was successfully added to your cart.

Cart

Action and Duration Times of Animal, GM ‘Human’ and Analogue Insulins

By Uncategorized

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 you admitted to hospital
Frequently asked questions
Allergic reactions to insulin

horizontaldots

Action and duration times of animal and GM ‘human’ insulins

Table 1 shows the different insulins according to their origin and their length of action.

Table 1

insulin

Rapid

Short

Intermediate

Long

Analogue

Apidra
Humalog
NovoRapid

 

 

Lantus
Levemir

Animal

 

Hypurin Bovine Neutral
Hypurin Porcine Neutral

Hypurin Bovine Isophane, Hypurin Porcine Isophane

Hypurin Bovine lente
Hypurin Bovine PZI

Human

 

Actrapid,
Humulin S,
Insuman Rapid

Humulin I,
Insuman basal,
Insulatard

 

Also available are pre-mixed insulins of rapid-acting or short-acting insulins with an intermediate-acting insulin. These are usually used where only two injections are day are required.
Table 2 shows the different pre-mixed insulins.

Insulin

Pre-mixed

Analogue

Humalog Mix 25 and Mix 50, NovoMix 30

Animal

Hypurin Porcine 30/70

Human

Humulin M3, Insuman Comb 15, 25 and 50,
Mixtard 30

Table 3 shows the relative activity curves of animal, ‘human’ and analogue insulins. It must be noted that these times are a rough guide of peak activity and duration as the action peaks and duration of action will vary in different people.
Table 3

Insulin type

Onset

Peak [hours]

Effective duration
[hours]

Maximum duration [hours]

ANIMAL

 

 

 

 

Regular [short]

0.5 – 2 hours

3 – 4

4- 6

6 – 8

NPH
[intermediate]

4- 6 hours

8 – 14

16 – 20

20- 24

‘HUMAN’

 

 

 

 

Regular
[short]

0.5 – 1 hour

2 – 3

3 – 6

6 – 10

NPH
[Intermediate]

2- 4 hours

4 – 10

10 – 16

14 – 18

ANALOGUES

 

 

 

 

Rapid

Immediate

Immediate to about 1 hour

Tails off from peak over 3- 4 hours

About 4 hours

Lantus
[long]

2 hours

None

24hours

 

Levemir
[long]

2 hours

None

14 or more hours

 

Note: Long-acting beef insulins [Bovine lente and Bovine PZI] are available but they are not included in this table as they are rarely used.

 

Key facts about insulins and their actions:

  • The manufacturers’ profiles of the speed of onset, peak of action and duration of action are only a rough guide and may vary. Insulins act differently in different people.
  • The speed of action of injected insulin varies at different injection sites. For example, if Hypurin Porcine Neutral is injected above the umbilicus [tummy button] its speed of action is much quicker, and similar to a rapid-acting analogue, than if it is injected below the tummy button.
  • The depth of the injection also affects the speed of action and it is important to have the correct sized needle for the amount of fat at injection sites.

Hypoglycaemia and Alcohol

By Uncategorized

Hypoglycaemia and Alcohol

Alcohol can cause delayed hypos in people with Type 1 diabetes – low blood sugars the day after drinking even modest amounts of alcohol the previous evening. Research carried out at the Royal Bournemouth Hospital [Diabetes Care, July 2005] showed that alcohol has been implicated in up to one fifth of hospital visits for hypoglycaemia, low blood sugars. The researchers investigated the effect of evening alcohol in 16 people with Type 1 diabetes who had normal hypo warnings and who drank alcohol on a regular basis. The participants were evaluated with continuous blood glucose monitoring on two occasions – after taking orange juice and vodka or just orange juice followed by the same meal and same dose of insulin. They experienced 1.3 episodes of hypoglycaemia per day during the 24hours after the alcoholic drink compared to 0.6 episodes after a non-alcoholic drink. The researchers suggest that this research may encourage people to be more ‘proactive’ in adjusting their insulin appropriately if they are drinking alcohol.

Just a few words of warning:

  • Try to learn how alcohol affects you and learn the best ways to cope with it.
  • It is always best to drink with a meal and to tell someone you are with that you have diabetes.
  • You should not assume that drinks which contain carbohydrate will counteract the hypo risk because they don’t.
  • Low carb alcoholic drinks such as Pils contain more alcohol – so not a good idea!
  • The warning signs of hypos can be missed with too many drinks and other people may mistakenly think that you are drunk rather than you are hypo.
  • Carry out more blood glucose tests to check for hypos for at least the next 24hours.

Kidney Failure

By Uncategorized

Kidney Failure

AS we have said above, each kidney contains about I million nephrons to carry out the filtration of the waste products. If the number of nephrons is reduced by damage to the kidneys then the remaining nephrons work harder and the overall kidney function is maintained. However, once a certain amount of kidney tissue has been damaged the surviving nephrons are under increased pressure, become damaged and kidney function declines.

What can be done if my kidneys fail?
If your kidneys fail then you will be treated like any other kidney patient.

