OCTOBER 2002 NEWSLETTER
On
·
The reviewers ‘could not identify substantial differences
in the safety and efficacy between ‘human’ and animal insulins [mainly pork]’.
·
‘Most studies were of poor methodological quality’.
·
Many patient-oriented outcomes like health-related quality
of life or diabetes complications and mortality were never investigated in high
quality randomised clinical trials.
·
No differences were found in metabolic control, with no
differences in HbA1cs between ‘human’ and animal insulins.
·
There was no
difference in the presence of insulin antibodies.
·
70% of the
trials were funded by insulin manufacturers.
·
Only 40% of
the trials provided at least some information on adverse effects. Apart from
hypoglycaemia, other adverse effects were hardly ever mentioned. The overall
picture does not show any substantial differences in hypoglycaemia events
between insulin species.
·
None of the
studies assessed costs or socio-economic effects.
·
‘Human insulin
was introduced into the market without scientific proof of advantage over
existing purified animal insulins, especially porcine insulin.’
This review means that although ‘human’ insulin has become the first
choice insulin for the majority of prescribing doctors, this prescribing habit
is not based on any evidence of benefit for the people they are treating. The
lack of evidence of any superiority of ‘human’ insulin over animal insulins,
and the fact that the research that was done has been shown to be
methodologically poor changes the whole perspective for patients, for doctors
and indeed for government health departments. The absence of investigations
into mortality, complications and quality of life is at best careless, at worst
negligent and certainly does not put patient welfare at the top of the agenda.
But this absence means that no one knows whether treatment with ‘human’ insulin
improves or more importantly, harms the lives of people with diabetes compared
to treatment with animal insulins with their proven safety records stretching
back over 70 years.
While IDDT and our members knew this already, this is not the time for
saying ‘I told you so’ but the time to recognise the importance of the
publication of this independent, ‘gold standard’ Cochrane Review. Doctors and
healthcare professionals can now provide their patients with insulin treatment
choices based on evidence, not assumption. Developing countries can now ensure
that affordable animal insulins remain available knowing that they are not providing ‘inferior’ insulins
for their citizens. Above all, this review empowers patients.
It provides us with information to make truly informed choices about
the species of insulin we wish to use. Our choices are simple - animal insulins
with a history of 70 years research and post marketing surveillance [being used
in real life for 70 years] or ‘human’ insulin with an absence of meaningful
research and an ongoing history of reported adverse reactions.
* For the
Consumer Summary of the Review, the abstract and the implications see page 8.
An outbreak of serious illnesses linked to the anaemia drug,
Eprex, shows that some patients do not react to genetically engineered proteins
as if they were natural.
This is a quote from an article in the New York Times, July 30, 2002, which also explains that human proteins like insulin and growth hormones are made through genetic engineering and given to people who do not make enough of their own. In the case of Eprex, a genetically produced anaemia drug from Johnson and Johnson, the patients react as if the protein was a foreign germ and the immune system tries to destroy it. The cause of the problems remains a mystery and the Johnson and Johnson factory in Puerto Rico is under criminal investigation.
The New York Times
says that although the Eprex case is the most serious, as some people become
dependent on blood transfusions to survive, virtually all genetically produced
drugs provoke immune responses in some patients, though usually small numbers.
But these reactions are becoming of greater concern as the numbers of
genetically produced drugs increase.
Dr Hubb Schellekens,
a professor at Utrecht University in the Netherlands, says of genetically
produced drugs, “Sometimes there are miracle drugs, but they can still have
severe side effects. That has come as a surprise to us, really.”
This is exactly what
was said about ‘human’ insulin when increased hypoglyceamia appeared in the
early trials – the problems were a surprise! If patients had been listened to
once ‘human’ insulin was on the market, the side effects from other genetically
produced drugs may not have come as a surprise 20 years later!
