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Placenta derived diabetic foot ulcer treatment effective: but only available in the USA

Feb 10, 2016Feb 10, 2016 kaitiscotlandLeave a comment

Diabetic foot ulcers that don’t respond to usual care can respond very well to a new membranous patch that is available to patients in the USA.

Dr Dan Fetterolf, head physician at the MiMedx Corporation, gave an interview to Diabetes in Control this month and described how this treatment fits into therapy for foot ulcers. The Epifix patches are derived from the amniotic membranes of women who have been screened for blood borne viruses and who are to be delivered by caesarean section. At delivery the placenta is put in a sterile container and sent to the USA production site.

Diabetic foot ulcers are bad news for patients. In the USA the cost of ulcer treatment or amputation has to be borne between the patient and health maintenance organisation. Thus there tends to be more interest in preventative treatments even when these are expensive. When an ulcer has not responded to the usual debridement, moist dressings and anti-microbial efforts after a month, these ulcers have a relatively poor prognosis and the use of amniotic membrane treatments make financial good sense.

Diabetics have a lifetime risk of getting a foot ulcer of 25%. Around a fifth of these people will go onto having an amputation. Many of these will have additional factors that increase the risk such as neuropathy that prevents people from feeling trauma to the feet, peripheral vascular disease that delays healing and obesity that adds to the pressure on the feet. Once an amputation occurs that person’s life expectation reduces and their ability to earn decreases. They need much more in the way of social and medical support. These factors all affect the person’s family as well as the economy of the countries concerned.

Prevention of diabetic foot ulcers involves good glycaemic control, daily shoe and foot examination by the person with diabetes and regular foot examination and testing by health care professionals. If an ulcer does develop then tighter adherence to preventative measures becomes essential. Weekly follow up of patients is required.

To allow maximal healing it is important to offload weight on the affected foot as much as possible. Dressings should not be allowed to dry out or else the layer of protective epithelium can be removed at the same time the dry dressing comes off.

Chronic ulcers come with a whole collection of adverse healing factors. Most people will have neuropathy and at least a degree of peripheral vascular disease. The healing ability of the skin is reduced as inflammatory cytokines reduce the healing process. In addition the immune system is rendered less effective by the glycation of immunoglobulins and other factors.

Diabetes now affects 7-10% of the USA population and in certain countries it is higher. The Pima Indians have worldwide the highest proportion of adult diabetes at 50% partly due to genetics and partly due to their very high sugared drinks ingestion. In the affluent areas of the Middle -East such as Dubai and Saudi Arabia levels are also very high. There is a genetic issue here but also a very high sugar intake. Scotland is remarkably dreadful too. A lot of this is due to deprivation and our characteristically poor diet. Many families eat no fruit and vegetables at all. Well, if we can’t beat England at football, we can certainly be winners when it comes to obesity- diabetes prevalence.

From our point of view on diabetesdietblog.com we welcome a strategic approach to reducing the number of people who develop diabetes, and improving the outlook for those who do develop the condition. Proper dietary education and provision in the public domain are essential. Only by doing this can glycaemic control be tackled in a robust manner. When a patient does develop an ulcer, resources to heal this effectively and reduce the progression to amputation is key. If this new treatment could become available in the UK it would be very much welcomed as a way to improve patient’s lives as well as cut back the nursing and medical costs associated with the prolonged treatment of ulcers.

Five types of mindless eating. Do these habits sabotage your weight goals?

Feb 3, 2016Jan 26, 2016 kaitiscotland2 Comments

Dr Brian Wansink is a behavioural economist who studies people’s behaviour around food. Specifically he is interested in how the environment can be manipulated to support or sabotage weight loss efforts. In an interview for Diabetes in Control at the ADA conference in 2012 he outlined the five areas in which we tend to eat more than we intend.

Party bingeing. This is the “I deserve a break”, “I’m celebrating”, “It’s only this once”, “It would offend the host” types of excuses come into play and we abandon our regular habits and go a bit mad with the calories. Alcohol increases our appetites and loosens our will power. If we had any in the first place. Unusual or attractive party food becomes hyper-alluring, and for some of us the urge to try a little bit of everything, three desserts for instance, makes us terribly glad that we wore an elasticated waistband that day. The party phenomenon can also translate to longer binges such as holiday eating or even more problematic, the CRUISE.