  • Dialysis. There are two forms of dialysis which remove extra water from the body and the waste products that have built up in the blood. This keeps you ft and well while you are waiting for a transplant.
  • Kidney transplantation replaces the lost kidney function. It is a treatment not a cure. For many people it provides the optimum method of treatment because it removes the constraints of dialysis and restores a ‘normal’ lifestyle. There are two barriers to widespread successful kidney transplantations – a shortage of donor organs and rejection after surgery by the body’s immune system.
  • Dietetic advice on what foods can help to make you feel better.
  • Medications from your doctor to help other problems such as blood pressure and water removal.

Wrong Sized Shoes

By Uncategorized

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

 

Back to Related Health Issues
horizontaldots

Wrong Sized Shoes

A study at Dundee University of 100 people with diabetes found that 63 had badly fitting shoes – the wrong size and mainly the wrong width. [Int Journal of Clinical Practice, Nov 2007] People with diabetes who also have neuropathy [nerve damage] can lose the sensation in their feet and so damage from ill-fitting shoes can go unnoticed.

If shoes are too narrow, tight or loose, they can cause blisters or ulcers which can be slow to heal and lead to infections. People with neuropathy may choose shoes that are too tight because the increased pressure makes them feel the right size. In addition, feet get larger and broader in older people but they often continue to buy the same size. The study showed that a third of the patients said they took a different shoe size from the one they were actually wearing, probably due to the fact that shoes sizes vary from maker to maker. It also showed that only 29% of people checked their feet and legs regularly for any sign of damage which could lead to problems and 22% never checked their feet.

There is a call for shoe manufacturers to standardize their shoe sizes and increase the range of width fittings. But there is a clear message here for people with diabetes – having well-fitting shoes may be expensive but not as costly as the damage that can be done by not doing this!

The Need For Diagnosis

By Uncategorized

Depression and Diabetes

Statistics
How do You Know You Are Depressed?
The Need for Diagnosis
Treatment
Depression in Parents of Children With Diabetes
GE Insulin, Hypoglycaemia and Depression
Useful Research – Depression and Diabetes

 

Back to Related Health Issues
horizontaldots

The Need For Diagnosis

Recent estimates suggest that up to three quarters of cases of depression in people with diabetes may go undiagnosed. This may be because of poor detection rates but it could also be that some people with diabetes don’t report their symptoms of depression because they see them as ‘just part of having diabetes’.

Screening for depression [not specifically for people with diabetes] has been recommended by national and international bodies and now in the UK, the Dept of Health recommends that all GPs use two simple questions to screen for symptoms of depression:

  • During the last month, have you been bothered by feeling down, depressed or hopeless?
  • During the last month, have you often been bothered by having little interest or pleasure in doing things?

If people answer ‘yes’ to either of these questions, they are given a questionnaire to answer to measure the extent and nature of the symptoms. It is important that similar methods are used in diabetes hospital clinics where many people with Type 1 diabetes receive their treatment.

Myopathy

By Uncategorized

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
horizontaldots

Myopathy

Myopathy is a general term used to describe any disease of muscles, such as the muscular dystrophies and myopathies associated with thyroid disease. It can be caused by endocrine disorders, including diabetes, metabolic disorders, infection or inflammation of the muscle, certain drugs and mutations in genes. Diabetes myopathy is thought to be caused by neuropathy, a complication of diabetes. General symptoms of myopathies include muscle weakness of limbs sometimes occurring during exercise although in some cases the symptoms diminish as exercise increases. Depending on the type of myopathy, one muscle group may be more affected than others.

Treatment – This varies according to the type of myopathy but may include drug therapy such as immuno-suppressants, physiotherapy, bracing or surgery.

IDDT News

By Uncategorized

This section provides up-to-date news and views about treatments, research and latest developments. IDDT’s quarterly Newsletters and Type 2 and You, are available on line here so there’s something for everyone interested in diabetes. These publications also cover personal experiences and discuss ‘hot’ topics in the world of diabetes.

Driving and Medicines

By Uncategorized

Driving and Diabetes

Driving and the EU law
News release: EU changes night-time hypos driving rules for people with diabetes
Driving and hypoglycaemia – what are doctors being advised to do?
Test Strips – Department Of Health Warning For Doctors And Pharmacists
Vehicles You Can Drive
Insulin and Driving Taxis
Hypoglycaemia and Driving
Driving and Medicines
Driving and Visual Field Loss

 

Living with Diabetes
horizontaldots

Driving and medicines

Facts

  • The link between alcohol and road traffic accidents is well established.
  • There is increasing evidence that some prescribed medicines and some over-the-counter medicines may also impair driving ability.
  • A recent survey has shown that 17% of drivers involved in road traffic accidents were found to have traces of medicines in their blood eg antidepressants and antihistamines.

The commonly used medicines that may impair your ability to drive are those that may cause drowsiness are:

  • Some antidepressants
  • Strong pain killers eg codeine
  • Powerful tranquillisers eg those used for the treatment of some types of mental illness
  • Some medicines used to treat epilepsy eg phenobarbitone
  • Benzodiazepine tranquillisers used to treat anxiety and insomnia
  • Some antihistamines for treatment of hayfever and allergies

Your ability to drive may also be impaired by:

  • Eye drops that cause blurred vision.
  • Insulin and some oral anti-diabetic medicines that may cause confusion as a result of low blood glucose levels.

How do you know if your medication may impair your ability to drive?

All medicines that may cause drowsiness are labelled with this warning:

"Warning. May cause drowsiness. If affected do not drive or operate machinery."

