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Availability of Natural Animal Insulins in the UK

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GM Vs animal insulin

Choices – The Evidence
Evidence from people with diabetes
A little bit of history
Facts
Action and duration times of animal and GM ‘human’ insulins
Hypoglycaemia and loss of warnings
‘Dead in Bed Syndrome’
The concerns of patients are justified
Availability of natural animal insulins in the UK
Changing your insulin
What to do if your consultant refuses to change your insulin
Availability of animal insulin if admitted to hospital
Frequently asked questions
Allergic reactions to insulin

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Availability of natural animal insulins in the UK

GM ‘human’ insulins are supplied in the UK by three major pharmaceutical companies: Eli Lilly, Novo Nordisk and Sanofi-aventis. Information about the availability of insulins by these companies is readily available from your GP or diabetes clinic. However, information about natural animal insulins is not so readily available and all too frequently patients are not informed of their availability, despite their right to an informed choice of treatment. Even when suffering unaccountable symptoms and loss of warnings of hypoglycaemia, most people are not given the opportunity to try animal insulin. As a result, many people do not realise there are other options or that they are being prescribed a genetically modified drug. Some believe that ‘human’ insulin is actually insulin obtained from man. It is not, it is produced genetically from bacteria or yeast. Animal insulins are extracted from the pancreases of pigs and cattle.

Animal insulins in the UK are supplied by one company:

  • Wockhardt UK [formerly CP Pharmaceuticals Ltd] – Supply pork and beef insulins in both vials and cartridges. The following are available.

Pork Insulin

Hypurin Porcine Neutral

Short acting in 10ml vials and 3.00ml cartridges

Hypurin Porcine Isophane

Intermediate acting in 10ml vials and 3.00ml cartridges

Hypurin Porcine 30/70 mix

Mixture of 30% Neutral and 70% Isophane in 10ml vials and 3.00ml cartridges

 

Beef Insulin

Hypurin Bovine Neutral

Short acting in 10ml vials and 3.00ml cartridges

Hypurin Bovine Isophane

Intermediate acting in 10ml vials and 3.00ml cartridges

Hypurin Bovine PZI

Long acting in 10ml vials

Hypurin Bovine Lente

Long acting in 10ml vials

 

Future availability:
Wockhardt UK CP Pharmaceuticals are committed to supplying beef and pork insulins in the future and do supply to people in countries where animal insulins through importation for personal use schemes. .

Wockhardt website: www.wockhardt.co.uk

Note: Novo Nordisk Pharmaceuticals Ltd discontinued their pork insulins, Actrapid, Insulatard and Mixtard 30/70 at the end of 2007 in the UK. Some health professionals, including pharmacists tell people that animal insulins are no longer available because they seem unaware that they are manufactured by Wockhardt UK.

As part of their global strategy, Novo Nordisk has discontinued animal insulins in all countries. In October 2002 Novo Nordisk confirmed to IDDT that they supply 20,000 people in the UK with pork insulin but despite this need, they made the decision to cease supplying at the end of 2007.

Retinopathy

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Retinopathy

Statistics

  • Diabetic retinopathy is the leading cause of blindness in people of working age in industrialised countries. It is estimated that 12% of people who are registered blind or partially sighted in the UK have diabetic eye disease.
  • 50% of people with Type 1 diabetes and 30% of those with Type 2 diabetes will develop some form of retinopathy in their lifetime and need treatment to reduce the risk of vision loss.

Facts

  • If diagnosed early enough diabetic retinopathy is a treatable condition.
  • The best way to try to prevent the development of retinopathy is to aim for tight control of blood glucose levels [as near normal HbA1cs as possible] and good control of blood pressure [lower than 130/80mm Hg]. These targets are not always achievable in everyone.
  • The only treatment for diabetic retinopathy is laser treatment. It can stop the progression of retinopathy and help to maintain sight.
  • Everyone with diabetes is entitled to free eye screening for retinopathy. In 2003, the Government set national targets for eye screening – everyone with diabetes was supposed to be screened by 2008. In 2009 Department of Health figures show that around 700,000 people with diabetes in England are still not being screened.
  • There are two vulnerable groups of people susceptible to retinopathy – firstly, pregnant women and secondly, children and adolescents. In the long term children and adolescents are at greater risk of microvascular and macrovascular complications of diabetes.

What is diabetic retinopathy?
Retinopathy is usually classified according to its severity. This may not be the same in both eyes. There are two classifications of diabetic retinopathy:

Background retinopathy
This is the first stage of the development of retinopathy and it is rare before 8 to 10 years of diabetes duration. At this stage the vision is normal and sight is not threatened. If there are diabetic changes present such as small haemorrhages, fatty deposits [exudates] or abnormal blood vessels [microaneurysms] then this is a sign that the retinopathy is worsening and the doctor will be alerted to arrange more frequent follow ups.

Proliferative retinopathy
This is where the blood vessels [capillaries] block and starve the retina of nutrients causing new vessels to grow. These new vessels grow either in front of the retina on to the back of the vitreous or occasionally on to the iris. The new vessels are fragile and may bleed into the vitreous which then affects the sight and may cause floaters, dots or lines and if severe, may cause clouding of the vision or loss of vision.

If the vessels grow on the iris, they can cause a rise in pressure in the eye and severe, painful glaucoma. The new vessels eventually cause scar tissue and this can lead to a retinal detachment where the retina becomes detached from the back of the eye resulting in severe loss of sight.

Points to remember:

  • If diagnosed early enough diabetic retinopathy is a treatable condition.
  • Regular eye checks do not prevent retinopathy but do enable early diagnosis and early treatment which will benefit your sight.
  • Small blood vessels in the retina become blocked, swollen or leaky causing oedema and new, fragile vessels grow haphazardly in the retina. This process can continue for years without causing visual symptoms or visual impairment: during this period, retinopathy can only be detected by eye examination.
  • For people with diabetes, eye checks are free in the UK.
  • In insulin treated diabetes, annual eye checks should be carried out and in children and young people after the onset of puberty.
  • In people with diabetes not using insulin, then eye checks should take place annually from diagnosis onwards.

Who may be at risk of developing diabetic retinopathy?

Retinopathy can affect people with all types of diabetes:

  • Anyone with diabetes treated with insulin, both young and old.
  • People with Type 2 diabetes treated with diet and tablets or diet only.
  • People who have well-controlled diabetes can develop retinopathy.

Can retinopathy be prevented?
No, but early ‘good’ blood glucose control and blood pressure may slow down the rate of progression of the condition. Improving diabetic control rarely has an effect on diabetic retinopathy itself, but it can prevent further deterioration. Therefore you should:

  • Always take your diabetic treatment – not doing so is harmful.
  • Control your diet.
  • Avoid becoming overweight.
  • Avoid smoking and alcohol.
  • Have regular blood pressure checks.

Retinopathy and genetically produced synthetic ‘human’ insulins
Two of the major insulin manufacturers have admitted that ‘human’ insulin therapy may cause serious adverse reactions. These are very much in line with the evidence from a significant number of patients.

On April 24th 2000, insulin manufacturer, Aventis Pharmaceuticals, issued the following statement in a press release:

“Human insulin therapy may be associated with hypoglycaemia, worsening of diabetic retinopathy, lipodystrophy, skin reactions (such as injection-site reaction, pruritus, and rash), allergic reactions, sodium retention and oedema.”

In the Patient Information Leaflets for some of the insulin analogues, oedema in the eye has also been listed as a possible adverse effect.

The use of synthetic may be putting some people at risk of unnecessary and avoidable complications to which they are already susceptible. Any increased risk of blindness or visual impairment is unacceptable to patients when there are natural insulins available in the UK that have not been said to cause such risks.

Retinopathy and driving
You should tell the DVLA and your motor insurers, if you have retinopathy that requires treatment or has been treated as this can affect your vision or visual fields. It is a condition that should be declared under the item ‘has there been any material change that could affect your driving.’ If you were involved in an accident and you had not declared that you have retinopathy, then you may not be insured and the DVLA could take action because you have not informed them.

Pycnogenol – are we missing something?

What is it and what does it do?
Pycnogenol is the extract of bark of a particular pine tree only known to grow in a specific area in France. Apparently French people with diabetes and retinopathy are often treated with a patented pill called Pycnogenol – not known to be used in the UK or the US.

Pycnogenol apparently is made up of a particular group of bioflanonoids that have been shown to improve the elasticity of the very small blood vessels [capillaries]. It has also been shown to have antioxidant powers that get rid of the free radicals – these are harmful molecules that lead to vascular and other problems.