Experts now believe
that because genetically produced drugs are made by living cells, the outcome
is not as predictable as chemically made drugs and even slight changes can
affect the product, sometimes in unpredictable ways. So the tide may be turning
for these synthetic drugs and for genetically produced ‘human’ insulin. Let us
hope that this awareness filters through to experts involved in diabetes care.
The New York Times
quoted ‘human’ insulin made by genetic engineering as having a small percentage
of people that cannot tolerate the ‘human’ version and are trying to keep beef
and pork insulin available. What is a small percentage? If it is only 5% of
people using insulin, then in the UK alone 20,000 people suffer adverse effects
to genetically produced insulin – unnecessary effects because the natural
alternatives are available. Imagine what this figure is for people using
insulin throughout the world!
Are these large numbers the reason the experts, the health departments and the insulin manufacturers will not backtrack? Maybe they fear litigation, as has been threatened in other countries? If this is so, then they are failing to understand that the vast majority of people who need animal insulin simply want it to be available so that they have healthy and good quality lives. They want choice. If litigation was to succeed, financial compensation cannot bring back the years lost to ‘human’ insulin and financial compensation is valueless if life is plagued by adverse reactions.
Research has shown
that depression may occur in up to 14-18% of people with diabetes with some
research showing that people with chronic conditions, including diabetes, are
three times more likely to suffer depression than the general population.
A study by Brazilian
researchers, presented at the American Diabetes Association Conference 1998,
showed that among a group of people with diabetes with average HbA1c levels of
less than 9%, only 21% tested positive for depression using a standardised
test. By comparison of those with HbA1cs over 9%, 42% tested positive for
depression.
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.
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.
Research [Ref 1]
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.
Ref
1 Archives of Internal Medicine, Nov 27, 2000
DAILY
MAIL, August 29, 2002
‘The
GM Injection’ by Jo-Ann Goodwin
Many of you will have
read this article but for those that haven’t we are enclosing a copy with this
Newsletter. It is a well-balanced article that emphasises that while the
majority of people appear to be fine using GM produced insulin, some people
have experienced very real adverse reactions that have had a tremendous effect
on their lives. IDDT has been inundated with phone calls and e-mails from
people with diabetes or their partners, none of whom have criticised the
article although there has been expressed anger at the misinformation or lack
of information they have been given.
Perhaps the overriding feelings are of relief:
·
Relief that
they are not alone with the adverse effects they are experiencing. Relief that
these are not ‘all in their mind’ as said by their diabetes team when they are
not believed. Relief that there are alternative insulins for them to try –
natural animal insulins. Relief that the Cochrane Review has shown that
synthetic insulins are not superior to animal insulin. Relief that now there is
no reason why they should not change to pork or beef insulin and there may be a
way out of the problems they are having. ‘Light at the end of the tunnel’.
·
Relief from
people that are already using animal insulins – they have discovered that IDDT
is actively campaigning to try to maintain availability of the insulins they
need to maintain their health and wellbeing.
A great deal of anger expressed!
·
Anger that
they were never told that the ‘human’ insulin they are taking is produced by GM
technology. Anger that the very name ‘human’ implies that it is derived from
human beings.
·
Anger that
they have never been given the choice, especially now they know that GM insulin
has no advantages over natural animal insulins. Anger that they or their loved
ones have suffered all the adverse effects in the article but no one has ever
suggested trying animal insulin to see if their adverse effects disappear.
·
Anger that so
little research has been carried out to compare GM and natural animal insulins,
especially when people have complained of adverse effects from the outset.
·
Anger at the
apparent lack of honesty and at the marketing techniques used when their health
and wellbeing is at stake.
The gratitude!
To Jo-Ann and the
Daily Mail for publication and for the in depth investigation. To IDDT for
being there and not giving up, despite all the odds and for providing
information and support – ‘just to talk to someone that believes me is
wonderful’. And many people want to turn this gratitude into action to ensure
that animal insulins continue to be available; that people with diabetes are no
longer mislead and that they receive the informed choice of insulin they
deserve. With this support, IDDT’s cause will go from strength to strength!
