JANUARY
2008 NEWSLETTER
ANOTHER YEAR – 2008!
The Trustees of IDDT send their best wishes for
2008 to all our members and readers. It’s a time to make New Year resolutions
even though sometimes we know in our heart of hearts that we won’t keep them!
However flippant or serious our resolutions may be, they do mean that we have
looked at our lives and decided that there are things that we would like to try
to change. Perhaps it is the trying that is really important. Diabetes is a
condition where we have to try all the time, whether as someone with it or as a
parent or carer.
I am sure there are others that will join me in a
New Year wish that in 2008 all our trying will be appreciated when we go to the
diabetic clinic. Our results may not be what the doctor or nurse want to see,
but that doesn’t mean we haven’t been trying. It doesn’t mean that we deserve a
slap on the wrists or to be told ‘you must have been eating the wrong things’!
Some useful and practical advice on how to achieve their targets without
increasing the numbers and severity of hypos would help but so too, would some
praise!
Perhaps only those who live with diabetes can
appreciate that we can try our utmost but sometimes, it just goes adrift and we
don’t know why. Perhaps you have to live with diabetes to understand that this and
the constant trying can just get us down - the Americans call it ‘diabetes burn
out’. A bit of praise, encouragement and understanding wouldn’t go amiss and
can play a big part in preventing ‘diabetes burn out’.
So what are IDDT’s resolutions for 2008? That we will keep trying too!
At the end of 2007 Novo Nordisk pork insulin
disappeared but the need for pork insulin has not. IDDT will continue to do all
it can to ensure the Department of Health keeps its promise that pork insulin
will continue to be available.
We will also continue to try to ensure that people
with diabetes have the informed choice of treatment they deserve. If this means
that we raise issues that are unpopular in some quarters, so be it. If this
means that we identify gaps in research to show that the treatments of adults
and children with diabetes are not evidence-based, we see this as step forward as
it highlights the need for further research.
We will continue to hold the view that it is
unacceptable for people with diabetes to be automatically treated or changed to
the latest insulin or drug, simply because it is ‘modern’. There has to be
evidence of benefit and superiority and as patients, parents and carers, we
have to know that new insulins and drugs have been fully investigated using
outcomes that are important to us, such as comparisons of mortality and
complications rates, quality of life and above all, that long-term safety is
known. As individuals we can all play our part in ensuring that our treatment
is not changed simply because a new ‘modern’ insulin or drug has come on the
market – we just have to ask for the evidence about risks and benefits of the
proposed changes in treatment.
IDDT is a relatively small organisation but just as
individual people with diabetes try, so does IDDT. We have no hidden agenda, no
outside influences upon us and we are completely independent of the
pharmaceutical industry. We are motivated by the need for people who live with
diabetes to have an informed choice
of treatment, to have treatment that is individualised to their needs and that
is known to be safe.
To help us achieve these goals, we could all make
the same resolution for 2008 – that we will be more assertive, we will not be
afraid to ask questions about our treatment, we will not unquestioningly accept
changes and we will be involved in making decisions about our own diabetes and
ultimately, our health.
YOUR OPINION COUNTS
Creative Market Research
Ltd [CMR] is a specialist research company operating exclusively in the field
of healthcare. They are effectively the channel through which people with
diabetes can feed back their ongoing experience direct to the meter, pen and
insulin manufacturers, a process that helps to drive the development of better
and more effective products.
CMR operates to the
highest ethical standards and is meticulous when it comes to patient
confidentiality. Research at CMR is internet-based and involves no phone calls
If you have access to
the web and are prepared to share your experiences for the benefit of yourself
and others, log on at: www.medisurveys.com
If you would like to
help improve the products you use every day, join the panel.
If you have any problems
or questions do call Sue Reynard on 01473 832211 or email her at
sue@creativemarketing.co.uk
DIABETES
AND YOUR SKIN
After
a time I think that most of us start to realise that diabetes can affect almost
every part of the body and the skin is no exception.