An article in Diabetes Interview [March 1999] reports a man who was diagnosed with retinopathy requiring laser treatment in 1982. He searched for a possible solution himself and found Pycnogenol in France – his retinopathy regressed and he has had no laser treatment.

We have to be aware that this could happen naturally but…

  • A study published in Ophthalmic Research in 1996 proved Pycnogenol’s beneficial effects on the retinas of pigs and cows.
  • In the Journal of Cardiovascular Pharmacology, October 1998, it was shown to counteract the blood vessel restricting effects of adrenalin, to decrease the clogging of blood vessels by decreasing platelet clustering and adhesion.
  • In the journal Free Radical Biology and Medicine, May 1998, it was shown to significantly decease nitrogen monoxide generation [this is important in many diseases including diabetes].
  • In Biotechnology Therapeutics, 1994-95, it was shown to protect the cells lining the lymphatic vessels and the heart from injury due to oxidation.
  • In Phytotherapy Research [15;219-233:2001] 30 people with diabetes were treated with 50-mg doses of Pycnogenol 3 times a day for 2 months and 10 people in a control group were treated with a placebo [dummy pill]. The researchers found that in those who took Pycnogenol there was a slowing down of the progression of retinopathy and in some cases the progression actually halted but in the control group using the placebo, retinopathy only got worse. This study should be treated with some caution because it was only small.

Despite efforts to achieve near normal blood glucose levels, in industrialised countries diabetic retinopathy is still the leading cause of blindness in the working population. This emphasises the need to investigate all possible avenues to prevent people from becoming blind or visually impaired. Therefore IDDT welcomes the findings of this last study and believes that it should not be dismissed simply because Pycnogenol is a herbal remedy. There needs to be further independent studies using Pycnogenol involving greater numbers of participants over a greater duration of time.

To those that either have or are at risk of retinopathy, every avenue of possible prevention or stabilisation should be considered and explored. We now have laser treatment but this does not mean that we should be complacent and not look for other means of prevention and treatment. It surely must be worth some research funding or a review of published studies.

IDDT Warns!
The use of Pycnogenol must not be a seen as a substitute for ‘good’ control and because of its powerful antioxidant effects should only be used in consultation with your medical adviser, as indeed should all supplements and complementary medicines. It is also essential that the use of Pycnogenol does not replace essential regular eye examinations.

More information is available on the manufacturer’s website www.pycnogenol.com

Low Glycaemic Index Diets Better for Weight Loss

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Low Glycaemic Index Diets Better for Weight Loss

A Cochrane systematic review from Australia found that the low glycaemic index diet [GI] is satisfying and has proven benefits. The glycaemic index ranks foods rich in carbohydrate based on their effect on blood sugar levels.

Low GI foods, such as lentils, sweet potatoes and apples produce more consistent blood glucose levels compared to high GI foods such as white rice and French fries. Previous studies suggest that keeping blood sugar levels steady throughout the day may stimulate more weight loss so the reviewers evaluated randomized controlled trials that compared weight loss in people eating foods low GI foods to weight loss in people on higher GI diets or other types of weight loss plans. The conclusions were:

  • Those eating low GI foods dropped significantly more weight – about 2.2 pounds more than those on other diets.
  • Low GI dieters also experienced greater decreases in body fat measurements.
  • None of the studies reported adverse effects associated with consuming a low glycaemic index diet.
  • The low GI diet is more satisfying than other diets so people are less inclined to feel hungry and therefore are more likely to maintain this diet than other strict diets on which they feel hungry.
  • Low GI diets appear to be effective even in obese people – obese low GI dieters lost about 9.2 pounds, compared with about 2.2 pounds by other dieters.
  • People eating low GI foods experienced greater improvements in total blood cholesterol and LDL [bad] cholesterol.

The message really is that the success of low glycaemic diets lies with the person’s willingness to comply with its nutritional principles.

Ref 1. Low glycaemic index or low glycaemic load diets for overweight and obesity.
Review, Thomas, DE, Elliott EJ, Baur L. Cochrane Database of Systematic Reviews 2007, Issue 3

Relieving Joint Pain

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Relieving Joint Pain

Drugs often used to relieve arthritic joint pain [and therefore often used by people with diabetes] are called non-steroidal anti-inflammatory drugs, NSAIDs for short. Ibuprofen is just one example common example of this type of drug. They come in tablet form and also in creams, gels, foams and sprays and these are referred to as topical NSAIDs because they are applied to the skin surface.

According to Health Which in 1998 the prescriptions for topical NSAIDs cost the NHS nearly £20million and there is an additional use because this figure does not include those bought over the counter. The sister journal, Drugs and Therapeutics Bulletin [1999;37:87-88] looked at how effective topical NSAIDs are in relieving chronic arthritic joint pain. Their results produced a recommendation that topical NSAIDs should not be prescribed on the NHS for the following reasons:

  • There was little reliable evidence about where the products go in the body after they are put on the skin.
  • It is not known how well topical NSAIDs work when used in the long term or how likely they are to cause serious side effects because of absorption into the body.
  • What evidence is available suggests that they might be slightly better than a placebo [dummy] preparation at relieving joint pain.
  • There is no reliable evidence that they are more effective than standard treatments for joint pain, such as paracetamol or NSAIDs taken by mouth or other topical preparations called rubefacients that work by irritating the skin over the painful area.

We are we using preparations that are easily available to us over the counter and the NHS is paying a high price for those given on prescription. But they are not proven to be effective and even worse there is no science to say that they are safe for long term use.

Useful Research – Depression and Diabetes

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Diabetes
Stress, Anxiety and Depression

Stress
Anxiety
Depression
Depression in Parents
GE insulin, Hypoglycaemia and Depression
Useful Research

 

Stress, Anxiety and Depression
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Useful Research – Depression and Diabetes

Research in young adults with Type 1 diabetes
Research in Australia surveyed 92 young adults with Type 1 diabetes with an average age of 22 and found that 35% of them reported depressive symptoms. Importantly those with depression tended to have poorer blood glucose control than those without depressive symptoms, so putting those with depression at greater risk of complications such as cardiovascular disease. [Diab Med, 2008;25:91-6] The study concluded that as many young adults reported significant levels of psychological distress, health teams caring for young adults with Type 1 diabetes should provide psychological assessment and support.

Research in older people with diabetes
Research in Canada has shown that people with heart disease maybe at risk of further attacks if they suffer from depression or anxiety. People with diabetes are more at risk of developing heart disease, so this study again emphasises the importance of treating depression in people with heart disease as well as those with diabetes.
[Arch Gen Psychiatry 2008;65:62-71]

Research in the US looking at the relationship between diabetes and depression found that depression treatment reduces mortality by half in older people with diabetes. Again this emphasises the need to diagnose and treat depression in people with diabetes.
[Diab Care 2007,30:3005-10]

Depression link with poor blood glucose control
Research has also shown that in young people with Type 1 diabetes, depression tended to be linked to poorer blood glucose control. This could be through hormonal changes but it is thought that the most likely cause is the negative effects that depression has on people making self-management of their diabetes more difficult with the following effects:

  • lack of exercise
  • increased smoking and alcohol consumption
  • lack of or poor blood glucose monitoring.

Research using questionnaires has shown that depression in people with both Type 1 and Type 2 diabetes may have the following effects:

  • They are less likely to eat the types and amounts of food recommended.
  • Less likely to take all their medications.
  • Less likely to function well, both physically and mentally.
  • Greater absenteeism from work.

[Archives of Internal Medicine, Nov 27, 2000]

Note: Depression is also associated with increased weight and obesity and depression itself can cause Type 2 diabetes.