It is important to note the words ‘if affected’ in this warning as it places the responsibility on you to decide whether or not the side effects of drowsiness are likely to impair your driving ability. In other words, you have been warned, so if you had an accident as a result of being drowsy, then the responsibility rests with you!

If alcohol is taken with some medicines, then this can make the drowsiness worse and so labels may also contain the warning:

"Avoid alcoholic drink."

A clear message:

Always read the information leaflet about any medications you take whether prescribed by your doctor or bought over the counter at your pharmacy. You can obtain further information about your medicine from:

  • Your doctor
  • Your pharmacist

Cochrane review of short-acting insulin analogues versus regular human insulin in patients with diabetes mellitus

By Uncategorized

Cochrane review of short-acting insulin analogues versus regular human insulin in patients with diabetes mellitus

May 2004

It is the right of patients to have an informed choice of treatment and it is important that they have the best information possible to exercise this right. People with diabetes should be told of their insulin choices including information about risks and benefits and any adverse effects. Insulin analogues are the latest form of GM synthetic insulin and this review compares short-acting analogues [Humalog and NovoRapid] with regular ‘human’ insulin. It is important to note that insulin analogues have not been compared to natural animal insulins because no such trials have been carried out as far as we are aware.
In order to have an informed choice of treatment, it is necessary to look at evidence from high quality systematic reviews. The following Cochrane Review comparing insulin analogues and regular ‘human’ insulin provides just such high quality evidence.

This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration.

Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus
Siebenhofer A, Plank J, Berghold A, Narath M, Gfrerer R, Pieber T.

Background: In short acting insulin analogues the dissociation of hexamers is facilitated, achieving peak plasma concentrations about twice as high and within approximately half the time compared to regular human insulin. According to these properties this profile resembles the shape of non-diabetic patients more than that of regular human insulins. Despite this theoretical superiority of short acting insulin analogues over regular human insulin, the risk-benefit ratio of short acting insulin analogues in the treatment of diabetic patients is still unclear.

Objectives: To assess the effect of treatment with short acting insulin analogues versus regular human insulin. SEARCH STRATEGY: A highly sensitive search for randomised controlled trials combined with key terms for identifying studies on short acting insulin analogues versus regular human insulin was performed using the Cochrane Library (issue 1, 2003), MEDLINE and EMBASE. Date of last search was December 2003.

Selection criteria: We included randomised controlled trials with diabetic patients of all ages that compared short acting insulin analogues to regular human insulin. Intervention duration had to be at least 4 weeks. DATA COLLECTION AND ANALYSIS: Trial selection as well as evaluation of study quality was done by two independent reviewers. The quality of reporting of each trial was assessed according to a modification of the quality criteria as specified by Schulz and Jadad.

Main Results: Altogether 7933 participants took part in 42 randomised controlled studies. Most studies were of poor methodological quality. In patients with type 1 diabetes, the weighted mean difference (WMD) of HbA1c was estimated to be -0.1% (95% CI: -0.2% to -0.1%) in favour of insulin analogue, whereas in patients with type 2 diabetes the WMD was estimated to be 0.0% (95% CI: -0.1% to 0.1%). In subgroup analyses of different types of interventions in type 1 diabetic patients, the WMD in HbA1c was -0.2% (95% CI: -0.3% to -0.1%) in favour of insulin analogue in studies using continuous subcutaneous insulin injections (CSII) whereas for conventional intensified insulin therapy (IIT) studies the WMD in HbA1c was -0.1% (95% CI: -0.2% to -0.0%). The WMD of the overall mean hypoglycaemic episodes per patient per month was -0.2 (95% CI: -1.2 to 0.9) and -0.2 (95%CI: -0.5 to 0.1) for analogues in comparison to regular insulin in patients with type 1 diabetes and type 2 diabetes, respectively. For studies in type 1 diabetic patients the incidence of severe hypoglycaemia ranged from 0 to 247.3 (median 20.3) episodes per 100 person-years for insulin analogues and from 0 to 544 (median 37.2) for regular insulin, in type 2 the incidence ranged from 0 to 30.3 (median 0.6) episodes per 100 person-years for insulin analogues and from 0 to 50.4 (median 2.8) for regular insulin. No study was designed to investigate possible long term effects (e.g. mortality, diabetic complications), in particular in patients with diabetes related complications.

Reviewers’ Conclusions: Our analysis suggests only a minor benefit of short acting insulin analogues in the majority of diabetic patients treated with insulin. Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues. Due to fears of potentially carcinogenic and proliferative effects, most studies to date have excluded patients with advanced diabetic complications. For safety purposes, we need a long-term follow-up of large numbers of patients who use short acting insulin analogues. Furthermore, we need well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.

The full version of this Cochrane Review can be found at: www.cochrane.org

What does this review of short-acting insulin analogues and regular ‘human’ insulin mean for people with diabetes?
Cochrane reviews are designed to assess the evidence from randomised controlled trials to provide high quality evidence to help patients and doctors make informed choices about insulin treatment. So this review provides just this! Looking at the review in details tells us the following:

The trials:
Altogether 7933 participants took part in 42 randomised controlled studies. 25 studies were carried out in people with Type 1 diabetes, 5 in people with Type 2 diabetes, 5 with a combination people with Type 1 and Type 2 diabetes and one in women with gestational diabetes.