Facts about skin
·
It
is the largest organ of the body.
·
The
skin of an average sized adult covers about 18 square feet and weighs about 7
pounds.
Structure of the
skin
The
skin is made up of three layers: the epidermis, the dermis and the subcutaneous
layer.
The epidermis - is the outer
layer of the skin and contains cells that determine skin colour and protect
against damage. Epidermal cells are constantly being warn away and replaced
with new ones. Damage to this layer of the skin is not normally a problem
because it repairs itself very quickly but in people with diabetes this healing
process is often slower than in people without diabetes.
The dermis – is the layer
under the epidermis and contains:
·
blood
vessels and sweat glands to help regulate body temperature
·
nerve
endings
·
hair
follicles
·
sebaceous
glands [glands that produce oil] to help prevent loss of too much sweat by
coating the skin with a layer of oil.
Injury
to this layer of the skin is a greater problem than injury to the epidermis
especially for people with diabetes. As diabetes can affect the nerves and
blood vessels, the dermis can cause the skin to become dry. Once it is dry, it
can crack and become open which means it is more difficult to heal.
The subcutaneous
layer
– is below the dermis where fat is stored. The sweat glands originate here and
it supports the blood vessel and nerves that feed the outer layers of the skin.
Any damage or injury to the dermis or subcutaneous layers will cause pain as
they both carry the nerves, this assumes that the nerves are not damaged by
diabetic neuropathy or any other cause. The pain caused by a response from the
nerves to the brain acts as a protection eg if you touch a hot oven, it is the
nerves in the dermis and subcutaneous layers of the skin that pass pain
messages to the brain. In diabetic neuropathy [nerve damage] the nerves do not
work properly so pain is not felt and there is a risk of further injury due to
lack of feeling of pain.
Diabetes can affect
your skin
If
blood glucose levels are too high and you pee a lot, then this can lead to
dehydration. Then the blood vessels and glands that normally keep your skin
moist can be affected causing dry skin. Dry skin can cause premature aging but
more importantly, the dry skin can crack and infections can develop and this is
made worse by the slower healing due to diabetes.
Prevention is the
best
As
with many aspects of diabetes, preventing the problem from arising is the best
course of action and as with all things connected with the care of diabetes,
firstly this means aiming for blood glucose levels and blood pressure to be as
near normal as possible, eating a healthy diet with plenty of fluids and taking
regular exercise. [I know we’ve heard it all before!] It is also important to
look at your skin to detect any changes and to keep all your skin clean and
moisturised with moisturisers, lotions or creams and this is not just important
for the ladies!
AT LAST!
Up to now the American Diabetes Association [
LATEST NEWS…..
ON AVANDIA
And would you believe? Research presented
at the European Association for the Study of Diabetes in September 2007 showed
that drinking green tea was as effective as Avandia at lowering blood glucose
levels in people with Type 2 diabetes who were just able to tolerate sugar. And
without the risk if heart attack! Green tea contains the antioxidant
epigallocatechin gallate and at the end of the 10 week trial, the green tea
extract was also found to preserve insulin-producing tissue and offered other
protective effects in the pancreas.
ON ANTI-OBESITY DRUGS
British Medical Journal, 16.11.07 – a meta-analysis review of 30 trials of
anti-obesity drugs suggests that in many cases ant-obesity pills achieve little
in terms of weight loss. 20,000 obese people weighing on average 100kg [15.7
stone] reduced their weight by 2.9kg with orlistat [Zenical and Alli in the
US], 4.2kg with subtramine [Meridia] and 4.7kg with rimonabant [Acomplia] but
it was unclear whether this was sufficient to have big health benefits.
Orlistat reduced the incidence of Type 2 diabetes in one study and all three
drugs lowered certain types of cholesterol. A separate study in The Lancet the
same week, found that patients given rimonabant were at increased risk of
severe psychiatric events, including suicide.