From January 1st 2002
the federal health insurance programme covers an annual glaucoma test for the
following groups of Medicare recipients:
·
People with
diabetes
·
People with a
family history of glaucoma
·
High risk
groups such as African Americans aged 50 and over because they are five times
more likely to develop glaucoma than Americans of European decent
Glaucoma affects 3
million Americans and early detection and treatment helps to prevent blindness.
Also from January 1st
2002 Medicare covers medical nutrition therapy for people with diabetes as well
as those with kidney disease. This decision was based on a study carried out by
the Institute of Medicine showing that nutritional therapy with a registered
dietitian was cost effective for the elderly and improved their quality of
life.
Approval for Hypurin Bovine Neutral cartridges
Health Canada, the
drug regulatory body in Canada, has approved Hypurin Bovine Neutral insulin
cartridges for importation from CP Pharmaceuticals in the UK with the
appropriate documentation. Other Hypurin Bovine insulins may also be imported
in vials only. The significance of Health Canada approving importation from the
UK is that this means that the costs may be covered by the insurance companies.
Carol Baker, IDDT-
Canada, has clarified the situation with Health Canada. Contrary to rumour,
Hypurin pork cartridges have not been approved by Health Canada for importation
and nor has beef insulin from Brazil. Anyone importing from Brazil risk having
their insulin confiscated at customs.
Since the July
edition of the IDDT Newsletter there seems to have been a cluster of official
warnings issued to doctors about drugs and medical devices that could affect
people with diabetes. In the US and Canada these notices are made public so
that ‘patients’ as well as doctors have the information but in the UK such
warnings about drugs are issued to a whole range of professionals but not to
the very people that use the drugs! These warnings are important so surely
everyone should be aware of them, whether patients or doctors, so that we as
patients, are not reliant on the information being received and read by
professionals and then transmitted to us.
30 May 2002
Zyban is a drug
licensed to help people to stop smoking. Since it was first on the market it is
estimated that 419,000 people have used Zyban. But the Committee on Safety of
Medicines [CSM] have received over 5,000 Yellow card reports of adverse
reactions. 126 of these reports were of people having seizures.
Therefore the CSM
have issued warnings to doctors:
·
changes in the
recommended dose
·
the use of
Zyban is contraindicated in people with certain conditions where there is
already a risk of seizures.
·
there are
certain conditions where Zyban must NOT be prescribed and these include people
treated with oral hypoglycaemic drugs and those treated with insulin. Clearly
this means that people with Type 1 and Type 2 diabetes should NOT be prescribed
Zyban. The exception to this is where there is compelling clinical
justification that the potential benefit of stopping smoking outweighs the
increased risk of seizure for prescribing Zyban.
The MDA and Eli Lilly
have received reports of the breakage of both engagement tabs on the blue
insulin cartridge holders for the HumaPen Ergo injection pen. Some of
these breakages have meant that people
have given themselves insufficient insulin resulting in loss of blood glucose
control. The breakage can usually be identified by the user when the pen is
primed prior to injection.
Lilly has made design changes to the cartridge holder as a result of these reports. The original blue cartridge holder has been replaced with a clear one since when there have been no reported breakages.
This Device Alert has been issued to remind healthcare professionals of the insulin cartridge holder replacement programme being run by Eli Lilly because there is still a significant number of users that have not yet had there cartridge holder replaced.
Action
· If the cartridge holder is clear, then no further action is needed. Pens with blue cartridge holders were not distributed after October 2000.
· If the cartridge holder is blue, it should be replaced and a new clear holder fitted.
· New clear cartridge holders can be obtained from Lilly on freephone 0800-085-3847 or from community pharmacists, diabetes clinics and dispensing GPs
Avandos
[rosiglitazone] and Actos [pioglitazone] are both drugs for the treatment of
Type 2 diabetes. In the UK they should only to be used in combination with one
of the other oral drugs for Type 2 diabetes, metformin or a sulphonylurea and only when adequate blood glucose control
cannot be achieved with these drugs although in the US Avandia and Actos can
used either on their own or in combination with the other two drugs. Neither
Actos nor Avandia are approved for use with insulin.