Injection related anxiety in insulin treated patients
This study set out to look at whether the presence of injection related anxiety and phobia influences compliance, glycaemic control and quality of life in people with diabetes. 115 unselected insulin treated people, 80 with Type1 and 35 with Type 2 diabetes, completed a standardised questionnaire providing injection anxiety scores and general anxiety scores. The results showed that in14% of cases injections had been avoided because of anxiety and 42% expressed concern at having to inject more frequently. A significant correlation was found between injection anxiety scores and general anxiety scores. The latter was significantly associated with injection avoidance and expressed concern at increased injection frequency. No significant correlation was seen with HbA1cs and either type of anxiety. The authors conclude that symptoms relating to injection anxiety and phobia have a high prevalence in an unselected group of people with diabetes and are associated with higher levels of general anxiety.
Diabetes Res Clin Pract 1999 Dec;46 [3]:239-46

Prevalence of symptoms of depression and anxiety in a diabetes clinic population
While waiting for their routine hospital appointment adults with Type 1 and Type 2 diabetes were asked to fill in a questionnaire to measure psychological symptoms and the perceived need for psychological support. From the patients records the presence of complications was recorded and the HBA1 was also recorded. The response rate was high [96%]. The presence of psychological symptoms was also high with 28% of the participants reporting moderate to severe levels of depression or anxiety or both. Men were more likely to report moderate to severe depression symptoms and women more moderate to severe anxiety symptoms. There was a significant link between depressions and poor gylcaemic control, as measured by the HbA1, in men but not in women. A third of the participants reported that at that moment they would be interested in receiving counselling if it was currently available in the diabetes clinic. The authors conclude that there is a significant proportion of people who require psychological support which, if available, might help to improve glycaemic control and so overall wellbeing.
Diabetic Medicine, March 2000, 17; 198-202

Dupuytren’s Contracture

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Joint and Muscle Problems Associated with Diabetes

Introduction
Connective Tissue Disorders
Tests Your Doctor May Carry Out
Myopathy
Cheiroarthropathy
Frozen Shoulder
Trigger Finger
Dupuytren’s Contracture
Carpel Tunnel
Stiff Man’s Syndrome [SMS] Also Known as Stiff Person’s Syndome
Diffuse idiopathic Skeletal Hyperostosis [DISH]

 

Back to Related Health Issues
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Dupuytren’s Contracture

This is a fairly common condition in the palm of the hand that can cause the fingers to contract. It occurs when the connective tissue under the skin in the palm of the hand begins to thicken and shorten and as the tissue tightens it may pull the fingers down towards the palm of the hand. The first sign is a nodule near the base of the little finger and the ring finger. Gradually other nodules may appear across the first joint of the fingers, the skin puckers and the finger is pulled towards the palm. It usually affects the ring finger first followed by the little, the long and the index fingers but there is evidence that in diabetes, different fingers are affected. The problem is not pain but the restriction of movement. Although again the cause is unknown, there is a genetic link because it affects people of northern European decent. It is seven times more common in men than women and usually does not show up until after 40 years of age. People with diabetes, alcoholics and those taking anticonvulsant drugs have a higher risk of Dupuytren’s contracture.

Treatment – The only treatment is surgery but this is usually only if the contracture has developed into a deformity. The outcome is usually good.

Pre-conception

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Facts
Pre-conception
Pregnancy
Caesarean Section
Report – Diabetes in Pregnancy: Caring for baby after birth [2007]
Breastfeeding and Weaning
Gestational Diabetes

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Pre-conception

It has been known for some years that good diabetic control at the time of conception improves the chances of having a healthy baby. Entering the pregnancy with good control increases the chances of a healthy baby because important organs of the foetus develop during the early part of pregnancy – the brain, the spine, the heart, the kidneys and the gastrointestinal system. Malformations associated with diabetes are spina bifida, where the spine does not completely close and heart defects. As these malformations are formed during early pregnancy, getting into better control later in the pregnancy does not change what has already developed. However, it is important to remember that just because a woman is not in good control does not mean that she is bound to have a baby that is affected.

For these reasons, a planned pregnancy with good blood glucose control at the time of conception is the ideal situation although it is estimated that as many as two thirds of pregnancies are unplanned. A planned pregnancy also means that folic acid supplements, which reduce the risk of spina bifida and other defects, can also be taken prior to conception. Many diabetes clinics now offer ‘pre-conception counselling’ for couples intending to have a baby to try to ensure that the mother’s blood glucose control is good at conception and from the outset of the pregnancy.

Checking the safety of insulin and other drugs
It is worth checking at this stage the safety of the insulin you are using and any other drugs. None of the analogues have been tested in pregnant women or those planning pregnancy so any risks to the foetus and/or mother are unknown. Commonly prescribed for people with diabetes are ACE-inhibitors for the treatment of blood pressure and/or to slow down the progression of kidney disease and also statins to reduce cholesterol levels. Both these classes of drugs are potentially toxic for the foetus.

But do women attend pre-conception counselling?
Researchers in Hull [ref1] who carried out a study looking into the use of Humalog during pregnancy were struck by the large number of women in this study who did not have pre-conception counselling despite the fact that this was freely available to them – only 40% took it up.

So they carried out a questionnaire study in 69 women between the ages of 16 and 45 to survey their attitudes and knowledge of maternal diabetes and pregnancy. 18 of the women already had children and the rest didn’t. The results were surprising but according to the researchers are similar to other studies:

  • In both women with and without children, a high proportion of women [85%] knew that their diabetes could affect the health of the baby and that good control was important at the time of the conception.
  • Of the 18 with children only 44%, less than half, had attended pre-conception counselling before their last pregnancy.
  • Only 52% of those without children and 28% of those with children reported the intention to do so before a future pregnancy.

So although the knowledge about the need for pre-conception counselling was there, this knowledge is not acted upon. What is more, the women that had already had one pregnancy were even less likely to seek counselling before a future pregnancy! The researchers point out that teaching and knowledge do not necessarily change behaviour and they suggest that a novel approach is needed if pregnancy outcomes are to be improved and that this should continue throughout the reproductive years.

Just a comment…
It is a shame that the questionnaire did not ask why women don’t attend pre-conception counselling. It is well recognised that pregnant women with diabetes go to great lengths to maintain very tight blood sugars to safeguard the health of the baby and indeed, their own health, so it is surprising that so few women attend. Perhaps the term ‘Pre-conception counselling’ is not one that appeals to people contemplating having a baby, especially young people! The word counselling alone can be off-putting for some people. Straight forward ‘Family Planning’ may be more appealing but a little imagination would produce a better name.
Ref 1 Diab Med 2002, Vol 19:605

Healthy Travelling

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Holidays and Travel Tips

Looking after your insulin
Healthy Travelling
Travel Insurance
Increased Security on Flights affects people with Diabetes

 

Living with Diabetes
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Healthy Travelling

Deep vein thrombosis
Recent cases of deep vein thrombosis [DVT] on flights longer than 4 hours has caused concern for travellers.  There are several misconceptions about DVT that should be corrected:

  • It is often thought of as an economy class syndrome – it isn’t as it has also occurred in first and business class passengers.
  • DVT can be caused by travelling at 33,000 feet in the air, it can also be caused by sitting for long periods in cars, buses, lorries and trains.

Some people are more at risk of DVT than others. The at risk factors are:

  • Certain forms of cardiac disease
  • Abnormalities in blood clotting
  • Pregnancy
  • Recent major surgery or injury
  • Recent immobilisation for a day or more.

In addition to these factors, recent research has shown that there may be additional risks from smoking, obesity and varicose veins.

Avoiding the development of DVT:

  • Drink adequate amounts of fluids, especially water.
  • Avoid drinks that contain alcohol and caffeine.
  • Avoid smoking.
  • Avoid sitting cross legged.
  • Walk around in the cabin whenever you can.
  • Stand up and stretch your arms and legs periodically.
  • Wear loose fitting clothes when travelling.

Jet lag
The main cause of jet lag is crossing time zones and there is plenty of research shows that it is worse going from west to east than from east to west but people vary and are affected differently.

Advice for minimising jet lag:

  • Try to keep calm before the journey as excitement, stress and nervousness can make it worse.
  • Have a good night’s sleep before the journey.
  • Try not to eat too much on the flight.
  • Avoid alcohol, tea and coffee.
  • Drink plenty of water because the body is susceptible to de-hydration on long flight.

Cochrane Review – long-acting analogues vs NPH insulin in Type 2 diabetes

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Cochrane Review – long-acting analogues vs NPH insulin in Type 2 diabetes

A Cochrane Review April 2007
K Horvath, K Jeitler, A Berghold, SH Ebrahim, TW Gratzer, J Plank, T Kaiser, TR Pieber, A Siebenhofer Cochrane Database of Systematic Reviews 2007 Issue 2 (Status: New)

 Insulin analogues are the latest form of GM synthetic insulin and this review compares long-acting analogues glargine [Lantus] and determir [Levemir] with long-acting ‘human’ isophane [NPH] insulin for Type 2 diabetes. For us to have an informed choice of treatment, it is necessary to look at evidence from high quality systematic reviews and Cochrane Reviews provide just such evidence.

