] but the statistics for 22 countries were
actually available and these showed a different picture.
Just shows what manipulation of statistics can do!
YOG
Some studies in people with Type 2 diabetes have
shown that yoga positions can lower fasting blood glucose levels and also can
increase nerve function in people. Certain postures and movements have greater
effects than others by stimulating the endocrine glands in the body.
·
The Yoga postures that induce relaxation and
certain breathing exercises are thought to stimulate the pancreas – this could
be due to the alternating contraction and relaxation of the abdominal muscles
and increased blood flow to the pancreas making it more efficient.
·
The rotation of the body and the holding and stretching
positions increases circulation – thought to be because yoga increases the
elasticity of the blood vessels.
·
Meditation is an essential part of yoga to attain a
relaxed mental state and this can have a calming effect and relieve stress. In
people with diabetes high stress levels often cause high blood sugars, so it is
important to remember that yoga meditation could cause unexpected low sugars.
In Type 1 diabetes the body does not produce
insulin and stimulating the pancreas is not effective. It is likely that yoga
will not have as big an impact on people with Type 1 as people with Type 2
diabetes.
Having said this, it is important that people with
both Type 1 and Type 2 diabetes who attend yoga classes to regularly monitor
their blood glucose levels, take their medication as directed and have
emergency glucose available in case of sudden drops in blood sugars. Some
people with Type 2 diabetes who regularly participate in yoga do end up
reducing their medications.
What do we know
about the effects of stress?
Short bursts of stress can be good
for you -
scientists have known for a long time that stress can have a negative effect on
the body. But researchers have looked at 300 scientific papers about stress
involving 19,000 people and found that a short burst of stress, such as that
caused by giving a speech, may strengthen the immune system. However,
long-term, unrelieved stress such as that caused by living with a permanent
disability or caring for someone with a long-term disability, may weaken the
immune system making people less able to fight infections. 'Good' stressful
situations that last only a short time appear to cause the 'fight or flight'
adrenaline response and this boosts the body's natural defence against
infections. The important factor appears to be knowing that the event causing
the stress or anxiety will end soon.
Short bursts of stress and diabetes - a study published in Diabetes
Care, June 2007, looked at the effects of short-term mental stress in people
with Type 1 diabetes with fairly good blood glucose control. It found that both
in a fasting state and after a meal, mental stress had little effect on blood
glucose control although heart beat, blood pressure and salivary cortisol
levels increased. [Salivary cortisol is a hormone produced in response to
stress.] This study only looked at short-term stress and not chronic stress and
it only looked at people with 'fairly good control' - the results may be
different for people with long-term mental stress or in people with 'poor' control.
Stress may raise
cholesterol levels -
studies in the past have shown that stress is linked to increased heart rate
and weakened immune systems. Recently a team from University College London has
found that stress also appears to raise cholesterol levels over the long-term
in some people.
199
people were given stress tests and cholesterol tests three years apart.
Cholesterol levels had gone up over time in everyone but some people showed
large increases even in the short-term while others showed very little
response.
GENERIC DRUGS
The differences between brand-name and generic
drugs can sometimes affect how a drug works, particularly in cases where the
exact dose is critical. Certain conditions require people to maintain a
constant and precise level of medication in the blood over long periods and
switching drugs for certain conditions may upset a delicate balance eg
epilepsy, asthma, diabetes and thyroid problems.
What are generic drugs?
Once a brand-name drug has run out of patent, it is
allowed to be made by other companies and can be sold much more cheaply.
Generic drugs have to have the same quality, strength, purity and stability as
brand-name drugs but they may differ in the inactive ingredients eg
preservatives.
If you experience difficulties with a drug, discuss these with your
doctor and if necessary your drug can be changed.
Note: in an online survey of 781 registered nurses in
the
SP
It is
recognised that caring for someone with a physical disability or an illness can
be and is stressful and tiring but so often diabetes is a ‘hidden’ condition –
not obvious to people around. It is sometimes hard for people with diabetes to
understand or recognise that their diabetes can be a worry for their partners,
spouses or parents [their family carers]. Indeed, some people would resent the
suggestion that their families have to do any ‘caring’ from them. But family
carers may have their own fears and worries that are quite different from those
of the people with diabetes they love. For example:
·
carers
often have to handle hypos, especially in the night and then they may live with
the fear of having to handle another hypo.
·
If
they are the person who does most of the cooking, they may feel their level of
knowledge is not adequate and worry about the food they are preparing.