The evidence from the review says:

  • There was only a minor benefit of short acting insulin analogues compared to ‘human’ insulin.
  • Until long term efficacy and safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues.
  • Due to fears of potentially carcinogenic and proliferative effects, most studies to date have excluded patients with advanced diabetic complications.
  • For safety purposes, we need a long-term follow-up of large numbers of patients who use short acting insulin analogues.
  • Furthermore, we need well designed studies in pregnant women to determine the safety profile for both the mother and the unborn child.
  • 81% of the studies were sponsored by the analogues insulin manufacturers themselves and sponsors were not declared in the remaining 7 studies.

Other information from the review:

  • Quality – most studies, 83%, were of poor methodological quality.
  • Long-term effects – no study was designed to investigate possible long-term effects (e.g. mortality, diabetic complications), in particular in patients with diabetes related complications.
  • The severity of diabetes – this was rarely reported in the studies and in the 17% of studies where pre-existing complications were described in detail eg retinopathy, neuropathy and nephropathy, the outcome on these complications when under drug treatment was only reported in one trial dealing with pregnancy.
  • Hypoglycaemia – 17 studies had to be excluded, some because there was no information. Analysis did not confirm the often-claimed advantage of reduced hypoglycaemia after analogue treatment as there were no statistical differences in overall hypoglycaemia when analogues were compared with regular insulin.
  • Nocturnal hypos – only 6 studies mentioned night hypos and overall nocturnal hypoglycaemic events were presented in only two studies. One showed a significantly reduced rate with analogue treatment from midnight to 6.00am whereas the other study showed no statistically difference from bedtime to breakfast time.
  • Quality of life – 11 studies reported on quality of life and analogues showed a significant improvement compared to regular human insulin but this was largely due to convenience, flexibility and continuation of treatment. The reviewers suggest that this is probably due to the difference in injection timings with analogues injected immediately before a meal compared to 30 minutes before for regular human insulin.
  • The mitogenic and carcinogenic potential of insulin analogues – in terms of these effects, the review says that only very limited information on the long-term safety is currently available.

Human insulin has a weak mitogenic effect. [Mitogenic effect mean cell multiplication with the potential for the development of tumours.] The molecular composition of insulin analogues and/or structure has been modified compared to human insulin and these structural modifications could increase the mitogenic potency possibly resulting in the development of tumours especially with long-term use of insulin analogues. This is thought to be due to the structural similarity to insulin-like-growth-factor-1 [IGF-1] and/or faulty signalling through the insulin receptor. The similarity to IGF-1 could also affect the progression of retinopathy.
The first example of this mitogenic effect was in the AspB10 insulin analogue, developed by Novo Nordisk. Trials were stopped because it was found to induce mammary tumours in rats. Therefore the European Agency for the Evaluation of Medicinal Products [EMEA] states that a thorough assessment of the carcinogenic potential is indicated for all new insulin analogues.

It is also worth looking at the EMEA approval documents for each analogue insulin on their website www.emea.europa.eu

IDDT is not being alarmist, although we may be accused of it!
All this information is already in the public domain and we cannot and should not avoid discussion of these potential effects of insulin analogues – they must form part of our informed choice when considering whether to use them. Indeed, at IDDT’s meeting with the Dept of Health [May 26th 2004] when analogues were discussed as an alternative choice to animal insulins, we pointed out that although analogues have not been compared to animal insulin, there is an 80year long-term safety history of animal insulin without obvious tumour development. This cannot be said for the insulin analogues – we simply don’t know and won’t know for many years to come and even then, this assumes that there is or will be continual monitoring of these effects in people using analogues.

Information packs for teachers and for parents

By Uncategorized

Information for teachers and for parents

Children and young people with diabetes are a particularly vulnerable group as they grow up with diabetes. We know from parents’ experiences that school can present problems for children with diabetes and additional worries for parents. So we have developed Information Packs to try to help and alleviate some of these problems.

Parents Pack
This contains the following information, which is especially for parents of children and young people with Type 1 diabetes, including the Parents Passport for Schools to give to the teacher.

Teachers Pack
This Pack contains information about diabetes to provide them with a better understanding of diabetes and help to understand the needs of children with the condition. 

All the above are provided FREE of charge from IDDT and with membership of IDDT you can also receive the general quarterly newsletter.

Introduction: Enter Dr Lawrence

By Uncategorized

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
horizontaldots

Introduction: Enter Dr Lawrence

I am a diabetic and have been on insulin for seventy years. For much of that time, I was a patient of Dr. R. D. Lawrence, 1892 – 1968. The wisdom and compassion he bestowed on me has enriched and protected my life. I shall be happy if I can pass on to my fellow diabetics some of what I gained from knowing him.

Dr. Lawrence was one of the first people whose life was saved by the discovery of insulin in 1921. “In the successful treatment of diabetics the patient, the nurse, the practitioner and the specialist are often partners working together to establish the patient’s health. In the long run the most important part, the melody, is played by the patient and the accompaniment may be almost unheard.”(1)

When patients visited Dr. Lawrence in his Harley Street rooms, he greeted them with a hearty handshake. He always had a pink carnation in his buttonhole and never wore a white coat. After a friendly exchange of family news, I remember he would always ask to be shown the glucose sweets I was carrying. He would explain, with a twinkle in his eye, that in the past his patients had seemed too good to be true. Every one of them said they always carried glucose sweets ready for an emergency. When he asked to see what they were carrying, he found his fears were justified. Only about one in ten could produce the sweets they said they had. He told me he wouldn’t like me to be one of those irresponsible people on insulin who go around without the sugar they will need to counteract a hypo.