The authors’ conclusions are:

"If at all there is only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2 treated with "basal" insulin regarding symptomatic nocturnal hypoglycaemic events. Until long-term efficacy and safety data are available, we suggest a cautious approach to therapy with insulin glargine or detemir."

Below is the ‘Plain Language Summary’ but the full review can be found on the Cochrane Database www.cochrane.org

Plain language summary
No unambiguous clinical benefits of treatment with long acting insulin analogues in the majority of people with type 2 diabetes mellitus demonstrated NPH (Neutral Protamine Hagedorn) insulin is the current standard for basal insulin in the blood glucose lowering therapy in people with type 2 diabetes mellitus. The mode of action of this insulin is highly variable, which may be the cause for the difficulties some people with diabetes have to achieve current goals for long-term metabolic control. Therefore, new insulins which are thought to show more favourable properties of action have been developed: insulin glargine and insulin detemir. Because of their theoretical advantages, it is thought that treatment with these new insulin analogues might lead to a beneficial effect, for example less hypoglycaemia or a better metabolic control, possibly resulting in higher quality of life and treatment satisfaction less late diabetic complications such as problems with eyes, kidneys or feet and myocardial infarction, stroke or death.

Although epidemiological studies indicate that high concentrations of blood glucose carry a higher risk for these late complications, evidence for a beneficial effect of glucose-lowering therapy is conflicting. Following from the different results of large clinical trials, interventions seem to carry different substance specific beneficial or adverse effects. As a consequence, conclusions on the effects of different blood glucose lowering interventions on these outcomes can not be drawn from their effect on blood glucose concentration alone.
Methodological quality of all the studies was rated low ("C"). Eight studies investigated altogether 2293 people. Trials lasted between 24 and 52 weeks. Our analysis of the currently available long-term trials comparing long acting insulin analogues with NPH insulin showed that insulin glargine and insulin detemir were almost identically effective compared to NPH insulin in long-term metabolic control (HbA1c). Fewer people experienced symptomatic overall or nocturnal hypoglycaemic episodes with treatment with either of the two analogues. No conclusive information on late complications or on possible differences in the number of fatalities exists. For insulin glargine one study found a higher rate of progession of diabetic retinopathy in patients treated with insulin glargine, while in another investigation the opposite result was found. It was thus not possible to conclude for certain whether insulin glargine treatment is safe or not.

From the retrieved trials it was also not possible to draw firm conclusions on the effects of these new insulins on quality of life or their cost effectiveness. Until long-term data on benefit and risk are available, we suggest a cautious approach to treatment with insulin glargine or insulin detemir.

If this language is not plain enough, let’s make it plainer…

  • We know that Lantus, Levemir and human long-acting insulins are the same in terms of blood glucose control as measured by HbA1s.
  • We know that fewer people in the studies experienced symptomatic overall or night hypos with both the two analogues but we don’t know about the numbers of hypos without warnings [asymptomatic].
  • We don’t know if treatment with Lantus and Levemir results in more or less complications over time or if there are any differences in death rates.
  • We don’t know if Lantus causes higher rates of retinopathy – one study showed it did and one that it didn’t, so we don’t know if it’s safe or not.
  • We don’t know if these insulins improve quality of life or not.
  • We don’t know if they are cost-effective or not.
  • We do know that the authors recommend a cautious approach to their use.

From this review we know two things – there are an awful lot of uncertainties about long-acting analogues and the authors’ recommendation for a cautious approach to prescribing these insulins is not being adopted in the UK and many other countries.

Growing Up with Diabetes

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Growing up with Diabetes

Growing up is not easy and growing up with diabetes, or any chronic condition, makes life that much more difficult for your child. This is something that we can recognise and try to understand, but unless we have actually had the experience ourselves we don’t know how it really feels. This is perhaps something that our teenagers with diabetes will remind us of on many occasions!

Here are just some of the experiences that our children may have as they grow up:

  • Feeling different from other children.
  • Being treated differently from other children at home, at school and socially.
  • Not feeling as good as their friends or the other children at school – having a low self-esteem.
  • Being aggressively determined to be as good, if not better, than everyone else.
  • Being frightened of looking foolish if they have a hypo at school or when out socially and being called names.
  • Feeling pressurised to achieve and do everything, by messages of being ‘normal’ when they don’t feel normal.
  • Being excluded from school activities or parties because they have diabetes.  

The feelings and experiences of our children with diabetes will vary with the age of diagnosis and there will be different effects for them and the family. It is difficult to grow up with diabetes from a young age and perhaps never know what it is like to not have diabetes and be treated normally. But it is equally difficult to be diagnosed in the teenage years – perhaps more difficult. Suddenly being faced with diabetes and all the changes this means in both lifestyle and self-image during the teenage years, are all happening at one of the most difficult stages of growing up.

One mother’s Experiences of the teenage years!
When my daughter was quite young I remember her going through a phase of believing that no one would want to marry her because she had diabetes. When I was young I believed that no one would want to marry me because I wore glasses. The answer to that was relatively easy – you can wear contact lenses! Not so easy to hide diabetes or to give reassurances to a 10 year old.

So when boyfriends started to appear on the scene at 14 or 15 years old there was always the worry of "when do I tell him about diabetes?" At this age she was very reluctant to tell anyone about it – she just wanted to be like her friends. The good text book standard advice of ‘always tell your friends that you have diabetes, just in case’….. really was totally ignored and understandably so. Teenagers are teenagers and with or without diabetes, they do not want to be different from their friends.

So what does a parent do in this situation? Perhaps this question should be " what can you do in this situation?" I think perhaps the answer has to be – nothing. Sit back, keep your fingers crossed, hope and have a bit of faith.

  • Hope that in the long run common sense and self-preservation will prevail. Hope that in the short term if she does have a hypo while she is on the date that it won’t be that bad that she can’t handle it before he notices. Hope that if the worst comes to the worst and he discovers she has diabetes before she has told him, he’s a nice lad and is not put off.
  • Faith is very important and sometimes very difficult when we see our teenager at home breaking all the rules, being stroppy and from tome to time being fairly objectionable! But having faith is very important to give your teenager the confidence they badly need and to show that even though you would prefer it if they told their new boy or girlfriend about their diabetes, you do understand how they feel.

This all sounds a bit like women’s magazine stuff, but my 30 plus years of experience as a parent has taught me that the one thing young people do not like is looking foolish in front of their friends. So, they make damn sure that they do not go hypo by eating plenty or by drinking normal [not diet] coke. It is called self-preservation – so have a bit of faith in that, if nothing else! 

What are the alternatives?
There is only one and that is conflict, probably a word that can never be over used when discussing teenagers, parents and diabetes. You can insist that they do the right thing, but you cannot make them. You can keep them cosseted at home longer because of their diabetes, but what are you achieving? Conflict, resentment and a breaking down of family relationships probably at a time when your teenager needs you the most [even though they would not admit it]. You are not needed in the way you were – to manage their diabetes for them, but to just be there, to boost their confidence by showing that you trust them [even if you don’t always!] and to pick up the pieces if or when necessary.

I wasn’t a wonderful parent
If I sound as if I was a wonderful parent who got it right, make no mistake, I wasn’t – you only have to ask my daughter! I learnt the hard way and we struggled through. We had conflicts, battles and tears, both hers and mine. Things improved but the change came from me, rather than her. I attended a course on listening skills and it slowly dawned on me that I wasn’t really listening to my daughter, that my own feelings, my emotions and my worries were preventing me from really listening to her, to her fears and to her concerns. She had them despite the bravado that so often appeared.

So I tried to put all my emotions out of the way and truly listen to her. My emotions were largely ones of caring for her but nevertheless, came over to her as being over protective and not letting go of the apron strings. By putting aside my feelings, many of the conflicts disappeared. It enabled us to develop a good relationship that has continued to today, albeit that there have been some ups and downs along the way!

Two adults together looking back over those years
Now that my daughter is 39 we can look back over the years, the difficulties and the conflicts. We can also look at the good times. I think that we understand each other. She understands that I did the best I could and I admit that I did not always get it right and I have apologised for this, although this probably makes me feel better and rather than her!

Why should parents always get it right, even worse, why should we think that we ARE right! If we have not grown up with diabetes then we do not know how it feels – the difficulties, the conflicts and the worries that our children have. Diabetes in the family is a new experience for all of us, we have no previous experience to guide us through it and it is a continual learning curve. We can only do our best but of one thing I am sure, we have to let go of our children. If they make mistakes in the process, then we have to hope that they are not too serious or damaging, but we have to be there for them when they need us. That is a parent’s role, made more difficult by diabetes but even more essential. 