Distributors of
orlistat have applied for it to be an over-the-counter drug [OTC] in Europe as
it is in the US but in an editorial in the BMJ Prof Gareth Williams, said,
“Selling antiobesity drugs over the counter will perpetuate the myth that
obesity can be fixed simply by popping a pill and could further undermine the
efforts to promote healthy living, which is the only long-term escape from
obesity.” He is concerned that casual users will abandon it due to the
unpleasant side effects, such as oily stools and faecal incontinence. Its
modest benefits which are equivalent to leaving a few French fries off the
plate, eating an apple instead of an ice cream or having 10-20 minutes sex.
In March 2007 the United Nations’ International
Narcotics Control Board [INCB] issued a warning about the rise in the use of
weight loss drugs in a number of countries stating that they are being used
indiscriminately in some countries to feed society's obsession with being slim.
Some countries have introduced measures to reduce their use but in others such
as
In
October 2007, the drug regulatory body in the
Can Byetta be
substituted for insulin in people with Type 2 diabetes already using insulin? A study carried
out by manufacturers of Byetta, Lilly, has shown that this was possible in less
than two thirds of patients without alteration of glycaemic control. However,
in an editorial, the design of the study is highly criticised because no
attempt was made to optimise insulin treatment and therefore the results could
well be biased in favour of Byetta – good for marketing it! [Diabetes Care Vol
30, No 11]
November 2007, the once a week
version of Byetta is superior to the currently used twice-daily version. A
30-week study involving 295 patients with type 2 diabetes compared HbA1c
levels. Once-weekly Byetta showed a statistically significant improvement of
about 1.9% compared to an improvement of about 1.5% for twice-daily Byetta.
Similar weight loss of about 8 pounds (3.6kg) on average was seen with both
patient groups. The once-weekly version may not receive approval until 2009 and
may be beaten to the market by Novo Nordisk’s type 2 drug liraglutide.
JUST A THOUGHT……….Since the 1980s,
the recommended diet has been high carbohydrate/ low fat diet for the general
population as well as people with diabetes. 25 years later we have a population
that is more overweight and obese than ever before. Common sense would suggest
that the recommended diet isn't working. Isn't it time for a re-think by the
powers that be?
AND ANOTHER ………..The pharmaceutical
industry spends £850 million a year marketing its products to UK GPs. Does this
influence GPs when it comes to writing prescriptions? It is claimed that it
doesn't but if this is the case, it seems a waste of their £850million!
FOR
THE LADIES
·
Pregnant
mums with diabetes - important message
An
issue that has been raised with IDDT is that mums who have given birth to
healthy babies have had their babies removed from them and placed in the
special baby care unit – even in hospitals with a ‘good reputation’. Some
pregnant diabetic women are being told that their newborn baby will be placed
in the special care unit as if this is a necessary and normal procedure.
Obviously
this could be necessary on health grounds but many diabetic mothers are being
separated from their babies for no other reason than hospital convenience or
‘hospital policy’.
Recently
the Confidential Enquiry into Maternal and Child Health [CEMACH] stated that in
over half of mothers with Type 1 and Type 2 diabetes their babies are
automatically moved to a special care baby unit. CEMACH goes on to say that if
the babies are healthy at birth there is no reason for this and it has negative
impacts – breastfeeding becomes difficult because infant formula is used in the
special care unit and newborns’ body temperature becomes harder to regulate. It
does not require a report from CEMACH to know that mums and their newborn
babies are better not separated unless there are health grounds for doing so.
The
Chief Executive of CEMACH has stated that more babies could stay with their
mothers than is presently the case and mothers with diabetes should be
encouraged and supported to breastfeed their babies. He goes on to say that if
these aims were achieved, it should be better for both mother and baby and also
save the NHS money.
IDDT advice to
pregnant women with diabetes: make sure that you know the hospital
system before you are due to have your baby and make it clear that you don’t
want to be separated from your newborn baby unless there are medical grounds
for doing so.