They belong to a
class of drugs known as the thiazolidinediones or glitazones and the first drug
of this type, troglitazone [Rezulin] was withdrawn from the market following at
least 92 known deaths in the US from liver failure and/or congestive heart
failure. Avandos and Actos are successors to troglitazone and from the outset
prescribing doctors have been advised that patients using either of these drugs
should have liver function tests before starting the drug and at regular
intervals thereafter. It has also been known that they may cause fluid
retention [oedema] that can lead to congestive heart failure, especially in
people with an existing heart condition.
On April 26th
2002 the FDA issued a new warning notice that thiazolidinediones or glitazones,
which include Avandia and Actos, may cause fluid retention that can progress to
heart failure. They should not be used in people who have or have had heart
failure, fluid retention or active liver disease.
Patients who develop oedema,
shortness of breath, weakness, fatigue or sudden weight gain should advise
their doctor immediately.
They also warn that it is important to note that people with Type 2 diabetes are at an increased risk of diabetes related complications such as heart failure whether they take any specific type of diabetes treatment or not. Following discussions with the FDA, the manufacturers of Avandia and Actos have issued letters to health professionals reminding them of these safety concerns.
As early as October
2000, Takeda Chemical Industries, Japan's largest drugmaker, warned doctors of
potential dangerous side-effects of Actos and in November 2001 Health Canada
issued warnings to Canadians of their safety concerns related to the use of
Avandia and Actos after 4 deaths were associated with Avandia. Health Canada
warned that these drugs are not to be used in patients with acute heart failure
or active liver disease and patients who develop oedema, shortness of breath,
weakness, fatigue or sudden weight gain should advise their doctor immediately.
Therapeutics Initiative in Canada [a body that functions rather like the UK’s
NICE] states “Long-term trials are required
to know whether this class of drugs reduces morbidity and mortality outcomes”.
Worth noting!
Special Note -
Avandia and Actos are NOT approved for use with insulin.
IDDT has received several calls from people that are using insulin and
have been prescribed Avandia or Actos. In view of the fact that neither of
these drugs is approved for use with insulin, we would recommend that you
discuss this with your doctor.
COELIAC DISEASE – A TICKING OFF!
In the Spring 2002
Newsletter I included a short article about coeliac disease and diabetes and I
got a nice but sharp rebuke from one of our members for not providing the
obvious information about coeliac disease and its symptoms. For this I
apologise! I thought of it as a follow up article to ones published previously
but I now realise that this was quite some time ago – time passes so quickly!
So here goes.
·
It is a
condition in which the lining of the small intestine is damaged by gluten.
Gluten is a protein found in rye, wheat, barley and possibly oats.
·
This damage
causes foods to not be absorbed properly by the small intestine and so before
diagnosis there is weight loss and possibly malnutrition.
·
Treatment is a
gluten free diet.
·
It is
relatively uncommon with an incidence of 1 in 1000 people in the UK and it may
occur at any age.
Coeliac disease can cause people to be acutely and severely ill with weight loss, vomiting and diarrhoea or there may be chronic symptoms, such as tiredness, lethargy and breathlessness but usually the symptoms are somewhere between the two. However, some people are diagnosed without having any symptoms.
Adults may have a
history of abdominal discomfort or they may develop coeliac disease at any
time. Anaemia, mouth ulcers and weight loss are common signs.
Babies are fit and well until the introduction of solid foods that contain gluten when the baby becomes pale, bulky, offensive-smelling stools and is lethargic and miserable.
All these symptoms
could apply to other conditions so it is important that you do not assume that
you have coeliac disease but seek medical help. It is nearly always diagnosed
by a gastroenterologist who carries out an intestinal biopsy.
Both diabetes and coeliac disease are autoimmune diseases and there are increasing amounts of research to show that there is a link between the two in adults, children and adolescents. Increasingly there are views that more attention should be given to this link and that tests for coeliac disease should be routinely carried out.