Eating too much at meals is particularly easy to do if you were brought up in a household where you were encouraged to “clear your plate”. Thanks to my mother’s pleading, threats, stories of starving children of you name it, I was 40 years old before I was able to leave anything on my plate. I always had the spectre of my mother behind me at every meal. Things were fine as long as I was able to put food on my own plate, but if someone else handed it to me….down it went.

Some of us don’t feel we can leave a meal unless we are absolutely stuffed. After all, there could be an earthquake, flood, famine, ice-age between lunch and dinner, so you’d better be prepared. Although the advice given to young ladies at Charm School was to always leave the table a little hungry… that is not how many of us do it.

Restaurant behaviour can follow on from the meal stuffing habit. After all, you’ve paid for it! And you are jolly well going to eat it. Things get even worse around buffets. For many of us, buffets are a terrible source of temptation. We have just try a little something from every dish. And when it is an all you can eat buffet….well, there is nothing like a challenge. In any restaurant, no matter how stuffed we may feel, there always seems to be room for a delicious dessert. These are particularly hard to resist if you can actually see them as opposed to just reading about them off of a menu. For most of us, restaurants are a treat, so the party bingeing mentality, “It’s just the once…I’ll go back to eating properly tomorrow” come into play too.

Snacking and grazing are what many of us to between meals. It should be meaningful work, time with those who matter, or physical activity, but no. The most popular activity is probably more eating. Snacking can be brought on by genuine hunger. In this case Dr Wansink’s best advice is to eat a hot protein breakfast at the start of the day to get out of the elevenses habit. For others snacks are freely available in the workplace or in the home. Most of the time these are not vegetables with dips or fruit, nuts and cheese but crisps, Doritos, maltesers, chocolates, sweets, biscuits and cakes. On trains and planes they can include booze as well. Calorific drinks such as hot chocolate and syrup enhanced coffees are popular too.

So when does snacking not count? Well, when you can’t actually remember doing it? Does that make it not count? When you are watching the television, in a cinema, using the computer or even driving it is amazing how dextrous human beings can be. One hand can be employed on mouse skills or on the steering wheel with the conscious brain and eyes engaged on really pretty complex tasks. Meanwhile the non-dominant hand and the subconscious brain are totally absorbed in hand to container to mouth skills just as finely tuned as the finest snooker player can pop the balls into the holes.

Brian says that essentially the first step for anyone is to become aware of any of these habits. You then need to devise strategies that interrupt the unwanted patterns of behaviour. He suggests that people start with one habit and change that first. Starting with what seems easiest and most achievable can give a feeling of mastery that can be worked on. For most things changing the environment around the problem is much more effective than reliance on will-power.

Public Health Collaboration: A Group Of Doctors Are Crowd-funding To Solve The Obesity & Diabetes Epidemic

Feb 1, 2016Jan 27, 2016 kaitiscotland1 Comment

In the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down. Together they cost the NHS £16 billion a year and the UK economy at large £47 billion a year.

These perilous percentages and shocking statistics have presented themselves despite the fact that as a population Britons are following the dietary advice that is being recommended.

Based on the latest National Diet and Nutrition Survey published in 2014 by Public Health England, our total food consumption is on average 383 calories below the recommended, our total fat consumption is just below the recommended 35%, we’re just one portion shy of the recommended 5 fruits and vegetables a day, and lastly we’re only 1 g over the recommended amount of daily red meat intake.

Seemingly the issue of obesity and diabetes in the UK isn’t that Britons are over consuming but that they are following the dietary guidelines, known as the Eatwell plate given by the NHS.

A complete overhaul of these dietary guidelines is needed based on the most up to date scientific evidence in order to improve the health of the UK.

From Monday 1^st February – Monday 29^th February a group of 12 doctors have come together to solve the UK’s obesity and diabetes epidemics by crowd-funding to set up an independent public health charity called the Public Health Collaboration (PHC).

The group of doctors include deputy chair of the British Medical Association Dr. Kailash Chand OBE, dietitian Dr. Trudi Deakin, cardiologist Dr. Aseem Malhotra, psychiatrist Dr. Tamsin Lewis, general practitioner Dr. Rangan Chatterjee, clinical psychologist Dr. Jen Unwin, diabetologist Dr. David Cavan, general practitioner Dr. Katharine Morrison, general practitioner Dr. David Unwin, general practitioner Dr. Joanne McCormack, general practitioner Dr. Ian Lake and general practitioner Dr. Ayan Panja.

The PHC needs to initially raise £5,000 to publish it’s first public report on healthy eating and weight loss guidelines given by the NHS. Alongside funding it’s ambitious campaign for change within the NHS.

