Not so nice aftermath of nice publication
Following publication of the much awaited NICE recommendations for the use of continuous subcutaneous infusion pumps for diabetes, and the welcomed result of the therapy being available on the NHS, subject to their guidelines, the numbers of people with diabetes starting on pumps appears to have dropped to zero!
What has happened ?
5 year old Mustafa’s mum from Halifax has just received, the good news that Mustafa is to be funded at last, and he is happily settled on his pump, but there are still other children who are on pumps and despite the nice recommendations, not being funded, or being denied access to pumps, despite poor glycaemic control. Why?
Most of the articles written here are personal opinions or experiences and should not be used instead of obtaining appropriate medical advice
Look What I’ve Got!
Brandon shows it as it is.
Run for it, Bill
Bill Lamb, consultant diabetologist at Bishop Auckland hospital, to run 500 miles to provide pumps for children
The local children and adolescents with diabetes in County Durham have been asking for pumps, and laid on a presentation for their local NHS Trust and PCTs, at which funding for pumps for local local youngsters was agreed. However, nothing happened.
So now Bill Lamb is planning to run a sponsored 500 miles to raise the money himself for his patients to get pumps. Wow!
What a consultant!
If you would like to sponsor Bill or want to know more, look on www.run500miles.com
Carbohydrate Counting Book by Jo Sutton –
Correction
Sorry to all of you who wished to buy this book, we have since discovered it can only be purchased by users of Disetronic pumps and equipment.
However, for those of you with Medtronic pumps, they also do a carbohydrate counting book and you can request one by telephoning Yolande on 01923 205167
Book Review
Dr.Berstein’s Diabetes Solution by Richard K Bernstein M.D.
Is a book that I just could not put down until I had read it all.
It is about diet and its effects on the diabetic body systems, and it is the total opposite of everything we were ever told about dietary advice for diabetes. It advises having a high protein, low carbohydrate diet, something that has worked for the author, himself diabetic, personally over the past 50 years.
My first reaction was, ‘no way, this can’t be right’, but having read his experiences feel there may be times when this approach may help, such as for those who have been unable to get anywhere near reasonable glycaemic control, and possibly those who are type 2 and exercise.
It is certainly a book to make you think and challenge your diet beliefs, and for some, possibly who are not on pumps, it may be an opportunity to try another approach to diet that may work for them.
Deborah Beskine.
Medtronics new Paradigm pump
Is now out and in use by some of you – what are your first reactions and thoughts ? please let us know.
01590 677911
Variable delivery rates for low basal rates.
On another note, for those with younger children on low basal rates, we have heard there may be a problem with a variable delivery of these low levels of insulin, possibly only on one type of pump. If you think this may affect your child, please ring John or Debbie on 01590 677911/01462 626695 as we are collecting information.
School Issues
A new American publication containing the ‘ultimate diabetes resource’ for schools has just come out and is available to download free from the internet on http://americandiabetesassn.org/GoNow/a16366a78388a106403313a17
Diabetes Uk
also do a school information pack that you can obtain by calling them on 0207 424 1030.
School and Public Exams
If your child is at secondary school, do you know if the school has an exam policy in place for adolescents with diabetes?
Are they allowed to carry out blood tests before and during the exam?
If they are high or low, does the exam clock stop until their blood sugar has recovered to a normal level, and then recommence? As it may take 45 minutes for a blood sugar to adjust, it is worth ensuring the school has such a policy in place.
For a copy of Chris Aspeys report on how blood sugars can affect adolescents and exams, email Debbie on
Shortage of Childrens’ Diabetes Nurses
There appears to be a shortage of diabetes specialist nurses for children at present, especially those with pump knowledge. Or is it something to do with what the hospitals are expecting the nurses to do as well as their specialist field ?
If you have a good childrens diabetes nurse, make sure you value him or her!
It’s hard to deal with emergencies and questions about diabetes and the pump when there is no –one to ask or ‘phone you back!
Highlight on FATS
We are always being told that a low fat diet is a healthy diet, so what is fat ?
We eat fat in our food; it is a nutrient needed by the body, but not in large quantities; it can be either saturated (such as butter) or unsaturated fatty acid, and the unsaturated fatty acid can be monounsaturated (such as in olive oil, avocado pears and rapeseed oil), or polyunsaturated (such as in sunflower, soya and fish oils).
Some soft margarine contains trans- fatty acids. These are unsaturated fats that have been converted to saturated fats during processing.
Excess carbohydrate that is eaten and not required by the body for energy, can be converted into fat for storage in the body, and it is for this reason Dr.Bernstein, in his book, recommends
a low carbohydrate diet. It is also why a high HbA1c is not good for people with diabetes, as it reflects too much sugar (carbohydrate) in the blood stream for a period, which can increase the chances of getting heart /arterial disease.
In our bodies we store fat under the skin, around organs, in the liver and in the blood stream.
One of the complications of having diabetes is that it affects the body’s ability to metabolize fats. We all need a certain amount of fat, after all, our cells membranes are made of fat. However, too much fat can increase the chance of getting heart disease and hardening of the arteries, and people with diabetes already have a far greater risk of getting these then people who do not have diabetes.
There is fat circulating in the blood plasma, called lipids, as cholesterol and triglycerides.
Triglycerides come from fat in food, fat made by our body or from unused carbohydrates we have eaten that are converted to triglyceride for storage. If we need energy and we have not eaten, the body can convert the stored triglyceride back to energy.
Cholesterol is made in the liver from fat and links with protein to be carried around the body; it is then called lipoprotein, and these can be HDL – high density lipoprotein – or LDL – low density lipoprotein.