A strict gluten free diet is the only treatment that puts the intestine back to normal.
Diabetes requires a
well balanced diet with plenty of carbohydrate but once coeliac disease has
been diagnosed, providing carbohydrate becomes more difficult as many of the
carbohydrates we eat and enjoy, such as bread, pasta, cereal, pastry, crackers,
biscuits and cakes contain gluten which has to be avoided. This is particularly
difficult for children. These foods can be replaced with gluten-free products,
some of which are available on the NHS in the UK. But as there is no gluten in
the flour, the products do not have the same consistency and taste and are
often not so delicious.
Some products are available with a gluten-free symbol but there are some difficulties:
·
There is a
lack of choice.
·
Pre-prepared
foods are much more difficult to obtain because many of them contain gluten eg
the flour used to thicken sources contains gluten.
·
It takes time
to become familiar with the ‘hidden’ gluten eg wheat flour is often used as a
carrier for flavouring in such things as crisps.
·
Buying
gluten-free products is very expensive.
NOTE: IDDT has now produced a leaflet ‘Diabetes and Coeliac
Disease’. If you would like a copy contact IDDT, PO Box 294, Northampton NN1
4XS
Tel 01604 622837
e-mail bev@iddtinternational.org
The mhi-500 needle-free injection system – is an alternative to pens or syringes for injections. It works by forcing a fine stream of insulin at high speed through a precision engineered nozzle. It costs £120 and is not available on the NHS although the manufacturers, The Medical House, are seeking approval. For more information there is a freephone helpline: 0800 917 7328 or visit www.insulinjet.com
Insulin aspart [NovoRapid] -
the fast acting insulin analogue is now licensed for use in the insulin pump by
subcutaneous insulin infusion through the stomach wall. Absorption from this
site is faster than other injection sites.
Latest government figures for pharmaceutical company profits
- all pharmaceutical companies
operate to strict limits on their profits from NHS sales based on a maximum 21%
return on capital employed. The last government figures show an actual profit
of 17%.
CP praised
– After visiting CP Pharmaceuticals, Doug Touhig, from the Ministerial
Sub-Committee on Biotechnology praised the company for supplying animal insulin
to the Czech Republic. CP’s Chief Executive, Charles Savage, said the company
was able to respond at fairly short notice to a request from the Czech Republic
for animal insulins following Eli Lilly’s announcement that they was replacing
animal insulins with synthetic ‘human’ insulins. Mr Savage said that if the
demand for animal insulins grows, it is still possible for additional
manufacturing lines to be installed.
The Wall Street Journal, 19.6.02 - Medtronic Inc announced that early research in 5 people
in France suggests that a surgically implanted device like an ‘artificial
pancreas’ could be on the market in the next few years. The device would
monitor blood glucose and pump insulin into the bloodstream and would have the
advantage of preventing hypoglycaemia and long-term complications.
DRIVING ACCIDENT – THE VICTIM’S WIFE WRITES TO IDDT
In July 2002 many of the Newspapers reported that Jo
Taylor’s husband was killed in a motor accident by a driver with diabetes who
was hypo. Jo has written to IDDT and asked us to publish her letter.
My husband Phillip was killed by a diabetic driver last
July, aged 33 years, the father of my two year old daughter. At Reading Crown
Court on 3rd July 2002, Richard Turpin was found not guilty by a jury who
accepted his defence of automatism. How
does your organisation respond to the evidence of a man who got into his car
everyday without testing, taking food or injecting himself before commencing
his journey to/from work. He stated that
at the time that he was having problems recognising the signs of hypo's coming
on, and his doctor changed his medication.
He stated in Court that he took no extra precautions with his new
regime. A doctor gave evidence in his
defence, having last treated him as a patient 4 years previously, stating that
he had never told his insulin dependent patients to self-test prior to driving.