Conclusion: Commonsense Rules

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Diabetes commonsense

Introduction: Enter Dr Lawrence
Balance: Signpost to Success
Juggling the Blue Carbohydrate and Red Insulin Balls
The Great Debate: Natural Animal or Artificial ‘Human’ Insulin?
Conclusion: Commonsense Rules

 

Diabetes Common Sense
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Conclusion: Commonsense Rules

Has there been any progress in the treatment of diabetes since Dr. Lawrence died on 28 August 1968? The traditional treatment which he devised involved two injections in twenty four hours. Nowadays, some diabetics on insulin are expected to prick the skin as often as five or even six times a day. This can hardly be regarded as progress. “There is nothing wrong with what is called conventional therapy, twice daily doses of short and longer acting insulins, and it is quite possible to achieve ‘good’ control on this regime.

The multi-dose treatment encourages people to keep changing doses and then there can be too many variables involved to achieve stability.”(9) Despite all the modern methods of treatment and so many professionals working with diabetics, there is not much to show for it. The Cohort Study, carried out from 1972 to 1997 by the British Diabetic Association (now Diabetes UK), based on research into trends or causes of death, states that “although care has been improving and quality of life for people with diabetes has improved, the study does not show that there has been the reduction in the rates of death among younger diabetics under the age of forty that might have been expected. Only further studies will show if this improved knowledge will reduce deaths in the future.” Unfortunately, some people on insulin are still at risk of being found dead in their beds and, as Dr. Gerlis points out, these are avoidable deaths that should never occur.

Could it be that commonsense has been forgotten and research has taken a wrong turn? Recently, genetically modified ‘human’ insulins have appeared in bewildering varieties. This has confused everybody. In the effort to make a right choice, the possible advantages of old-fashioned animal insulin, with its slower action and better warning of hypos, can be overlooked. With these new insulins, the threat of sudden hypos has increased rather than decreased, cutting away our safety net. When we recover from the distress of a sudden hypo, we wonder why nothing has been done to replace the blood sugar control system we lost when we became diabetic. It is high time that scientific research should concentrate on giving us back this valuable warning system instead of flooding the market with new ‘designer’ insulins of doubtful value. Dr. Laurence Gerlis has stated that there is not a shred of evidence to show that human insulin has any benefits over animal insulins.(10) Indeed, many thousands of us have suffered from its disadvantages. Commercial pressure seems to be the main reason for promoting these synthetic insulins. Perhaps this explains why information about animal insulin as a viable alternative has been suppressed and, worse still, why it has been taken off the market in many countries.

Of course it would be wonderful if a cure for diabetes could be found. In the meantime, however, a general problem in modern medicine has to be addressed, to allow for individual personal dynamics. For people with diabetes, this is especially true. An awareness of the many differences in treatment and dietary needs is crucial for good medicine and good health. Knowing this, patients and doctors must find out how to co-operate on equal terms. My hope for the future is that the capabilities and expertise of the patient may come to the surface, and that commonsense will rule, with balance close beside it on one side and informed choice on the other. We must become skilled jugglers, working with the blue carbohydrate and the red insulin balls before we can live successfully with our diabetes. Sadly, diabetic welfare can be threatened by commercial interests. The right to decide which treatment suits us best should not be negotiable. I shall end as I began, by reverting to the wisdom of Dr. Lawrence. The care team should provide the accompaniment but, as an intelligent diabetic, it is for me to play my own melody and to be in control.

© Copyright Beatrice Reid 2000

Footnotes

  1. R.D.Lawrence, Almost All About Diabetes, London: A Family Doctor Booklet, British Medical Association. P. 2.
  2. ibid. P. 31.
  3. Peter Sonksen, Dr. Charles Fox, Sue Judd, Diatetes at Your Fingertips, London: Class Publishing,     Fourth Edition Reprinted 1999. P. 58.
  4. ibid. P. 56.
  5. Dr. Laurence Gerlis, report from AGM of IDDT, Birmingham, October 1999. P. 5.
  6. ibid. P. 6.
  7. Jenny Hirst, IDDT Newsletter No. 21, July 1999.
  8. Report from AGM of IDDT, October 1999. P. 1.
  9. Dr. Laurence Gerlis, ibid. P. 5.
  10. ibid.

Useful Addresses

InDependent Diabetes Trust
PO Box 294
Northampton
NN1 4XS
England

tel: 01604 622837 
fax: 01604 622838
e-mail: enquiries@iddtinternational.org  

Diabetes UK [formerly British Diabetic Association] 10 Queen Anne Street
London W1M 0BD
England

tel: 01 171 3231531

Diabetic Federation of Ireland
76 Gardiner Street Lower
Dublin 1
Ireland

tel: 01 8363

CP Pharmaceuticals Ltd [now Wockhardt UK]
Ash Road North
Wrexham Industrial Estate
Wrexham LL13 0UF

Help line: 01 1978 666172

Further copies of this booklet may be obtained from IDDT, see above.

External Links

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www.diabeteschoices.org.uk – A useful source of information about food and drinks for people with Type 2 diabetes.

www.nhs.uk – the NHS Online is the country’s biggest health website and gives all the information you need to make choices about your health.

My Ageing Parent www.myageingparent.com – A resource for everything you need, or want to know about elderly care. This includes positive ways to keep ageing parents, friends and relatives active and healthy, maintaining their finance and legal needs to information on care options, local authority funding and managing age-related health issues.

The Association for Nutritionwww.associationfornutrition.orgThe Association for Nutrition (AfN) defines and advances standards of evidence-based practice across the field of nutrition and at all levels within the workforce. We protect and benefit the public by Championing Registered Nutritionists (RNutr), whose entry onto the UK Voluntary Register of Nutritionists (UKVRN) is an assurance that they meet our rigorous standards of competence and professionalism; Supporting frontline health and social care workers with essential tools which enable individuals to evaluate and enhance their nutrition competences; Recognising high quality, relevant nutrition training through our Course Accreditation, CPD Endorsement and Certification schemes.

Voyage MDwww.voyagemd.com – VoyageMD has been created to provide information for people travelling with diabetes.

antibiotic action www.myageingparent.com – Securing the future of antibiotic development… determined to make a difference.

MedicAlert is a global charity that provides medical ID jewellery for people with hidden medical conditions or allergies. Situated on the pulse points, it displays the international medical symbol to quickly identify your condition and speed up treatment in an emergency. Because every moment matters.

MedicAlert members benefit from peace of mind that goes far beyond their bracelet. Their conditions are reviewed by medically trained staff, who prioritise the text engraved on each piece of jewellery. A detailed medical record is also held in our secure database, which can be accessed 24/7 by emergency responders.

www.FocusOnDiabetes.nihr.ac.uk – the National Institute for Health Research website about diabetes features interviews with researchers into diabetes and includes resources for patients interested in taking part in research.

www.modernes-tierisches-insulin.de – German diabetes.

www.sugar-sweet.de – German site for animal insulin.

onlinepharmacycheck.com/~doc/facts-about-ua – IDDT’s Facts About Diabetes translated into Ukrainian

www.youtube.com/watch?v=tYlQTylh_0M&feature=player_embedded – ‘I’m Type 1 Aware: Are You?’ video by JDRF and Diabetes UK.

www.qub.ac.uk/elearning/public/WomenWithDiabetesThingsYouNeedToKnow/ – A very useful website raising awareness of reproductive health among women with diabetes.