Director of the PHC, Sam Feltham, is closing down his fitness business and only taking a London Living Wage in order to fight for the cause and says “Our £5,000 fund-raising target doesn’t sound like it’s enough to change anything on such a large scale, especially if you’re used to big budgets, but we’re in a fortunate position that our founding members of doctors are not taking any money for helping write our reports and supporting our campaigns.

The PHC will have it’s first public report published in April 2016 on what the scientific evidence tells us should be the dietary guidelines for optimal public health. Once published we recommend that the NHS read the report and takes it seriously for the sake of the nation’s health and economy.”

You can contact Sam Feltham for further comment or to get in contact with our group of doctors by emailing info@phcuk.orgor by calling 07734944349. Website http://igg.me/at/PHCUKorg

Supermarkets catch on to the spiralling use of low carb vegetables

Jan 25, 2016Jan 25, 2016 kaitiscotland6 Comments

Spirallising vegetables such as courgettes and squash to use instead of pasta is becoming mainstream thanks to popularisation by such celebrity cooks as Davina McCall, the Hemsley sisters and Ella Woodward. John Lewis says it was one of their best- selling kitchen gadgets of 2015.

Now you can buy pre-spirallised vegetables in many supermarkets such as Tesco, Sainsbury, Marks and Spencer and Waitrose. From next month you will also be able to buy that good old low carb rice substitute cauliflower “rice” prepacked from Sainsbury.

The interest is due to the growing demand from low carbers and those who are pursuing a wheat/gluten free diet. The restaurant chain Bella Pasta even serves vegetable “spaghetti” in their restaurants.

Based on an article by Rebecca Smithers in the Observer 17.1.16

Thai Prawn and Chicken Soup

Jan 20, 2016 kaitiscotland3 Comments

Serves 2

2 cups water

2 cups coconut milk

1 / 2 bouillon cube of chicken

1 / 2 Lime

1 to 2 teaspoons chili paste (sambal oelek)

1 1 / 2 tablespoon ginger, grated, fresh

3 / 4 tablespoons fish sauce (Asian)

150 to 200 g chicken fillets without skin

A couple of handfuls ready cooked and peeled prawns

1 / 2 Chinese cabbage or cabbage

50 g Shiitake mushrooms or any other mushrooms

2 spring onions

1 / 2 red chilli

1 / 2 – 1 tblsp Coriander, fresh
____________________________________________________________________

Place water, coconut milk, broth, finely grated rind of lime, lime juice, chili paste, ginger and fish sauce in a large saucepan and bring to a boil.

Cut chicken into strips.

Add chicken and cook for 5 minutes.

Cut Chinese cabbage into strips, slice the mushrooms. Chop the spring onions and chilli, add all to the pan, cook for 5 minutes.
Add the prawns for a minute before the soup is ready. Just warm up, don’t boil them.
Put half the chopped coriander in the soup and stir.

Taste the soup. Maybe you want more zing? Then add a little extra sambal oelek.

Potatoes may give you gestational diabetes: but eat lots of them and base your meals around starch say Diabetes UK

Jan 13, 2016 kaitiscotlandLeave a comment

Potato-rich diet ‘may increase pregnancy diabetes risk’

Eating potatoes or chips on most days of the week may increase a woman’s risk of diabetes during pregnancy, say US researchers.

This is probably because starch in spuds can trigger a sharp rise in blood sugar levels, they say.

Their study in the BMJ tracked more than 21,000 pregnancies.

But UK experts say proof is lacking and lots of people need to eat more starchy foods for fibre, as well as fresh fruit and veg.

The BMJ study linked high potato consumption to a higher diabetes risk.

Swapping a couple of servings a week for other vegetables should counter this, say the authors.

UK dietary advice says starchy foods (carbohydrates) such as potatoes should make up about a third of the food people eat.

There is no official limit on how much carbohydrate people should consume each week.

Starchy carbs

Foods that contain carbohydrates affect blood sugar.

Some – high Glycaemic Index (GI) foods – release the sugar quickly into the bloodstream.

Others – low GI foods – release them more steadily.

Research suggests eating a low GI diet can help manage diabetes.

Pregnancy puts extra demands on the body, and some women develop diabetes at this time.

Gestational diabetes, as it is called, usually goes away after the birth but can pose long-term health risks for the mother and baby.

The BMJ study set out investigate what might make some women more prone to pregnancy diabetes.