The next conversation would be about blood sugar. Dr. Lawrence would say, “We’ll both guess what we think your blood sugar is now. I’ll write down the answers and put them in front of us on my desk. No cheating! Of course, you should be right and I should be wrong. I can’t expect to know as much about how your body works as you can.” Sometimes we were both slightly wrong but most times I was the winner.

We would then discuss the new medium and long-lasting insulins that were coming on to the market. He would try them out on himself in different strengths and combinations. He would often say, “Your diabetes seems to be happy as it is. I see no advantage for you in disturbing things. Why should you change?”

I have followed his advice to this day. Neutral, quick-acting animal insulin is the only one I have ever used, except for the distressing interlude when I hoped to take advantage of the promised, but never fulfilled, wonders of ‘human’ insulin. The result of this conservative behaviour is that my body has fallen into the habit of good diabetic control. It has not had to undergo the stress of fitting itself into the rhythms of new insulins or learn to tolerate the additives mixed in to make insulin last for a longer or shorter time. Perhaps this simplicity is what has found favour with my hormones and helps to explain the health and happiness that have coloured my life.

Fate was kind on that overcast afternoon so long ago in 1930 when it sent me to see Dr. Lawrence for the first time. He taught me many things, and one of these was not to regard the doctor as a god. One day, after examining my eyes to detect early signs of diabetic retinopathy, he looked worried and said “Always remember, Beatrice, for all our expertise and training, we doctors really know very little about the fundamental problems of life. We don’t understand the cause of diabetic retinopathy, we can’t prevent liver cancer or even cure the common cold.” This humility and wisdom gave me lifelong courage and insight. The wise man is the one who knows he does not know.

Research grants

By Uncategorized

Research Grant Applications
IDDT Funded Research Findings
Participating in research – OK to Ask

horizontaldots

Research Grant Applications

IDDT registered as a charity in 1994 and it aims to help and support people with diabetes. It is run by people who live with diabetes for people that live with diabetes and as such, IDDT has a stated policy of not accepting any funding from the pharmaceutical industry. This enables IDDT to be independent and uninfluenced by funding sources. For this reason the amount of money the Trust has to fund research projects is fairly limited but the Trust has grown and is now in a position to consider awarding research grants. Initially, we are prepared to consider applications for research in the area of primary care up to £30,000 for any one project but is happy to consider joint funding.

The Trust would not wish to interfere in any way with the publication of the research, if the applicants wish to do so.

The Trust is not accepting applications until further notice.

If an application has not been accepted, further applications may not be made for a further 12 months.

Application Procedure
For simplicity and speed, the Trust has four levels of procedure for applying for funding from its Research Fund. These are as follows:

Stage 1
Submission of an interim research application questionnaire (IQ) by the applicant. The IQ will be sent to all interested applicants on request.

The purpose of the IQ is so that it is simple and quick to fill in for the applicant. This should help to stop busy people wasting unnecessary time drafting a full application for research funding when their research field is outside the boundaries of the Trust’s “patient centred” areas of interest.

Stage 2
If the IQ is approved by the Trust’s research group, then the applicant will be invited to submit a full research application. However, we do suggest that the applicant considers Stage 3 carefully before deciding whether to continue with a full research application. i.e. Stage 4

Stage 3
Before submitting a full research application, the Trust suggests that applicants carefully consider what potential benefits the research could have for the average every day diabetic patient (if there is such a thing!).

The Trust is not against any research that might question generally accepted principals in diabetes care, providing it is reasonable and does not potentially put patients’ health or wellbeing at risk.

The Trust would particularly support new ways of thinking and treating diabetes especially when consumer input and consumer experience is put as a key aspect of the research. Learning from patient experiences and patient experts was one of the main reasons the Trust had to be started up to 10 years ago.

Stage 4
Submission of the full research application If approved may be paid in stages and may be conditional.

A full research application should include:

  • Why the research is needed.
  • Aims of the research.
  • Proposed method.
  • Proposed analysis.
  • The amount of consumer involvement.
  • Estimated cost.
  • Size of the research grant requested and details of other funding received or applied for.
  • Ethics committee approval if appropriate.
  • Any areas of potential interests or conflicts of interest.

For application forms please contact:

Jenny Hirst
Co-Chair
IDDT
PO Box 294
Northampton
NN1 4XS

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

Animal insulin – Minister’s letter

By Uncategorized

IDDT campaigning

Pork and beef insulins available in the UK
Synthetic ‘human’ insulin versus natural animal insulin
Animal insulin – Minister’s letter
Limiting availability of blood glucose test strips

 

Back to Here to Help
horizontaldots

Animal insulin – Minister’s letter

 

From the Minister of State
The Rt Hon Jane Kennedy MP

Department of Health
Richmond House
79 Whitehall
London
2NS

24.7.05

Jenny Hirst
Insulin Dependent Diabetes Trust
PO Box 294
Northampton
NN1 4XS

Dear Ms Hirst,

Thank you for coming to meet me at Portcullis House on July 11th, to discuss your concerns about the continuing availability of animal insulin.