Calibre audio Library – If you suffer from diabetic retinopathy you may have trouble reading print books this is where Calibre Audio Library can help.

www.spirit-healthcare.co.uk – Spirit Healthcare are an innovate Healthcare Retailer working to improve the quality of life for individuals with a range of long term conditions including diabetes. With the CareSens Blood Glucose Meter and the Mission Urine Testing range Spirit Healthcare have both products and resources available to help individuals with diabetes.

www.sugarbalance.co.uk/ – a useful site about ‘Sugar Balance programme’ run by Nic Lee, a diabetes coach and counsellor who has Type 1 diabetes. It aims to simplify the process of managing the highs and lows.

www.drugwatch.com – Drugwatch.com is a US-based comprehensive Web site featuring extensive information about thousands medications and drug side effects.

go.qub.ac.uk/womenwithdiabetes – a preconception counselling website developed in partnership with women with diabetes to raise awareness of the importance of reproductive health in women.

www.gsf-syrup.co.uk – a syrup for treating hypoglycaemia in orange, tropical and mint flavours. It is available on prescription for people with diabetes.

www.glucogel.co.uk– A useful gel for treating a hypo.

thependseytrust.org/ – The Pendsey Trust aims to provide access to education for those affected by diabetes in developing countries in the hope that this will enable these individuals to enter employment and support themselves into a healthy, more certain future.

www.carers.org– A carer is someone of any age who provides unpaid support to family or friends who could not manage without this help. Carers need support too, so visit this useful site.

www.drwf.org.uk – Diabetes Research and Wellness Foundation is a registered charity whose long-term mission to to discover a cure for diabetes and in the meantime, to support, advise and educate people with diabetes and the general public.

www.diabetesbible.com – practical guidance for health professionals on diagnosing and treating diabetes.

www.expertpatients.co.uk – Expert Patients Programme (EPP) courses are FREE and help people to improve their health and wellbeing by learning new skills to manage their condition on a daily basis. People who have already attended courses have told us it has helped them to deal with their pain, tiredness, feelings of depression, frustration and other difficulties that may come from living with a long-term condition.

www.guyculverwelltrust.com – Young people raising money for IDDT in memory of their friend, Guy Culverwell.

http://instituteofdiabetes.org/ – The Institute of Diabetes for Older People (IDOP) is a non-profit making, research and academic institution, based at the University of Bedfordshire, dedicated to enhancing the health and well-being of all older people with diabetes and related metabolic illness.

www.nmsociety.org – Useful website looking at the benefits of lowering carbohydrate intake.

www.glycosmedia.com – A free and editorially independent diabetes news service with the latest diabetes news and information for professionals and patients wishing to keep abreast of latest developments.

www.lindalliance.org – IDDT is affiliated to the James Lind Alliance which aims to identify the most important gaps in knowledge about the effects of treatments, and has been established to bring patients and clinicians together in ‘Working Partnerships’ to identify and prioritise the unanswered questions that they agree are most important.

www.friouk.com – if you are travelling to hot climates, Frio Wallets keep your insulin cool.

www.equip.nhs.uk – A source of good quality information.

www.cardiacmatters.co.uk – a single source of  information about the causes, symptoms and treatments of a range of heart conditions.

www.invo.org.uk – INVOLVE is funded by the Dept of Health to Promote and support active public involvement in NHS, public health and social care research. INVOLVE believes that involving members of the public leads to research that is more relevant to people’s needs and concerns, more reliable and more likely to be used.

www.owenmumford.com – Information about Owen Mumford’s medical devices including the AutoPen for use with animal insulins.

www.unistik3.com – Information about Unistik 3, a single use safety lancet is designed to make lancing less painful and is now available on prescription. Free samples are available, so people can try the Unistik 3 for themselves.

www.medipal.org.uk – Order online a MediPal medical ID card which provides immediate access to your medical details in case of emergency.

www.glucosemeters4u.com – Learn about Diabetic products.

www.rch.org.au/diabetesmanual/index.cfm?doc_id=2352 – Available free on-line an Australian Diabetes Manual for Parents manual from Westmead Children’s Hospital and the Royal Children’s Hospital – very useful for parents of children with Type 1 diabetes.

www.retinalscreening.nhs.uk/pages/default.asp?id=3&sID=135&cP=202 – This link will help you to locate and contact the local retinal screening programme responsible for your retinal screening. You can confirm which your screening programme is by contacting them using the contact details listed on the site.

www.hospitalhelp.co.uk – An independent website offering help to people going to hospital.

www.medicalshop.co.uk – Medical Shop is a mail order service for people with diabetes. It is possible to buy products online and over the ‘phone as well.

www.diabeteshealth.com/insulin – Diabetes Health presents a well-balanced and detailed article asking: “Where Have All the insulins Gone?” and “How Good and Safe are the Remaining Options?”.

www.radrr.com – Take a look and buy insulin pump covers that are ‘cool’ and durable for the toughest kids.

www.RemedyFind.com – RemedyFind is a free and unbiased site, not sponsored by any drug companies, that allows people to rate the effectiveness of the treatments they have used for specific health conditions. The site covers about 60 conditions and has 95,000 members.

www.yellowcard.gov.uk – The Dept of Health website for reporting adverse drug reactions and viewing those already made – now available to patients as well as health professionals.

www.dvla.gov.uk – The Driver and Vehicle Licensing Agency website that provides information about driving and diabetes.

www.wockhardt.co.uk – UK suppliers of pork and beef insulins in vials and cartridges.

www.diseasesconditions.com -Directory of information.

www.insulin-pumpers.org.uk – An essential visit for those contemplating using an insulin pump.

www.patients-association.com – Welcome to the Patients Association Website. Within this site you will find out what we do and will be able to let us have your thoughts on health care in the UK.

www.getcanadadrugs.com – An online sources or pork insulins that does nopt require a doctor’s letter, useful for people in the U.S.

www.xe.net – If you want to import insulin and need to convert currencies.

www.lilly.com – Eli Lilly website.

www.novonordisk.com – Novo Nordisk website.

www.nkfg.org – National Kidney Foundation.

www.neuropathy.org – Neuropathy Association.

www.feetforlife.org – Well worth a visit to learn how to care for your feet.

www.desang.net – Kitbags and organisers for people with diabetes to use to carry all their tools with them as they go about their normal daily lives.

www.jdrf.org.uk – Provides information about the progress of diabetes treatments and research as well as information on different aspects of living with diabetes, extremely useful to health professionals.

www.self-help.org.uk – Self Help UK provides a searchable database of over 1000 self help organisations and support groups across the UK that offer support, guidance and advice to patients, carers, and their relatives.

www.diabeticshop.co.uk – This site is designed to help people living with diabetes obtain products and services that can assist a diabetic in living a more natural daily life.

www.arcticmedical.co.uk – Arctic Medical supply a comprehensive range of diabetes care products, including a wide range of diabetes bags.

Ordering Leaflets

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IDDT Publications

IDDT provides a wide range of information which has been written to meet the needs of people with diabetes, their carers and health care professionals. This publication list has been compiled so you can order what you need free of charge. Simply state how many copies or items you require, fill in your address in the space provided and submit your order to IDDT.

Free Information

IDDT runs purely on voluntary donations and all the information we produce is free. If you would like to help us continue to provide this valuable information to people with both Type 1 and Type 2 diabetes please send us a donation via Just Giving or Charity Choice.

Healthcare professionals ordering multiple copies

All IDDT booklets and leaflets will remain free of charge. We are delighted that healthcare professionals and others are ordering multiple copies of our booklets and leaflets to give to people with diabetes and grateful for the help and support being given to people with diabetes in this way.

However, IDDT is a charity relying entirely on voluntary donations and due to the large and increasing demand for multiple copies of the booklets and leaflets by healthcare professionals for their patients, it is with regret that we have had to introduce a delivery charge for orders of more than 20 copies in total.

So in future the delivery charges will be as follows.

Number being supplied 20 copies 21 to 50 copies 51 to 100
Delivery charge FREE
6 monthly
£7.40 £9.40
  • For orders over 100 copies, please contact IDDT for the cost of delivery by telephone 01604 622837 or by email enquiries@iddtinternational.org
  • We will supply orders of 20 FREE copies once every 6 months.
  • Invoices will be sent with the order.
  • If funding the delivery charges is a problem, we are happy to supply FREE multiple copies of Publication Lists for healthcare professionals to give to their patients so that they can order direct from IDDT.

Thank You!

IDDT Leaflets

Actraphane – are patients really at the centre of care

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Actraphane – are patients really at the centre of care?

19th January, 2011

Diabetes charity questions whether patients really are at the centre of care

In June 2010, when 90,000 people with diabetes were given 6 months notice that the type of insulin they had been successfully using, Mixtard 30, was to be discontinued by the manufacturer, Novo Nordisk, the Insulin Dependent Diabetes Trust [IDDT] wrote to the Secretary of State for Health, Mr Andrew Lansley, asking for his help.

IDDT highlighted the effects of this change of insulin and injection device on the health and wellbeing of 90,000 people, the pressure only six months notice would put on the NHS staff and the present and future increased costs to the NHS incurred by the change and the ongoing monitoring of those affected.

Jenny Hirst, Co-chair of IDDT comments, “We were surprised that Mr Lansley’s response showed so little understanding of the effects this withdrawal would have on patients but also on the NHS. He showed an unwillingness to take any action on behalf of patients, especially the most vulnerable groups – those with visual impairment and manual dexterity problems who, as a result of this withdrawal would lose the injection device that enabled them to self-inject and maintain their independence“.