The study followed nurses who became pregnant between 1991 and 2001. None of them had any chronic diseases before pregnancy.

What is gestational diabetes mellitus?

It is a condition where there is too much glucose (sugar) in the blood
About three in every 100 pregnancies are affected in the UK
Symptoms include a dry mouth, tiredness and urinating frequently
Gestational diabetes can be controlled with diet and exercise, but some women will need medication to keep their blood glucose levels under control
If not managed properly, it could lead to premature birth or miscarriage

Every four years, the women were asked to provide information on how often potatoes featured in their diets, and any cases of gestational diabetes were noted.

Over the 10-year period, there were 21,693 pregnancies and 854 of these were affected by gestational diabetes.

The study took into account other risk factors, such as:

age
a family history of diabetes
overall diet
physical activity
obesity

It found a 27% increased risk of diabetes during pregnancy in the nurses who typically ate two to four 100g (3.5oz) servings of boiled, mashed, baked potatoes or chips a week.

In those who ate more than five portions of potatoes or chips a week, the risk went up by 50%.

The researchers estimate that if women swap their potatoes for vegetables or whole grains at least twice a week, they would lower their diabetes risk by 9-12%.

Cuilin Zhang, lead study author, from the National Institutes of Health in Maryland, US, said the findings were important.

“Gestational diabetes can mean women develop pre-eclampsia during pregnancy and hypertension,” she said.

“This can adversely affect the foetus, and in the long term the mother may be at high risk of type-2 diabetes.”

But UK experts stressed there was not enough evidence to warn women off eating lots of potatoes.

Simple swaps that can lower GI

Switch baked or mashed potato for sweet potato or boiled new potatoes

Instead of white and wholemeal bread, choose granary, pumpernickel or rye bread
Swap frozen microwaveable French fries for pasta or noodles
Try porridge, natural muesli or wholegrain breakfast cereals

Dr Emily Burns, of Diabetes UK, said: “This study does not prove that eating potatoes before pregnancy will increase a woman’s risk developing gestational diabetes, but it does highlight a potential association between the two.

“However, as the researchers acknowledge, these results need to be investigated in a controlled trial setting before we can know more.

“What we do know is that women can significantly reduce their risk of developing gestational diabetes by managing their weight through eating a healthy, balanced diet and keeping active.”

Dr Louis Levy, head of nutrition science at Public Health England, said: “As the authors acknowledge, it is not possible to show cause and effect from this study.

“The evidence tells us that we need to eat more starchy foods, such as potatoes, bread, pasta and rice, as well as fruit and vegetables to increase fibre consumption and protect bowel health.

“Our advice remains the same: base meals around a variety of starchy foods, including potatoes with the skin on, and choose wholegrain varieties where possible.”

This is an article published today BBC News

Gestational diabetes – NHS Choices

BMJ – British Medical Journal

Diabetes UK

Do you want to know your complication risk?

Jan 4, 2016 kaitiscotland2 Comments

Researchers in the United Kingdom have developed a validated risk assessment equation to show the 10-year risk of blindness and lower limb amputation in diabetes patients. Such tools have already been developed for the general population to assess heart attack, stroke and diabetes risk, and now the QDiabetes tool is the first tool for diabetics that gives an accurate assessment of their risk of these most feared complications.

Data has been collected from English General Practitioners since 1998 from over 400,000 patients. The algorithms are based on variables that patients are likely to know or that can be found from asking your GP. Knowing your risk could be worthwhile so you would know to intensify your control and monitor your condition more stringently.

For clinicians, complication risk could enable screening programs to be tailored to an individual’s need for support and the more rational use of scarce resources. Retinopathy could be done more frequently than once a year for those who need it and less frequently than once a year for those who do not. Those at higher risk of amputation might benefit from a proactive targeted program to prevent lower extremity amputation (including more frequent checks, tailored patient education, specially designed protective footwear, and early reporting of foot injuries), as this has been shown to substantially reduce the risk of emergency admissions, use of antibiotics, foot operations, and lower limb amputation compared with usual practice.

To see what your risk factors are click here: QDiabetes® (Amputation and blindness) equations.

Based on an online article at Diabetes in Control.

Hippisley-cox J, Coupland C. “Development and validation of risk prediction equations to estimate future risk of blindness and lower limb amputation in patients with diabetes: cohort study.” BMJ. 2015;351:h5441.

Beanz Meanz #&!<Z! What are FODMAPS anyway?