HDL is seen as being beneficial, giving protection from heart disease, and is thought to carry cholesterol away from the arteries and back to the liver, whereas LDL is the opposite; if there is a high level of LDl it can make fatty deposits on the artery walls, causing them to narrow (known as atherosclerosis) and in diabetics a particular form of very dense LDL is often seen.
It is not a good sign if the LDL level in the blood is higher than the HDL, and if the cholesterol levels and triglyceride levels are high, the body is at high risk of heart disease and stokes.
For the above reasons, diabetics have blood tests to check their blood lipid profile, so that early warning of rising levels can be monitored and treated if necessary.
Recently there has been then introduction of new margarines in supermarkets, advertising that they can help lower cholesterol levels as part of a healthy diet. These margarines contain plant sterols and stanols and research has suggested that they are effective in helping to reduce the total cholesterol and LDL levels.
In addition, it is believed that fish oil, rich in omega 3 oils, (which are polyunsaturated oils),
can help reduce triglyceride levels and also help prevent the blood clotting from sticky platelets.
Further information on the above can be found on
www.bhf.org.uk
“We have the proof that we can prevent the small vessel complications of diabetes such as diabetic eye and kidney disease. Even though 80% of people with diabetes will die of heart disease, we still do not have proof that we can prevent this type of heart disease” Dr.Gillian Booth, St.Michaels Hospital and Dept Medicine University of Toronto.
A new study carried
out in Massachusetts recently has shown that intensive blood sugar control therapy can slow down the development of atherosclerosis.
They looked at the thickness of the carotid artery, measured by ultra sound, in the necks of non-diabetic people, diabetic patients in the tight control group and those in the standard therapy control group, and then measured them again 6 years later.
At the end of the 6 years, all those with diabetes had thicker arteries than the non-diabetics, but those who were in the standard insulin therapy group had thicker arteries than those in the intensive therapy group.
It would be useful if children in the UK could have access to ultrasound scans to check their carotid arteries for thickening, especially those children who developed diabetes at a young age, and those who have had it for many years – how else are we to know the physical state of their blood vessels, and whether their control is sufficient to avoid heart problems.
News from American Diabetes Association
May 30 2003 Tel Aviv University
Israeli/US team create insulin-producing cells from stem cells
Diabetes in mice was cured by insulin-producing cells, from stem cells taken from 4month old miscarried human embryo and implanting them into type 1 mice. They are hoping that such cells could be transplanted into humans, once a way to prevent auto-immune attack is found.
It is thought the genetically engineered human cells will be ready for clinical trials in humans in 2-3 years time, but meanwhile the hunt is on for a carrier to hold and protect the cells from the body’s immune system.
The importance of this research is that for the first time an unlimited supply of insulin-producing human cells has been developed.
News from Medscape
Insulin patches Trial started.
A trial to assess the use of skin patches as an insulin delivery system started in May and is likely to be completed by the end of the year. The patch has a wafer thin layer of filaments containing insulin, and a hand held activator makes tiny holes in the outer skin. It is meant to be painless and needle-free, but is thought that if it is successful in trial will be available for patients with type 2 to begin with.
Home HbA1c Blood Test Kits now available in the UK
For the first time it is now possible to buy, by mail order, home HbA1c blood test kits.
Each test kit can only be used once, and uses drops of blood from a finger prick sample. The result takes 8 minutes from when the blood is applied to the meter, and the reading is accurate to within 0.9.
Each kit costs £15.90 and they are available from Chirus Ltd of Watford on 01923 212744. If the kit is not going to be used within 30 days, it must be stored in the ‘fridge
At 2 – 8 centigrade.
Article from Medscape
Reuters Health June 26 2003
Insulin Pump Therapy Lowers HbA1c More Than Insulin Glargine in Diabetic Children
By Megan Rauscher
NEW YORK (Reuters Health) Jun 18 - In a study of young type 1 diabetics, continuous subcutaneous insulin infusion (CSII) with insulin aspart was more effective in lowering HbA1c levels than multiple daily insulin (MDI) injections with insulin glargine and pre-meal insulin aspart. Moreover, patients preferred CSII.
Elizabeth Boland, a nurse practitioner on the Yale Pediatric Diabetes Team, presented her group's findings during the American Diabetes Association's 63rd Annual Meeting in New Orleans this week. Most previous studies of CSII in children were retrospective and lacked randomized comparisons with MDI, according to Boland and colleagues.
In an ongoing randomized, prospective study, they are comparing the use of pump therapy with insulin aspart versus multiple injections (4 per day) consisting of insulin glargine (once-daily) and insulin aspart taken at meals and snacks in 30 patients with type 1 diabetes 8 to 19 years of age.
"The relative efficacy of these treatment is of greater interest with the introduction of glargine as a better MDI basal insulin," the investigators note in a meeting abstract.
"Our preliminary findings [in 26 children] showed that pump therapy was more effective in controlling blood sugar, as measured by HbA1c, than the multiple injection regimen," Boland said. At 4 months, pump users significantly lowered their HbA1c levels to 7.2% from 8.1% at baseline. In contrast, HbA1c in the MDI group showed no significant change from baseline, dropping only to 8.1% from 8.4%.
Pump users but not glargine users significantly reduced their required total daily dose of insulin.
There were 4 episodes of severe hypoglycemia in the MDI group and 2 in the pump group, but no diabetic ketoacidosis in either group.
After 4 months, all 12 children in the pump group chose to continue on CSII therapy and 12 of the 14 children in the MDI group opted to switch to CSII.
"Pump therapy should be offered as a treatment to younger patients with type 1 diabetes to help them achieve better metabolic control to prevent later complications," Boland told Reuters Health.