May I first of all say that the Department of Health fully accepts that some people are better suited to animal insulin, and that animal insulin should continue to be made available. At this time, neither of the two suppliers of animal insulin to the UK has informed us that it intends to stop supply it, although Novo Nordisk says that it will make a decision in 2006.

We have again sought assurances from Wockhardt that it has no plans to discontinue supply of animal insulins. The company says that animal insulins continue to be key products for it. As part of an investment program in its UK sterile manufacturing facilities, production capacities for such products will be significantly enhanced over the next 6 to 12 months. The company says that this investment is essential in order for it to take full advantage of the commercial opportunities that may present themselves, including in the animal insulin market.

Although the market for animal insulin is relatively small, Wockhardt has recently underlined its commitment in this field by seeking registration of its porcine insulin range in Canada. It is expected that Canadian Marketing Authorisations will be in place before the end of the year, which will mean that patients currently being prescribed animal insulin from Eli Lilly, will have an alternative when this is withdrawn from the market early in 2006. Wockhardt has been working closely with Lilly and Health Canada to ensure that there is continuity of supply for patients who wish to continue taking porcine insulins.

As far as adverse effects of human insulin are concerned, it is current clinica practice to start patients on human insulins and there is no clinical evidence that human insulins cause any more adverse reactions than animal insulins. This view  has overwhelming clinical and professional support, and is borne out by the July 2000 Duabetes UK comparative report on all the various animal versus human insulin studies (as the British Diabetic Association).

We have considered whether further (non company) research might be carried out on the adverse effects of human insulin, but given the high demand on R&D budgets for research on subjects of high clinical and policy priority we have concluded that there seems little justification for commissioning research at this time. However you may wish to be aware that there is an ongoing (company-sponsored) study to examine the incidence of serious adverse drug reactions in 4,000 patients receiving the recombinant human insulin insulin analogue determir (brand name Levermir) – the findings from this study will be reviewed by the MHRA.

During our meeting, we discussed how the profile of the issue might be raised, particularly with doctors. As you will be aware, there have been two previous articles on hypoglycaemia unawareness on transferring from animal to human insulin in the MHRA’s drug safety bulletin "Current Problems in Pharmacovigilance", the most recent in September 2000. I have asked officials to make arrangements for another article to appear in the near future. I have also asked them to liaise with National Diabetes Support Team (NSDT) on the possibility of including an article on the Yellow Card Scheme on its next briefing and to discuss with Diabetes UK the possibility of inclusion on their website of a link to www.yellow.gov.uk where patients can report suspected ADRs.

Finally, the MHRA is currently taking forward the recommendations of the Independent Review of Access to the Yellow Card Scheme including patient reporting, access to Yellow Card Data and proposals for increasing awareness of the Scheme.

I hope this is helpful.

Yours sincerely

 

JANE KENNEDY

Depression

By Uncategorized

Diabetes
Stress, Anxiety and Depression

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

 

Stress, Anxiety and Depression
horizontaldots

Depression and Diabetes

The prevalence of major depression in the UK population at any one time is about 5%, although as many as one person in three may experience an episode of depression in their lifetime. The presence of other illnesses may complicate or worsen depression and vice versa.

Research has shown that depression may occur in:

  • Up to 60% of stroke patients
  • Up to 40% of people with Parkinson’s disease
  • Up to 42% of cancer patients
  • Up to 21% of people with irritable bowel syndrome
  • Up to 14-18% of people with diabetes

A study by Brazilian researchers showed that among a group of people with diabetes, of those whose HbA1c levels averaged less than 9%, only 21% tested positive for depression. By comparison of those with HbA1cs over 9%, 42% tested positive for depression. Other research has shown that people with chronic conditions, including diabetes, are three times more likely to suffer depression than the general population.
The researchers used cognitive therapy to reverse the depression. In those people where depression improved, there was an average HbA1c of 8.3% while those who showed little improvement had an average of 11.3%. While these results show an association between high blood sugars and depression, it remains unclear whether high blood sugars cause the depression or depression causes high blood sugars. [American Diabetes Association Conference 1998]

Research published in 2010 found that:

  • people with depression were 17% more likely to develop Type 2 diabetes
  • people with diabetes were 29% more likely to have depression compared with people without diabetes
  • the risk of diabetes was greater in those with depressed mood, rising to 25% greater in those on antidepressants
  • People with diabetes had a greater risk of depression rising to 53% higher among those treated with insulin.

The researchers recommend lifestyle changes to lower the risk of both conditions eg weight management and regular exercise. [Arch Intern Med 2010;170:1884-9]

How do you know if you are depressed?
The signs of depression include the following:

  • No longer enjoying or being interested in most activities.
  • Feeling tired or lacking energy.
  • Being agitated or lethargic.
  • Feeling sad or low much of the time.
  • Weight gain or weight loss.
  • Sleeping too little or too much.
  • Difficulty paying attention or making decisions.
  • Thinking about death or suicide.

If you have some or all of these symptoms over two weeks or more, then you should see your doctor.