·
Analogues
and pregnancy
Naturally
pregnant women or those considering pregnancy are always concerned about any
medications they take at this time. Clearly women with diabetes have to take
insulin but still need to know about any safety issues for both themselves and
the unborn baby. Here is some information that may be helpful.
Lantus - some experimental
studies have shown that insulin analogues have growth-promoting effects and
concerns have therefore been raised that use of Lantus insulin during pregnancy
could cause excessive foetal growth and other problems. Reuters reported that a
review actually recommended Lantus was not used during pregnancy, but called
for further studies to investigate its safety.
A
small study carried out in
There
were no significant differences in birth weight between infants born to Lantus
users and those born to standard insulin users. [The rate of excessively large
babies was actually slightly lower in the Lantus group: 38 versus 41%.] The
groups were also comparable in terms of infant complications, admission to
special care infant units, and congenital abnormalities.
The
authors recommend that large trials should be carried out to confirm the
efficacy and safety of Lantus for the treatment of pregnant women with Type I
diabetes and those with gestational diabetes.
Ref
1 British Journal of Obstetric and Gynecology, April 2007
NovoRapid – information from
the manufacturers of NovoRapid [NovoLog in the
A
recently published study [ref 1] concluded that NovoRapid is as safe and
effective as GM 'human' insulin in pregnant women with Type 1 diabetes as the
mother and pregnancy outcomes were the same. In this study the long-acting
insulin used was NPH insulin, a 'human' intermediate insulin and NOT an
analogue insulin.
Ref
1 Diabetes Care, April 2007
For the use of
other analogues in pregnancy, the Specific Product Characteristics documents
say:
Humalog: Data on a large
number of exposed pregnancies do not indicate any adverse effect on pregnancy
or on the health of the foetus/newborn.
Levermir: There is no
clinical experience with Levemir [insulin detemir] during pregnancy. ….Caution
should be exercised when prescribing to pregnant women.
Apidra: There are no
adequate data on the use of Apidra [insulin glulisine] in pregnant women.
Caution should be exercised when prescribing to pregnant women.
·
Fertility
in women with diabetes has improved
A
population-based study in
The
good news is that reduced fertility was confined to those diagnosed before 1985
although the presence of complications reduced fertility in all years. The
number of new born babies with congenital malformations was 11.7% in the years
1973-1984 but dropped significantly to 6.9% during 1995-2004. The researchers
suggest that stricter metabolic control during the last 20years may well have
helped to improve fertility and reduce the number of new born babies with
congenital malformations. Yet another good reason for keeping 'good' control.
[Diabetes Care,
·
Girls and
women skipping injections to lose weight.
Diabetes
UK estimate that 1 in 3 women with diabetes under the age of 30 in the UK are
missing insulin injections at any one time, to help them lose weight with a
high proportion of these are teenage girls. These figures are based on a small
study carried out in
With
today’s pressures to be thin, teenage girls and young women easily discover
that not carrying out some or all their injections results in swift weight loss
but those that have done it, admit that they feel ill a lot of the time, also
tired and thirsty. One of the problems is that people who are doing this are
unlikely to own up to it at the time but there will be many who admit that they
have done it at some time in their lives.
For parents who are wondering why their daughter’s blood glucose levels
are erratic, this could be one possible explanation.
· Genetic variation may account
for severe PMT
Researchers have found a genetic variation that makes women more
likely to suffer from the most extreme form of premenstrual tension or
syndrome. They carried out genetic tests on women suffering from premenstrual
dysphoric disorder (PMDD) - sometimes referred to as severe or extreme PMT and
discovered that the women had mutations in hormone receptor genes and also in a
gene that regulates the part of the brain responsible for mood.