My reason for writing
is that I am trying to get some awareness through the diabetic community that
it is imperative that a diabetic self test prior to commencing his/her
journey. We are being made more aware by
the media that this isn’t a one off. I
would really like to see diabetics taking more responsibility for their
condition, and to try and avoid another tragedy like this.
We DO NOT want to tar
all diabetics with same brush, but if we can save someone else’s life through
getting this message over, it will all be worth it! I would welcome your views
on this matter.
I look forward to
hearing from you.
Mrs Jo Taylor
One can only imagine Jo’s feelings in this awful situation
and I found my reply difficult to write but here are the main points. Jo
replied with a very nice letter of thanks saying that she was unaware of all
these points.
Dear Jo,
Firstly on
behalf of our Trustees, and I am sure every member of our organisation, I would
like to express our condolences to you and your daughter for the very sad loss
of your husband, Phillip. We all agree with you that their needs to be greater
awareness of the dangers of hypoglycaemia and especially in relation to
driving.
We are
constantly raising this issue because we are very aware that the insulin
automatically prescribed nowadays, synthetic so-called 'human' insulin, in some
people is more likely to cause loss of warnings of hypoglycaemia compared to
the natural beef and pork insulins.
In addition,
doctors now recommend that blood sugars should be as near normal as possible
but the drawback of this 'tight' diabetic control is a threefold increased risk
of severe hypoglycaemia which in turn increases the risk of loss of warnings
from which a state of automatism can arise.
It is also
essential that people are given correct instructions about testing their blood
glucose levels before driving and this should be given on their regular clinic
visits. People are not allowed to drive if they have lost the warnings of
hypoglycaemia and the doctors signing the medical fitness to drive forms should
not sign them if patients have lost their warnings, assuming the doctor knows
this to be the case. The vast majority of people are very conscientious about
their diabetes and many people voluntarily surrender their licences.
Unfortunately
many people with diabetes are not given all this information, as demonstrated
by Mr Turpin’s doctor admitting that he did not advise people to test before
driving. We do our best to make this information public. Within the last 4
months I have written to every local paper in the UK describing the adverse
effects of 'human' insulin, the dangers of hypoglycaemia without warnings and
telling readers that animal insulin is available and many people that have
changed to it find that their warning symptoms return.
I hope from
this that you can see that we, as an organisation, have taken action to raise
this whole issue in every way we know how since we formed in 1994.
Could I
suggest that you also write to Alan Milburn as Secretary of State for Health,
it is the Dept of Health that need to be made very aware of the dangers of
hypoglycaemia and unawareness and the need for more resources for patient
education.
Sincerely
Jenny Hirst
INTERESTING
NOTE!
Doctors must inform
patients of side effects of drugs
In June 2002 the supreme court of Hawaii ruled that doctors that fail to inform their patients about possible side effects of the medicines they prescribe may be liable, in the event of an injury or damage linked to the drug. The decision came in the case of an 11 year old girl who was knocked down by a car when the driver fainted at the wheel. He had been prescribed a blood pressure pill called Prazosin whose known side effects include light-headedness and fainting.
OUT OF THE MOUTHS….
I remember many years
ago being a rather overbearing Mum and trying make sure that my daughter did a
blood test before bed. One day she shut me up by saying, “Yes I do a blood test
before bed but it only tells me what my blood glucose is at that moment and not
what really matters before bed – whether I am going up or coming down.”
A LOOK AT DIABETES CARE AROUND THE WORLD
As we know
diabetes occurs in countries around the world and treatment and care varies
according to availability of health services and staff. Dr Ahmed is a doctor at
the diabetic clinic at King Faisal Hospital in Saudi Arabia. He is responsible
for the care of 2,500 people mainly with Type 2 diabetes. Here is his
perspective of diabetes in Saudi Arabia and the effects on his patients.
The Black Zone in the life of diabetic patients
By Dr Almoutaz
Alkhier Ahmed
Diabetes is a
disease of figures, and each figure represents a meaning in the life of
diabetics. At the moment of the first diagnosis, usually doctors ask for some
investigations to confirm the diagnosis of diabetes. The blood glucose level
(which is a figure) is the corner stone in diagnosis.