How does depression affect people with diabetes?
An international report has shown that having diabetes and depression has the greatest negative on quality of life compared to diabetes or depression alone, or other chronic conditions. [Lancet 2007;370:851-8]
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]

The need for diagnosis
Recent estimates suggest that up to three quarters of cases of depression in people with diabetes may go undiagnosed. This may be because of poor detection rates but it could also be that some people with diabetes don’t report their symptoms of depression because they see them as ‘just part of having diabetes’.
Screening for depression [not specifically for people with diabetes] has been recommended by national and international bodies and in the UK, the Department of Health recommends that all GPs use two simple questions to screen for symptoms of depression:

  • During the last month, have you been bothered by feeling down, depressed or hopeless?
  • During the last month, have you often been bothered by having little interest or pleasure in doing things?

If people answer ‘yes’ to either of these questions, they are given a questionnaire to answer to measure the extent and nature of the symptoms. So if you answer ‘yes’ to the two questions above or you have more mild symptoms, you are not alone and the clear message from research is to seek help from your doctor because there is a good chance that your life will improve.
It is important that similar methods are used in diabetes hospital clinics where many people with Type 1 diabetes receive their treatment.

Treatment
Treatment for depression in people with diabetes has been shown to be effective and has the additional benefits of improving blood sugar control. The evidence suggests that cognitive behaviour therapy and anti-depressant medicines are as effective in people with diabetes as in those without diabetes. One study found that not only did treatment improve blood sugar control but during treatment there was an improvement in mood and weight. As the treatment of depression can improve blood sugar control, it is also likely to reduce the risk of complications but importantly, it can also improve quality of life.
It is also well recognised that exercise helps to reduce depression, so although it may be the last thing that people feel like doing, it is worth increasing the amount of exercise being taken.

Medicines and Healthcare products Regulatory Agency

By Uncategorized

Medicines and Healthcare products Regulatory Agency

The Medicines and Healthcare products Regulatory Agency (MHRA) is today urging those with diabetes using Hypurin Porcine Isophane insulin cartridges to check their medication after a packaging error came to light.

The issue occurred when a carton for cartridges of intermediate acting Hypurin Porcine Isophane Insulin 100 IU/ml got into the production line for the short acting Hypurin Porcine Neutral Insulin 100IU/ml.

One such pack was identified by a pharmacist before it reached the patient and whilst the manufacturer, Wockhardt UK Ltd, believes it is highly unlikely there are any other such packs in the supply chain, patients and pharmacists are being asked to check their cartons.

The issue relates to one batch of Hypurin Porcine Neutral Insulin, with the batch number PL40147, and although it is considered highly unlikely that there are any other rogue packs in the supply chain, the MHRA has issued a drug alert following a precautionary recall by the manufacturer.

Pharmacists and wholesalers are being asked to check stocks of Hypurin Porcine Isophane Insulin and contact Wockhardt immediately if any packs of this insulin, embossed with this batch number, are identified.

Pharmacists are also asked to contact patients who may have stocks of this insulin. Cartons of Hypurin Porcine Neutral Insulin 100 IU/ml with the same lot number are not included in this recall and should not be returned. No other batches of Hypurin insulin are affected.

Gerald Heddell, MHRA Director of Inspection, Enforcement and Standards said: "It is important that patients continue to administer their insulin as required. Patients with any questions or concerns should contact their GP or pharmacist as soon as possible. An investigation has taken place and action has been taken to rectify the issue."

The drug alert can be viewed at:
http://www.mhra.gov.uk/Publications/Safetywarnings/DrugAlerts/CON184737

Hypoglycaemia and Loss of Warnings

By Uncategorized

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 you admitted to hospital
Frequently asked questions
Allergic reactions to insulin

horizontaldots

Hypoglycaemia and loss of warnings

Hypoglycaemia and loss or reduced warning symptoms of an impending hypoglycaemic attack are the most common reported adverse reactions to GM synthetic ‘human’ insulin. The fact that this happens to some people is not denied by regulatory authorities or the insulin manufacturers and warnings are issued in all GM ‘human’ insulin Patient Information Leaflets. Despite this, unfortunately many of the medical and nursing professionals are either unaware of this or do not accept it and this often can result doctors refusing to change people to animal insulin or even consider this as an option when their patients have lost their hypo warnings.

Note: In a book written by Charles Fox and Anthony Pickering for GPs, Diabetes in the Real World, the advice is "If a patient is showing signs of unhappiness over problems with hypos, it is always worth offering a change to the porcine equivalent of the insulin being used." As ‘human’ insulin has never been demonstrated to have any advantages over animal insulin, this advice is welcomed but unfortunately GPs often will not change the species of insulin without approval of the hospital consultant and it is usually here that the refusal to prescribe animal insulin occurs.

Understanding the effects of living with hypos and loss of warnings
As an organisation we wonder if healthcare professionals do not or cannot understand the effects of hypos and loss of warnings on the daily life of those of us who live with diabetes. Perhaps this offers one explanation of the refusal to change people to pork or beef insulin.

Hypoglycaemia itself, or the avoidance of it, is an acute daily problem for people with diabetes but when accompanied by loss or partial loss of warnings, it can have a dramatic effect on the lives of the person with diabetes and their families. There can be a marked reduction in the quality of life for all concerned.