The symptoms, such as severe depression, irritability and anger can have a
severe impact on quality of life, both for the women and their loved ones. This
research is only at a very early stage and more work will have to be done but
eventually it could help scientists to develop a diagnostic test and discover
drugs to treat it. [Biological Psychiatry,
·
Poor sleep
may lower women’s libido
A
study has found that low libido during menopause may be linked to disturbed
sleep and this is the first time that sleep disturbances have been
independently associated with diminished sexual desire. Of the 341 women in the
study, 64% reported a low libido and 43% said they had trouble sleeping. The
study author suggested that it seems reasonable that night sweats can disturb
sleep and poor sleep can reduce energy levels for everything, including sex. [American Journal of
Obstetrics and Gynecology, June 2007]
NEWS IN BRIEF
Inhaled
insulin has failed
Exubera,
the first inhaled insulin has failed to appeal to doctors and patients and in
October 2007 the manufacturers, Pfizer, announced that they were pulling it
from the market and would be offering advice over the next 3 months on
alternative products. The lack of sales is blamed on
the size of the inhaler, injections of long-acting insulin still being
necessary and concerns about long-term safety.
IDDT has not been alone in saying that industry should have
consulted people with diabetes about what is important to them and for the
majority, injections are not the worst part of having diabetes – it is the
daily grind of living with testing, with thinking about food, with planning
ahead, the fear of complications – do I need to go on?
The
financial press referred to Exubera as a ‘market flop’ and that Pfizer is
writing off the huge amount of $2.8billion (€1.96bn).
Global sales only achieved $4million.
Lilly and Novo Nordisk are developing their own versions of
inhaled insulin expected to reach the market in 2009 and 2010/11 respectively.
Both companies have stated that they will continue to develop these products.
We shall see……….
Nasal
insulin delivery
Nasal
drug delivery systems have been around for some time but there have been
problems. Now NanoDerm, an Israeli company, has developed a system that seems
to combat the difficulties and make insulin delivery through the nose not only
a viable option but perhaps a better option that inhaled insulin. The system is
based on nano-droplets [very, very tiny] of 10-50nm that form a gel in the
nostril so far less insulin has to be given nasally to lower blood glucose
levels than with inhaled insulin. These lower volumes are less likely to cause
irritation to users. It's already been tested in rabbits…………
Changes in
warnings for Zyprexa
Many
psychiatrists have expressed concerns that the antipsychotic drug Zyprexa
[olanzapine] raises blood glucose levels that can lead to Type 2 diabetes. On
October 8th 2007, the manufacturers, Lilly, officially agreed that
Zyprexa carries a greater risk of causing raised blood sugars than almost all
other drugs in the same class. Following discussions with the FDA [the
REPORT COMING SOON – ‘INSULIN AND CANCER’
The
first International Workshop ‘Insulin and Cancer’ took place in
PARTICULARLY
FOR CHILDREN………….
We
reported in the October 2007 Newsletter that Eli Lilly launched a second
re-useable insulin pen product – the Humapen Luxura HD pen for use with Lilly
insulin 3ml cartridges. This is now available in the
To
support children and their carers, Lilly are providing a pack of educational
materials with the Humapen Luxura HD featuring cartoon character Hu-Mee the
Frog and including a booklet, lunchbox, insulin pen case, monitoring diary and
Hu-Mee stickers. For more information visit www.lilly.com
REPORT OF THE 2007 ANNUAL MEETING OF IDDT
As ever, the meeting was well attended - over 130
members and non-members. Many described the meeting as enjoyable and thought
provoking – just what it should be. It was an opportunity to look at different
ways of living with diabetes and the various treatment options. It once again
made us realise that many people with diabetes have never been given choices
whether these are choices about diet, types of insulin or different insulin
regimes.
‘30 Years
of Synthetic Insulin, are people with diabetes getting the best deal?’
Co-Chairman, Jenny Hirst, opened the meeting with
the launch of this new IDDT Report. The report highlights a recent article [ref
1] by Professor Edwin Gale et al entitled ‘Nice
Insulins, pity about the evidence’ in which he acknowledges that there is
no evidence of benefit from the use of insulin analogues and questions whether
people with diabetes are getting the best deal. “When the choice is between treating 150-200 patients with
long-acting analogues instead of ‘human’ insulin or employing a full-time nurse
specialist educator at the same cost – which would be best for patient care?”