What is more there are dates that are important milestone of
diabetes mellitus:
·
1920
is the date when Dr/Frederick Banting prepared pancreatic extract.
·
1922
the first time insulin was tested after efforts to purify it by teamwork
Banting and Best, J B Collip, Professor J J R
McLeod).
·
1979
is the date of the first scientific look to diabetes by the National Diabetes
Data Group (NDDG).
·
1980
the World Health Organization (WHO) Expert Committee on Diabetes and later the
WHO Study Group on Diabetes endorsed the substantive recommendation of the
NDDG.
·
1995
an international expert committee, working under the sponsorship of American
Diabetes Association [ADA] reviewed the scientific literature since 1979.
To the figures in the life of people with diabetes.
The WHO
criteria for diagnosis is venous fasting blood glucose level is above 140 mg/dl
[7.70mmols/l] and 2hour venous blood glucose above 200mg/dl [11mmols/l]. Then
the Expert Committee of the ADA published its recommendations, which include
new figures for diagnosis and a new category - venous fasting blood glucose
above 126mg / dl [7mmols/l] for diagnosis and the new category of Impaired
Fasting Glucose where the venous fasting blood glucose is between 110 mg/ dl
[6.1 mmols/l] and 126 mg/ dl [7mmols/l].
“ What is the optimum figure for the good control of
diabetes?”
This is a daily
question raised by the diabetics in our
clinics.
To answer this
question we should state something, that whatever we do, we cannot reach the
level of adjustment of the living normal human body, but our goal will be
reaching the near-normoglycaemiac level. From our experience a figure below
150mg/dl [8.3mmols/l] is accepted to avoid the hazards of chronic complications
such as large vessels diseases.
So what do we mean by “THE BLACK ZONE”.
This Zone
represents the figures where blood glucose levels are high but where patients
with Type 2 diabetes do not have symptoms although the process of complications
is going on.
Factors that allow patients to slip into the black zone:
1. Lack of
health services provided to the diabetics. In some areas there are no health
services or the ratio of health care providers to the population is inadequate.
2. Defects in
the health education program provided to people with diabetes.
3. Some
patients are swinging in the early phases of emotional reaction to the
diagnosis of diabetes (the denial, anger, depression and bargaining) and never
reach the phase of adaptation with diabetes. It is important that the doctor
guides his/her patient safely and smoothly through these phases up to the
adaptation. The phase of denial is sometimes very prominent especially if the
patient has a bad family history due to diabetes and in the phases of anger and
depression the patient could practice a self-damage behaviour such as alcohol
or drug intake which may aggravate the development of complications
How can the diabetics detect early complications?
Day by day
science added new techniques and investigations to the benefit of diabetics.
Among those are:
1. Early
detection of microalbuminuria to check for early stages of diabetic
nephropathy.
2. Checking
for early warnings of vascular changes.
3. Checking
for autonomic neuropathy in diabetics of more than 5 years duration of
diabetes.
4. Annual
checking of the eyes to detect early retinal changes
Are there any lights to avoid falling into this Zone?
It is a matter
of time for people with diabetes to reach adaptation to the diagnosis of
diabetes, but it is possible to avoid falling into this black zone by the early
detection of complications and by decreasing the risk factors for them and so
increasing the life span of people with diabetes.
I am very aware that this Newsletter concentrates heavily on the issue of ‘human’ and animal insulins so reducing space for the usual articles about other aspects of diabetes. I make no apologies as this was the reason for IDDT formed. The Cochrane Review provides very reliable information we have never had before - the evidence that ‘human’ is not superior to animal insulin. So if people choose to be treated with animal insulin, then there is no scientific evidence on which this can or should be refused. The review means that animal insulins must not be discontinued because the adverse reactions and long term treatment with ‘human’ and animal insulins have not been researched. This is no longer an issue that matters to those people who know they cannot tolerate ‘human’ insulin but one that the whol