Information gathered in 1997 by IDDT from the experiences of people with diabetes and their families says that loss of warnings may result in the following:

  • A feeling of insecurity and loss of independence.
  • Embarrassment.
  • Being a danger to oneself and others.
  • Aggressive or violent behaviour.
  • Family conflict, breakdown of relationships.
  • Loss of driving licence – it is illegal to drive with loss of warnings.
  • Loss of job
  • A deliberate raising of blood glucose levels to avoid the risk of hypoglycaemia.

Even more worrying is the condition of hypoglycaemia automatism when in a hypo the person is unaware of their actions, often described as ‘functioning on auto-pilot’.

Research into the relationship between hypoglycaemia and crime that has shown that hypoglycaemia has resulted in the following crimes:

Person

  • Disorderly conduct
  • Resisting arrest
  • Assault
  • Murder

Property

  • Wilful destruction
  • Shoplifting
  • Petty larceny
  • Embezzlement
  • Driving violations

Behaviour

  • Exhibitionism
  • Blasphemy
  • Slander
  • Sexual perversion
  • Sadism
    [David Kerr and Joan Everett, Journal of Nursing Vol 1: N0 4 1997]

Repeated hypoglycaemia in children has been shown to cause a slight reduction in their IQ and cognitive functioning and so avoidance of hypos and loss of warnings is very important in children.

It is for these reasons, and many more, that IDDT believes that every possible option should be tried to reduce the risk of hypos and loss of warnings. Therefore if a person/child has unaccountable hypos, reduced or loss of warnings of hypoglycaemia, they should be offered a change to pork or beef insulin for a trial period of at least 6 months.

For more information on Hypoglycaemia and loss of warnings click here

Living With The Daily Risk of Hypos

By Uncategorized

Living With The Daily Risk of Hypos

Here are just a few quotes from people with diabetes:

  • “Hypoglycaemia is one of the worst parts of having diabetes”
  • “Hypoglycaemia screws up your life.”
  • “For some of us it is a constant battle that we go through everyday and every night to try to obtain some sort of normality in our blood glucose levels. The fears and experiences, especially of hypoglycaemia comas and seizures that many of us and our carers suffer, are ever present.”

Practical information from people with diabetes for people with diabetes:

  • One hypo can easily lead to another within the next 72 hours. This is because the first hypo used up much of the body’s emergency store of glucose so leaving the body vulnerable to another hypo.
  • Strenuous exercise can lead to low the blood sugars the next day.
  • Exercise sufficient to lower blood sugars and cause a hypo is not always the strenuous sporty-type exercise. For people with a sedentary job or the elderly, a trip around the busy supermarket is exercise and can be sufficient to cause a hypo.
  • Sexual intercourse is exercise and can cause hypos in both men and women.
  • Alcohol lowers the blood sugars and can cause hypoglycaemia both at the time and up to 48 hours later. Alcohol also masks the warning signs of a hypo. Hypos can be misinterpreted by others as ‘ you are drunk’.
  • Some drugs taken for other conditions may cause hypoglycaemia eg beta-blockers.
  • Emotional upset, stress and excitement, which may not always be apparent, can cause hypos.
  • With illness and especially vomiting, it is OK to eat or drink anything that will keep the blood sugars high enough to avoid hypoglycaemia.
  • All long- and intermediate-acting insulins contain crystals and they settle to the bottom of the vial. They must be re-suspended before drawing up and injecting the insulin. Research has shown that the vial must be rolled or tipped 20 times to achieve a satisfactory mixture. This also applies to insulin in pens. Failure to do this can result in unexpected hypos because there will be less crystals in the insulin and it is the crystals that slow down the action of the insulin.
  • A change of insulin type, species and even batch can affect diabetic control and cause hypos.
  • Genetically produced synthetic ‘human’ insulin in some people causes more severe hypos, more frequent hypos and reduced or loss of warning symptoms.
  • Hypos can occur for no apparent reason and in people who blood test frequently, as well as those who don’t.
  • Being able to function and walk around with low blood sugars does not mean that you are not hypo – it probably means that you have missed, or not had, the early warning signs.
  • Hypoglycaemia itself can lead to loss of warnings.
  • Good diabetic control means avoiding hypoglycaemia just as much as avoiding hyperglycaemia [high blood sugars].

Neuropathy and Antidepressants

By Uncategorized

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

 

Back to Related Health Issues
horizontaldots

Neuropathy and Antidepressants

IDDT has had quite a lot of queries from people who have neuropathy [damage to nerves] and are being treated with antidepressants and they find this difficult to understand. The reason for prescribing antidepressants for neuropathy is based on the suggestion that these drugs may inhibit the pain pathways in the central nervous system.
Drugs and Therapeutics Bulletin April 2007

When a simple painkiller, such as paracetamol, is ineffective in treating painful neuropathy, the next treatment is with what is known as a tricyclic antidepressant, such as amitryptyline. Other options are available including duloxetine [sold as Cymbalta and Yentreve] which has been specifically approved for peripheral neuropathic pain. It is recommended that its use is assessed 2 months after starting treatment and then 3 monthly. The trials carried out with duloxetine showed that there was a significant reduction in pain when compared to a placebo [dummy pill].

InDependent Diabetes Trust
IDDT