IDDT investigated the situation further and discovered from the MHRA , the government’s own regulatory agency, that a similar or near identical insulin made by Novo Nordisk, Actraphane, is licensed in the UK and can be prescribed and dispensed under the NHS. The same injection devices are available as for Mixtard 30 and patients could then simply have been changed to Actraphane and continued to use the same injection device.

Jenny Hirst added, “Novo Nordisk may have commercial reasons for withholding this information, but patients have been badly let down by Mr Lansley and his Department. The failure to inform patients, and health professionals, that Actraphane is licensed in the UK has denied patients the informed choice of treatment to which they are entitled. Government policy of ‘patients being at the centre of care’ appears to have been ignored for 90,000 people with diabetes“.

IDDT has informed members of the availability of Actraphane and the availability of the injection device for people with visual impairment and manual dexterity difficulties. However, the Department of Health has failed to provide patients with a fully informed choice of treatment options and failed to put them at the centre of care.

For further information contact:

Jenny Hirst
Tel 01604 622837
or e-mail enquiries@iddtinternational.org
Website: www.iddtinternational.org

The Health and Social Care Bill becomes Law

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After over a year going through Parliament and 374 amendment generated by the House of Lords, on March 20th MPs cast their final vote and the Health and Social Care Bill was approved by a government majority of 88. On March 27th, it received Royal Assent and will now be known as the Health and Social Care Act (2012).

Different terminology is being used to describe the changes in the NHS that will have to take place – the more positive amongst are calling it restructuring of the NHS while the more negative amongst us are calling the destruction of the NHS. Whichever side of the fence one sits on, it is clear that there are going to be major changes in the NHS with GPs taking control of most of the NHS annual budget of £106 billion, cuts in the number of health bodies and the introduction of more competition into services. All this has to take place at a time of financial cut backs.

Somehow the staff working in the NHS have to be brought together to work in a system  to which all raised serious objections on the basis that patient care will suffer. Those of us who have had to work in systems that go against our beliefs, know this is not going to be an easy task and it will not be surprising if the morale of NHS staff sinks to an all time low.

Possibly the most frightening aspect of the new system is that it is not based on evidence that it will actually work. It strikes me as an odd society that has a great deal of regulation and bureaucracy to ensure that there is evidence of safety and efficacy of prescribed drugs by regulation and bureaucracy and to ensure that research is safely and ethically carried out, yet a change to the whole structure of the NHS is brought in without any real evidence. We are not even being given a reason for the structural changes, certainly not a reason that stands up.

Like it or not, Members of Parliament, our representatives, have made the decisions about our future services. David Cameron and Andrew Lansley may well go down in history but it will not be for the same reasons as Beveridge and Bevan.

Yes, it leaves many of us as patients feeling insecure. Since July 5th 1948 we have had universal healthcare provided free according to need. Is the Health and Social Care Act setting in place a return to an insurance-based system with personal health budgets, year of care funding for long-term conditions and Foundation Trust Hospitals will be able to raise nearly half their funding from private patients? Could we return to the days our parents and grandparents remember, when you didn’t call the doctor because you couldn’t afford the fees? When services can be provided by ‘any qualified provider’, will we even know who is providing the services? Let us hope that this negative approach is ill-founded. Only time will tell…

As patients, we will need to be vigil to ensure that we receive the care and services which will enable us to receive timely, essential treatment to maintain our health.

If you have access to the internet, you can read the NHS Constitution for England, March 2012 by clicking on: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113613 
Hard copies of the Constitution can be obtained from the Department of Health, telephone 0800 123 1002.

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Thanks for Joining IDDT!

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Thanks for joining IDDT – your information has been added to our database. As a charity, we rely on donations in order to survive.

We appreciate that you’ve said you can’t donate today, but if you change your mind, please use the JustGiving form below – we’d really appreciate it!

Changing Your Insulin

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GM Vs animal insulin

Choices – The Evidence
Evidence from people with diabetes
A little bit of history
Facts
Action and duration times of animal and GM ‘human’ insulins
Hypoglycaemia and loss of warnings
‘Dead in Bed Syndrome’
The concerns of patients are justified
Availability of animal insulins in the UK
Changing your insulin
What to do if your consultant refuses to change your insulin
Availability of animal insulin if admitted to hospital
Frequently asked questions
Allergic reactions to insulin

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Changing your insulin

In the UK insulin is a prescription-only drug and therefore you will need to discuss your wishes to change your insulin type with your GP and/or clinic doctor.

The following guidelines are an extract from a talk given by Dr Laurence Gerlis, IDDT’s Medical Adviser.

  • Any change of insulin, type and brand, can alter your control in the first few days or weeks and so it is important to monitor your blood glucose levels more frequently.
  • Dose changes should be made in only 1 or 2 units at a time.
  • Dose changes should be kept to a minimum by altering the amount of exercise and the food at the next meal to cope with the odd high blood sugar.
  • There is nothing wrong with what is called conventional therapy, twice daily doses of short and longer acting insulins, and it is quite possible to achieve ‘good’ control on this regime.
  • Insulin is a delicate protein and small but subtle changes in the insulin molecule, such as the difference between the insulin molecule in pork and ‘human’, can affect diabetic control in some patients.
  • Both doctors and patients tend to raise the dose of insulin and rarely lower it. For example, if the morning blood sugars are high as a result of the body’s reaction to a hypo in the night, then raising the insulin dose will only make this situation worse. This leads to a vicious circle of increasing insulin doses to cope with highs, leading to more hypos and so it goes on.

Glaucoma

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Glaucoma

Statistics

  • Glaucoma is a leading cause of blindness.
  • Glaucoma rarely affects people under the age of forty.
  • In the UK it affects 2% of people over the age of forty.
  • There is an estimated 250,000 people in the UK with the condition and it is estimated that only half of the people with glaucoma have been detected.

Facts

  • Blindness is preventable if glaucoma is diagnosed and treated early enough.
  • Glaucoma is not catching and is not caused by diet, work or any other factors.
  • Glaucoma can be controlled with treatment but not cured.
  • Glaucoma cannot be prevented but having regular eye checks will enable early diagnosis and treatment and this applies particularly to the above categories. In the UK sight tests are free for people with diabetes and for close relatives of people with glaucoma once they are over 40 years old.

What is glaucoma?
Glaucoma is a condition where there is loss of vision due to damage to the optic nerve that carries the images from the retina to the brain. Usually glaucoma is accompanied by an increased pressure in the eye, but not always. This pressure is called the intra-ocular pressure or IOP. It is this pressure that damages the optic nerve.

There are different types of glaucoma:

Chronic open angle glaucoma – this is the most common form of glaucoma. It produces no symptoms – no pain or redness of the eye and the eyesight seems unchanged. It usually affects both eyes and develops slowly so the loss of sight is gradual.

The whole of the contents of the eyeball are nourished by a fluid, called the aqueous humour. This fluid circulates within the eyeball and leaves the eye by small drainage tubes at the front. If there is an obstruction within this system, then the fluid cannot escape and pressure builds up within the eye. It is this persistent increased pressure that may damage the optic nerve and cause vision loss.

Those most at risk of developing open angle glaucoma are:

  • People of Afro-Caribbean origin are between 5 and 8 times more likely to have glaucoma and it may come on earlier and be more severe.
  • People with a family history of glaucoma are more at risk. There is a 6 times greater risk if a near relative has it.
  • People who are very short sighted [myopic] are more at risk.

Acute angle glaucoma – Is where there is a sudden increase in the pressure [IOP] in one eye. The eye becomes red and painful often accompanied by misty vision and seeing haloes around lights.

Secondary glaucoma – This is a group of conditions where the IOP is raised and this is caused by other diseases of the eye.

Congenital glaucoma -Is where glaucoma is present at birth.

Note: it has been thought that people with diabetes are more susceptible to glaucoma. However, recent research suggests that the higher incidence of glaucoma in people with diabetes is more likely to be due to s greater detection rate because people with diabetes often have more frequent regular eye checks than the general population.

Tests for glaucoma

At a high street optometrist – there are 3 tests that should be done to but not all optometrists do all three tests, so check when you make your appointment.

The 3 tests are:

  1. To look at the back of the eye and the optic nerve with a bright light [ophthalmoscope]
  2. Measurement of the pressure [often called the puffer test]. A raised pressure at this stage does not necessarily mean you have glaucoma.
  3. Field of vision test where you are asked to look at a screen with a series of spots of light and you will be asked which ones you can see.