Jan 4, 2016Jan 8, 2016 kaitiscotlandLeave a comment

For many of us gastric distress is just intermittent but for others it is a constant source of discomfort, embarrassment and sometimes even pain. There are fermentable sugars released from various foodstuffs that increase the amount of wind generated in the gut. It is the distention of the gut by the wind that sometimes causes the bloating, discomfort and pain. And of course the gas has to go somewhere.

When it comes to gassy foods there is a variation depending on the type and amount of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols in the food. You can cut down on high FODMAP food and eat low FODMAP food instead to see if this settles your guts down.

Vegetables, beans, pulses and legumes are probably the most well- known culprits.

Of the vegetables artichokes, asparagus, beetroot, broccoli, Brussel sprouts, cabbage, cauliflower, fennel, green beans, garlic, mushrooms, okra, onions, peppers, snow peas and squash top the list. This is a pity because many of these feature highly in low carb diets and also improve the taste of many dishes.

For vegetables that are better tolerated try, bean sprouts, bok choy, peppers with the skin removed (by searing and them removing), carrots, celery, cucumber, corn, aubergines, lettuce, leafy greens, pumkin, potatoes, tomatoes, courgettes and all fresh herbs. ( eat very sparingly or not at all on a low carb diet)

Some people don’t deal with lactose very well and for these people ice cream, milk, soft cheeses, yoghurt and cream may cause problems. Lactose free dairy products and hard cheeses don’t cause difficulty.

Of the cereal group wheat products and rye may cause problems whereas spelt, gluten free bread products, rice, rice based breakfast cereals, quinoa and gluten free pasta may not.

Fruit tends not to aggravate the guts as much as vegetables but for some people avocado, apples, apricots, cherries, dates, dried fruits, figs, mango, nectarines, papaya, peaches, pears, plums, prunes and watermelon may give problems. The lower FODMAP items in this class are bananas, berries, cantaloupe melon, grapes, grapefruit, honeydew melon, kiwi, lime, passion fruit, pineapple, rhubarb and citrus fruits.

Food additives end to upset people especially the polyols in artificial sweeteners and foods with high fructose corn syrup or agave syrup. Chutneys, pickles, coconut, honey and jams can also cause problems. Thankfully most spices and herbs, mayonnaise, olives, onion powder, olive oil, pepper, salt, maple syrup, mustard, wheat free soy sauce, chilli sauce, sugar and vinegars are better tolerated.

I found that my guts under went a great improvement from stopping wheat and adopting a low carb diet. I do bake and use polyols to sweeten baking products in preference to sugars. The main thing to remember is that many of the effects are dose dependent, so limit your intake accordingly.

Based in Irritable Bowel Syndrome: new and emerging treatments. BMJ 27 June 2015.

Did you overeat this festive period?

Dec 31, 2015 kaitiscotlandLeave a comment

Sam Feltham is a personal trainer who likes to do experiments. On himself.

On a series of experiments he decided to overeat first fat, then carbs and then a vegan diet to see what would happen. Each experiment lasted three weeks, during which time he carefully monitored his calories in, his weight and his body fat.

As far as the physics goes and many people believe, a calorie is a calorie is a calorie. If so, the weight gain should be pretty uniform over each of the diets. Yet, we only start to obey the laws of physics once we die. Up till then we follow the laws of biochemistry. And the results are very different depending on where those calories come from.

Click on this link to see what happened: http://live.smashthefat.com/category/self-experiment-conclusions/

What helps and what doesn’t when type one diabetes is diagnosed in adolescence

Dec 26, 2015Dec 27, 2015 kaitiscotlandLeave a comment

Some young people cope very well with type one diabetes right from the start and others flounder. Sometimes a young person’s failure to get to grips with the condition has very serious and long lasting effects. So, what things help and what things hinder?

Dr Emily Robinson is a counselling psychologist based in Leicester Royal Infirmary. She interviewed eight type ones aged 28-36 years who had been diagnosed in adolescence and asked them about their experiences. They had been diagnosed between the ages of 11 and 17.

Previous research has shown that how people think about their illness impacts on how well they self-care, their degree of metabolic control and how happy and adjusted they are to diabetes.

Most participants went through a stage of shock and grief around the time of diagnosis. Laura stated, “At first I thought my world had caved in. I was thinking, why me? It is really unfair. I did kind of feel that my life was over”.

Yet, although in the minority, some young people just sort of “got it” right away. No fuss. No muss. Craig said, “I don’t remember there being a sudden change in the way I was personally. I wasn’t panicking for feeling like my life had ended.”