·
They
may worry about the risks of long-term complications.
·
Carers
can feel, and sometimes are, excluded from clinic visits despite having to know
about their loved one’s diabetes. We are pleased to see that the NICE
Guidelines for Type 2 diabetes state that ‘if
the patient agrees, families and carers should have
the opportunity to be involved in decisions about treatment and care.’
In 2006
a survey showed that there are 6 million carers in the
So if
you are a carer, think about your own health and ask your GP for a health check
that includes a blood pressure check, diabetes check and a mental wellbeing
check.
NHS NEWS
Prescription charges - in
Nurses have called for in-house cleaning in hospitals - at the Royal College of Nurses conference in
Specialist nurses could save the NHS could save money - research has shown that introducing diabetes specialist nurses [DSNs]
into emergency medical units could save the NHS £100million a year. In a trial
lasting a year DSNs made daily weekday visits to the emergency unit of
Leicester University Hospitals and found 111 people with diabetes of which 47
were discharged within 24 hours compared with the average stay of 11 days. The
number of hospital days taken with caring for people with diabetes was cut by
42% which saved the hospital £111,155 during the year. If this system was
implemented throughout the country, the NHS could save £100million a year.
Choice of hospitals expands – from
It
appears that there has only been a luke-warm response to this policy of choice
probably because it relies heavily on the GP electronic ‘choose and book’
system. This is currently only used for about half of all referrals so patients
and doctors have to phone round to hospitals.
Re-think on
electronic patient records –a National
Some
experts say that the system should be scrapped in favour of local IT systems.
One
of the problems is that the system uses implied consent by patients whereby
patients’ records are automatically on the IT system unless they specifically
opt out. This latest report recommends the opposite – to protect patients, they
should have to give explicit consent every time their electronic ‘Summary Care
Record’ is viewed, as happens in
New polyclinics are flawed according to expert - polyclinics are planned as part of the NHS reforms. These are
super-surgeries housing many GPs who will carry out relatively minor hospital treatment
- dermatology, physiotherapy, social services and importantly for our readers,
diabetes care.
The argument in favour?
The arguments against? Professor Martin Roland, of
We don’t know but we need reassurances that the
level of care will not fall, that doctors and nurses staffing polyclinics will
be trained, especially for specialist conditions such as diabetes.
TESTING FOR KETONES – just a reminder
Ketones are substances formed when the body breaks
down fats and carbohydrates for energy or food and this occurs if there is not
enough insulin present and therefore blood sugar levels are very high. If
untreated, this can lead to diabetic coma and ketoacidosis [DK
When there are too many ketones in the body they
spill over into the urine. So ketones in the urine occur with loss of diabetes
control and this can a sign of other illnesses eg ‘flu. Unusual physical or
emotional stress can also cause ketones.
When to test for ketones
Correction
The
SNIPPETS
Being obese is more dangerous than smoking
Sleep can keep you slim
Men think they are slimmer than they are
Men perceive
themselves to be more than three inches slimmer than they really are with most
of them under-estimating their waist size by an average of
2.7 inches. These were the findings from a study in
Having a large waist is one of the main risk factors for developing Type 2
diabetes so it is important that we don’t fool ourselves about our size.
Hospital food in
It seems that hospital food is not just a problem
in the
Japanese consumers opposed to GM foods and agriculture
Conflicting
evidence about cinnamon
A s we have reported in previous newsletters, some studies
have suggested that cinnamon added to the diet may help to lower blood glucose
and cholesterol levels in people with Type 2 diabetes. Now a recent study of 43
people with diabetes has found that cinnamon did not change either blood
glucose, insulin or cholesterol levels over 3 months [Diabetes Care, Sept
2007].
Laboratory
research suggests that cinnamon may make body cells more sensitive to insulin,
so the connection is that Type 2 diabetes develops when cells lose their
sensitivity to insulin. There is also evidence that cinnamon slows down
digestion which may tend to lower the blood sugars after a meal. However, this
new study suggests that cinnamon does not have any beneficial effects, so why
the difference? It could be that in this latest study the participants were
taking various diabetes drugs but in previous studies, the participants were
not taking any drugs.
Kisses are good for the soul but…….
Doctors have found out that they have the same
effect as strain on the body. Thyroid activity increases, blood sugar levels
rise, the body starts to produce insulin and each time we kiss someone our
heart beats faster. Kisses are also good for your teeth as they increase the
flow of saliva which in turn decreases acid levels in the mouth so reducing the
risk of tartar and decay.