If there are any abnormalities then the optometrist will refer you to your GP for referral to the hospital.

At the hospital – the following tests will take place at your hospital visit:

Measurement of the intra-ocular pressure – The eye is numbed by a drop of anaesthetic and the eye observed through an instrument called a slit lamp. The cornea [the front of the eye] is lightly touched with an instrument that measures the pressure.

One or more of the following tests will also be carried out:

Gonioscopy – This allows the doctor to observe the angle between the iris and the cornea.

Visual field measurement – You sit at a screen and keep your gaze fixed on a central light. Other lights flash on and off and you press a button when you see them. This test detects any blind areas of your visual field indicating where the nerve damage has occurred.

Optic nerve assessment – Drops are put in the eye to dilate the pupil so that the doctor can examine the back of the eye more fully and to record the health of the optic nerve by the appearance of the optic disk. Retinal photographs may also be taken so that these can be kept in your records to establish any changes in the future.

Note: You should NEVER drive yourself to the hospital because the drops used to dilate your pupils leave the vision blurry for a few hours.

Treatment

Eyedrops – The aim of treatment is to lower the intra-ocular pressure and prevent further vision loss. Most people with glaucoma require life-long treatment, usually with eye drops.

Surgery – In some cases the intra-ocular pressure can be reduced by opening up the draining channels with laser treatment or by surgery to make a small drainage hole at the top of the eyeball. In these cases, the need for ongoing treatment may be removed but not all cases are suitable and the majority of people with glaucoma need eye drops for the rest of their lives.

Tablets – In some cases tablets may be given to reduce the amount of aqueous produced. Initially these tablets increase the amount of urine passed.

Glaucoma and exercise – The Medical Director of the Glaucoma Foundation in the US says that there is research that shows that frequent activity such as swimming or brisk walking can lower the pressure within the eye. But he warns against sports that involve turning upside down – certain yoga positions and scuba diving, may raise the pressure. [Reported in Health Which? December 2000]

Glaucoma and driving – If glaucoma is diagnosed then you should inform the DVLA and your motor insurers. It is a condition that should be declared under the item ‘has there been any material change that could affect your driving.’ If you were involved in an accident and you had not declared that you have glaucoma, then you may not be insured and the DVLA could take action because you have not informed them.

More Information about glaucoma can be obtained from:
International Glaucoma Association
Woodcote House
15 Highpoint Business Village
Henwood
Ashford
Kent
TN24 8DH

Sightline (helpline) number: 01233 648 170
Administration number: 01233 648 164
website: www.glaucoma-association.com

Just Follow The Rules, Not Easy!

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Just Follow The Rules, Not Easy!

By Jenny Hirst

One report maintains that most of the benefits from weight loss achieved through dieting come with the first 5-10kg lost, but because dieting is stressful, 90% of people fail to achieve this, or if they do, they usually put the weight back on within a year. People with diabetes are no different to the rest of 90% of the population who fail. Or are the incentives of the long-term complications sufficient to keep people with diabetes on the straight and narrow year in and year out, especially for those who not only have to adhere to the healthy diet but also to a weight reducing diet too?

I am sure that for some people, looking to the future is sufficient to enable them to stick to the diet, but not for everyone nor is it sufficient to just hand out a diet sheet and an explanation of what people should do. If you are 15 years old ‘the future’ looks a long way off when all your pals are eating burgers at 3 o’clock in the afternoon. If you are 45 years old when diagnosed, you have a lifetime of eating habits, and possibly drinking habits, that have to change. A diet sheet alone does not bring about these changes.

For me, as the mother of a child, now grown up, diet always produced conflicts and guilt.

Conflicts and guilt
My memory of meeting a dietitian for the first time was when my daughter was in hospital 34 years ago at diagnosis. I couldn’t believe my eyes – she was very pleasant with an attractive face and she kindly went through the diet with me which, in those days, was very different and much more restricted. But she was, to put it bluntly, fat. I realise that Mum’s are sensitive at diagnosis but I could hardly contain my anger! How dare she tell me about the need for a strict diet for my little girl, which as she pointed out, would be healthy for the whole family, when she was fat?

She then told me to cut out all sweet stuff, cakes, puddings and above all thickening in the gravy. I know this sounds ridiculous now but she said it! It caused me real problems because I was brought up in Yorkshire and was taught from very early days that the way to a man’s heart was through his stomach and what could be better than roast beef, Yorkshire pudding and good thick gravy? Remember I had a husband and a son to think of as well as my daughter, so I really had great conflicts going on in those first few months.

What was I to do?

  • I couldn’t give my daughter thickened gravy.
  • I couldn’t give her different gravy from the rest of the family and make her ‘different’. I couldn’t give the men thin gravy as it was against all my Northern teachings – I might lose a husband and my son would never learn the value of good thick gravy!
  • I couldn’t disobey the dietitian.

In the end I resolved the conflict and we all had good thick gravy but this then left me with a huge sense of guilt because I was disobeying the dietitian’s orders. I always felt that I should confess at the clinic, but I never did.

So diet and dietitians have always made me feel pretty bad. The dietary advice conflicted with my cultural background and I had difficulty resolving this. Whichever way I had resolved it within the family, I would have felt guilty. The fact that I did not confess my disobedience at the clinic just added to this guilt.

Feeling inadequate, confused and a bit dim!
To add to this, dietary information always makes me feel pretty inadequate, confused and a bit dim. They keep changing the goal posts! I realise that knowledge has improved over the years and there is research to show the benefits of the present healthy eating recommendations but we do seem to be getting mixed messages.

  • If we are supposed to eat the healthy diet recommended for the rest of the population, why do diabetes magazines have pages of recipes in glorious technicolour?
  • Why did we stop counting carbohydrates? Well some of us never did and it is interesting that carbohydrate counting appears to be coming back!
  • How are the newly diagnosed supposed to balance their insulin and their food if they don’t know the carbohydrate content?
  • Now we also have the glycaemic index and I have to admit that the title alone is a total turn off for me.
  • What is wrong with talking about simple things like fast acting or long acting carbohydrates, fats and proteins?

So if you are feeling the pressures of the diet for your diabetes, you are not alone!

Here are just a few of the things I have learnt over the years:

  • Dietary information needs to be simple. We need to know the basic food information about carbohydrates, fats and proteins in a language that we, the patients or carers, can understand.
  • If you are a man with diabetes and your partner does the cooking, she needs to know what you should and should not eat to avoid undue anxiety on her part from lack of dietary knowledge. If you are a woman with diabetes, then you probably feel the pressures to cook ‘ordinary’ food for the rest of the family and this may make diet more difficult for you.

To our health professional advisers I say:

  • Don’t expect too much of us. Set targets that we can achieve so that we don’t always feel to be failing. Recognise that if we know what we should do, and don’t do it, we probably feel bad about ourselves anyway, so don’t be judgmental.
  • Recognise that changing eating habits may cause confusion, conflict and guilt for all sorts of reasons – cultural, social or work circumstances. That bingeing on sweet stuff can be a compensation for frustration, sadness or boredom in people with diabetes just as much as those people without it.
  • Recognise that some rules do actually make it easier for people than to just have a system of ‘healthy eating’. Too much freedom can cause confusion and anxiety, whereas rules can give a sense of security.
  • Remember that just because healthy eating is good for everyone, does not make it easier for people with diabetes. We do not really have a choice, unlike the general population, so this does make it different and more difficult. We HAVE to eat a healthy diet.

Diabetes and Hearing Loss May be Due to Neuropathy

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Diabetic Neuropathy

What is Diabetic Neuropathy?
Neuropathy Affecting The Feet
Advice on Cutting Your Toenails
Symptoms of Neuropathy Affecting Your Feet and Hands
Heel Fissures
Charcot Foot
Wrong Sized Shoes
Neuropathy and Antidepressants
Diabetic Holiday Foot Syndrome
Patient and Family Carer Experience
Diabetes and Hearing Loss May be Due to Neuropathy
Gastroparesis

 

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Diabetes and Hearing Loss May be Due to Neuropathy

Researchers in Italy are exploring the effect that diabetes may have on hearing loss. Forty seven people with insulin dependent diabetes and still with normal hearing abilities were studied and all of them had impairments in the spiral canal in the ear. These problems usually begin with a lesion in the inner ear spiral canal and can be caused by neuropathy. Previous studies have found that hearing loss is in the high frequency area of the ear with a progressive loss over time.

InDependent Diabetes Trust
IDDT