When children with diabetes are receiving
suboptimal care, and Primary Care Trusts (PCTs) are unable to fund educational
programmes, diabetes specialist nurses or provide essential self testing strips
for diabetic patients, it is shocking that PCT budgets are being consumed by
ever-increasing insulin costs that provide little benefit to patients.
The Report calls for:
·
Studies of ‘human’, analogue and animal insulins to
be carried out to compare the outcomes which are important to patients -
mortality rates, complication rates and quality of life.
·
The long-term safety and efficacy of insulin
analogues to be established.
·
Investigation into the cost effectiveness of
insulin analogues to ensure that valuable NHS resources are not being wasted on
these significantly more expensive insulins that have no substantial advantages
over ‘human’ and animal insulins.
·
The development of comprehensive guidelines on the
use of all insulins by National Institute for Health and Clinical Excellence
[NICE] to provide informed choice and to protect the safety of people with
diabetes.
IDDT has raised
these important issues by sending the Report to MPs who have supported IDDT’s
call for insulin choice, to primary care trusts all of whom need to look at
their expenditure on diabetes and to diabetes associations across the world,
especially important for countries where safe but affordable insulins are vital
for the survival of people with diabetes.
If you would
like a copy of this Report, please contact IDDT on 01604 622837, write to IDDT,
Ref 1 Nice Insulins, pity about the evidence.
Diabetologia (2007) 50;1783-1790. Holleman F, Gale EMA.
‘How you can achieve normal blood sugars with diet
and insulin’
Dr Katharine Morrison, a GP whose teenage son has
Type 1 diabetes gave a talk on how she has chosen to look after her son’s
diabetes. The points she made were:
People with diabetes deserve the choice over:
·
Dietary education
·
Insulin regime
·
Blood sugar monitoring regime
·
Complications monitoring regimes and treatment of
complications.
What levels of blood sugar control is right for
you?
·
What are your personal circumstances? What degree
of blood sugar control do you want to have? For instance, safe target blood
sugars differ if you live alone, are a driver, are pregnant or are a teenager,
a toddler or are elderly.
Dr Morrison’s choice for her son is to try to
completely avoid diabetic complications from high and swinging blood sugars and
to try to achieve normal blood sugars his regime is:
·
Low carb / low glycaemic index diet with good carb
counting skills
·
Avoid snacks – a protein rich breakfast helps to
avoid hunger pangs for snacks.
·
7 units maximum for each insulin injection
·
Careful matching of insulin type to food type
·
Consistent exercise regime.
To absolutely minimize the risk of complications Dr
Morrison suggested:
·
Testing frequently with very strict levels of
eating to the meter test results
·
Fasting and pre-meals targets of 4.7 to 5.2 mmols/l
and one hour after meals below 7.2mmols/l and 6.0mmols/l 2 hours after eating.
·
Resistance training exercises.
Dr Morrison pointed out that this type of regime
requires time to learn all the information, to plan and prepare food and to
learn the skills involved. Audience discussions emphasised the need for choice
of different approaches and many people felt that this strict and time
consuming regime was not a practical option for living as normal a life as
possible with diabetes.
‘Fitness, Motivation and Adherence’ was the theme
of John Roberts’ talk.
Between 20 and 70% of people starting an exercise
programme will drop out within 6 months but John pointed out that people do not
plan to fail, they just fail to plan. He highlighted some the reasons for
stopping exercising [familiar to many of us!] and gave us some tips to overcome
these:
“I get frustrated when I do not get results” – ask yourself if your goals are realistic and remember that progress can
take weeks and getting support can help.
“I get bored easily” – so try new routines, join
an exercise group, implement exercise into everyday activities.
“Exercise is not enjoyable or fun for me” – combine it with something you do enjoy, vary the type of exercise,
watch TV or read during exercise.
“I don’t know how I am going to find the time” – so break up your exercise to short sessions, limit TV watching, make
commitments to specific times.
