June 2016's Minutes

Sorry it’s taken me a while but here are June’s minutes.

We welcomed Professor Peter Evans from The department of Endocrinology and Diabetes at Richmond House, Royal Gwent Hospital.

Professor Evans started by giving us the history of insulin. Before 1921 people with Type 1 Diabetes invariably died, which obviously included many children.

In 1921 two doctors Dr Best and Dr Bantin started work, in Canada, investigating the pancreas of dogs, they found that after feeding on a certain diet they had a high blood sugar reading and they found a hormone from the dogs pancreas produced into an injection. The dogs were tested and provided   they died within 4 days, however if they received an injection of insulin then they lived for approximately 80 days.

****Please remember this was nearly 100 years ago when experimenting on animals was the norm.****

This injection saved 100’s of lives of people of the period. Before insulin was developed for use, people with Type 1 Diabetes, mainly children, we put into a sanatorium, they were put on a strict diet of no more than 400 calories a day so these children became more ill and stunted in growth with no energy.

One of the daughters of the Secretary of State had type 1 diabetes, she visited these sanatoriums to see these children, she was struck by the story of one boy in particular, his only ambition was to hold a bird in a birdcage. She sympathised with this boy and got a bird in a cage for him. His joy was obvious however the following day the boy was found dead having gorged on the bird’s bird seed.

Within a year insulin was available as the live saving drug it is today.

Later research established that there was a definite distinction between type 1 and type 2 diabetes. A link was also discovered thanks to troops returning from action who were given Sulphur antibiotics, they discovered that troops given this medication were going into hypoglycemia, as a result the exploration of sulphides side of diabetes medication increased to the level it is at today.

The exploration of diabetes medication even as unexpected side effects from other medication is always progressing. The most common medication for people with type 2 diabetes – metformin was originally derived from the french lilac plant.

It was found that combinations of acids, alcohol and insulin could lengthen the effects of insulin, leading to the mass production of long and short acting insulin. A big step forward for pump therapy.

A sample of insulin from Canada was taken to Denmark to manufacture human insulin as a derivative from pigs and cattle pancreas’. The Denmark production went on to become Novo Nordisk – a huge name in Diabetes research and medication.

The research has improved pump therapy and advances are constantly being made, drugs are improving for the control of diabetes for those who are not able to control it by diet alone. IT is being found that the medication is also having benefits in other areas, for example, a leader study into the use of Victoza (liraglutide) has found it helps with weight loss and shown a significant reduction in cardiovascular disease.

The medications we use work in different way, for example SGLT-2 (Dapa’s) block kidney use so sugars are excreted in urine, it also helps with weight loss. Sometimes not all side effects are good side effects such as metformin which has the effect of upsetting the stomach.

Doctors have established a list of approximately 8 most effective medications which can reduce other factors such as cancer rates and cardiovascular diseases.

The routine for prescribing is normally metformin first which although one of the oldest drugs still provides the best first stage “attack”, it is then a process of finding the right combination of medication. The main factor in prescribing is the patient. Things to consider by the doctors before deciding on the next medication are, is the partient overweight if so its best not to prescribe something that is going to cause weight gain. Is the patient underweight, can they afford to put on weight. Are they loose or weight neutral. Are they at risk of hypos – best to avoid a drug that could cause hypos.

The third step is sometimes an injectable – not necessarily insulin. Don’t forget diabetes is a progressive condition.

Really interesting things to think about not just a doctor writing a prescription before you’ve even sat down!!

Professor Evans described two different types of sugar, the fast acting kind that you find in coke or lucozade, 4 jelly babies or glucose tablets. And then slower acting sugars from carbs etc.

When treating a hypo, its important to give a fast acting sugar for an immediate boost but then to back it up with a slower acting sugar in the form of some carbs to eat.

Can you recognize a hypo??

Professor Evans described it as feeling anxious, sweaty, heart racing, the fight or flight feeling, feeling woozy, confused, aggressive and then drowsy and finally into a coma.  Some of these symptoms can appear similar to being drunk and many people – especially the younger adults can be wrongly assumed to be drunk.

******Not everyone will experience all of these symptoms of a hypo but to be aware that these are the common symptoms******

Professor Evans provided some excellent advice regarding the driving regulations of people with Diabetes.

HGV and PSV drivers are not allowed on insulin, due to the danger of hypos, it is important to test your blood sugars before you drive, it is also better to plan adequately for long journeys or possible delays. If you are driving and you feel the symptoms of a hypo coming on, find somewhere to pull over, remove the keys from the ignition and put them in the glove box and sit in the passenger seat, you can then not be accused of being in control of the vehicle. Remember if it’s 5 it’s ok to drive, 4’s the floor!!! Handy way to remember blood sugar values that are safe to drive.

Complications of diabetes come in all sorts of guises. One of the most common ones are diabetic peripheral neuropathy, which is the loss of sensation in the feet, and if caught early enough is treatable, with no advice or health checks the nail’s and foot can become badly infected which can cause the bones to become infected which can result in amputation.

The Ipswich Test is a test you can do at home to regularly check the sensations of the foot, if you can touch and feel the touch on the tip of the 1st, 3rd and 5th toe then your feet are ok to feel sensation if for any reason you can’t feel it, don’t wait until your next foot check with your diabetes specialist team be it at the GP or the Hospital go and see your doctor urgently to say you are not feeling the touch on your toes, early discovery can mean its treatable.

With all conditions some operation can cause complications so it is important that the healthcare team are aware of your control of your diabetes (or lack of it as the case may be).

July’s meeting is Thursday 21st July 7pm – 8:30pm with a talk from Podiatry services to be followed by the group AGM.

I look forward to seeing you there!!