“I’m tired” – exercise at the same time, you will feel more energetic
after you begin, keep regular bed times.
John’s final points were:
Discussion groups
This year more time was given to discussion groups,
the most popular ones being about insulin regimes and carbohydrates, showing
once again the need for people with diabetes to be provided with better
education.
This was followed by a panel discussion and the
meeting ended with Dr
IDDT would like to thank all the speakers and group
leaders and the people who attended for making our Annual meeting such an
interesting and enjoyable day.
IDDT
Annual Conference 2008
A
date for your new diary – IDDT’s Annual Meeting for 2008 will be held on
Saturday October 18th. We hope that you will be able to join us!
SICK DAY RULES
Professional advice – sometimes it needs a government health warning!
A member of IDDT who attended our Annual Meeting
brought with him a leaflet from his diabetes clinic ‘Diabetes and Sick Day Rules’. He has no wish to be difficult but
he was extremely concerned at the advice being given. So I might add was
everyone else.
In the section for people with insulin-treated
diabetes, these Sick Day Rules quite correctly say that:
·
NEVER STOP insulin injections
·
illness such as ‘flu or a chest infection may cause
the blood sugar to rise [actually any
illness or even slight infection, can cause blood sugars to rise].
·
blood sugars should be measured at least four times
a day, before meals and before bed.
·
If the appetite is poor replace normal meals with
fluids - milk, Lucozade, fruit juice.
But the problems arise when it gives advice on increasing the doses of
insulin!
It advises that:
“if the blood sugar is between 10 and 15mmol/l give 6 units extra of
clear insulin before each meal and at bedtime; if between 15 and 20mmols/l give
8 units extra of clear insulin before each meal and at bedtime; if over
20mmols/l give 10units extra of clear insulin before each meal and at bedtime.”
Just at a glance there are some obvious mistakes
here that could be dangerous!
·
It says clear insulin – for those on rapid-acting and long-acting
analogues, both insulins are clear. It should not
be assumed that people know that it actually means the short or rapid-acting
insulin – what about the relatively newly diagnosed?
·
It doesn’t say whether people have to increase their insulin dose as a
result of one higher than normal blood test or several. Are people supposed to increase their daily dose by 24 units [4 x 6
extra units advised] as a result of one test that could just be an odd one?
·
It advises on insulin dose increases without any regard for the dose of
insulin being used on normal days. Some people only
take 6 units or even less before each meal while others may take 20 or more
units – so 6 extra units in some people is a doubling of the normal dose but in
others it is a much smaller percentage increase.
·
It does not consider the different types of insulin that people may be
using which have different peaks and durations of actions. If people are using human or animal insulins before meals with twice
daily intermediate-acting insulin, this advice could lead to hypoglycaemia as
the short-acting insulin lasts longer and the intermediate insulins peak while
there is still some short-acting working.
·
What about people using pre-mix insulins? Whether using human, analogue or animal pre-mix insulins, then these
‘sick-day rules, simply do not apply to them as most of them will not have any
‘clear’, short-acting insulin! Unless of course, it is OK to take pre-mix
analogues which are clear. I don’t know – but isn’t that just the point?
The possible thinking behind these Sick Day Rules……..
Perhaps these ‘Rules’ were developed on the basis
that everyone is on the same type of insulin with the same regimes, which as we
know is not the case. Perhaps the authors of the ‘Rules’ believe everyone with
diabetes is the same, which we know is not the case. Perhaps they believe that
everyone takes large doses of insulin regardless of the type of insulin used,
which they don’t as those on animal insulin tend to take less insulin, as do those
on low or restricted carbohydrate diets.
To be fair these Sick Day Rules do advise people to
seek medical advice if blood sugars are over 20 on more than two occasions, if
vomiting develops, if moderate or large ketones are present or if you don’t know
what to do. But with Sick Day Rules like these, how can people be expected to
know what to do? We can only advise that you check that you know the correct
Sick Day Rules for you, for your insulin and for your regime.
WRONG SIZED SHOES
A study at