All participants described that their freedom had been at least temporarily curtailed and that they had missed out on things compared to their friends of the same age. Tony said, “I felt I lost my freedom and my ability to do things at the drop of a hat. I had always been a very active child and I was used to going out in the morning, walking and playing in the fields and not thinking of coming back home till I was hungry.”

There is a stage in adolescence where no one wants to be seen as different from anyone else in their peer group. Karen spoke about how this had serious effects. She stopped giving herself insulin injections and ended up in hospital with diabetic ketoacidosis several times.

Most participants described a sense of intense loneliness at the time of diagnosis. Not knowing any other young diabetics was a problem and sitting in medical waiting rooms along with just grown-ups and elderly did not help. One young woman, Laura, actually had severe depression. She put this down to not getting the help she needed from her parents.

Indeed parental involvement has been found to be the single most important predictor of positive adolescent outcomes. The less parental involvement and the more responsibility taken by the adolescent the worse the control. The growth of teenage diabetic transition clinics and internet forums may have made a good difference for todays newly diagnosed type ones.

Parental anxiety had a knock on effect on how well adolescents coped emotionally with their diabetes. “My parents were terrified and in denial”, said Laura. The reaction of friends had lesser but significant impact too.

Health care professionals need to be really careful about how they speak about diabetes to the newly diagnosed because everything they say is taken to heart. Jannine spoke of being shown pictures of gangrenous feet and being in a ward of people who had diabetic complications. The “shock treatment approach” left her so frightening and helpless that she avoided checking her blood sugars. “I have never quite forgiven them for that”, she says, over a decade later.

The way in which diabetes was explained at diagnosis has been found to be the strongest predictor of emotional response even two years after diagnosis.

Laura remembers, “I was having a really terrible time and I said something like, if this was a war, I would be surrendering. At the moment I feel that I am really losing. The doctor said to me, I bet you would just like a couple of weeks off, wouldn’t you? And that was one of the most understanding things a doctor has ever, ever, ever said to me.

Seeing the same clinician regularly was very important to about half of the participants. Having a nurse educate her in a supportive and encouraging way, being given choices, setting her own treatment goals and reducing her sense of isolation were particularly important to Jannine.

Over time, everyone with diabetes adjusted to having the condition in a much more positive way. Tony said, “I see myself as being normal. I’m me. I have diabetes but I don’t consider it to be a huge problem. I didn’t think like this when I was 16 or 20 years old.”

Support groups were a help to some participants. “It was astonishing to know that everyone else had problems too”.

Currently transition services for young people still tend to result in high dropout rates, poor attendance and sub-optimal control. Psychological input may help some people who are struggling at this time. More frequent appointments, active follow up, and seeing the same clinicians have been found to help.

Between the late 20s and early 30’s has been found a significant time in the lives of type one diabetics. After all, this is when parenthood is most commonly anticipated. A wish to tighten up control in preparation for a life time with diabetes is common. Emily thinks that refresher courses in diabetes management, which don’t currently exist in many areas, would be a good idea at this time.

(Of course, from my point of view, I think that diabetics of all ages would be a lot less demoralised if they were told the best ways to manage their diet and insulin regime.)

So in summary:

What helps:

Doctor gives an optimistic view of diabetes at diagnosis.

Parents, let your offspring do as much as their friends are doing and usual pursuits as far as possible.

Join family/ adolescent support groups at diagnosis.

Hospital managers provide adolescent clinics at different times from adult/complication clinics.

Outpatient management of insulin initiation avoids admission which can be distressing.

Treat parents as possible patients if they are very distressed. Do they need counselling? Do they need to meet other parents who are more experienced and coping well?

Health care professionals should make an effort to understand the person and the family who has diabetes.

Try to have the same clinicians see the family and patient regularly.

Tailor education to the individual.

Give as much control over to the individual as possible.

Consider psychological input if control is poor or distress is evident.

Provide consolidation courses for the 25-30 age groups.

What hinders:

Doctor gives a catastrophic view of diabetes at diagnosis.

Parents keep their child under a tight rein from diagnosis and inadvertently make child feel that they and their lives are very different now.

Being exposed as a new diabetic to very sick older diabetics at clinics or in wards.

Doctors and nurses not talking to parents on their own to see what they may be struggling with.

Too many cooks.

Generic courses.

Courses provided too early in the disease process that don’t seem relevant or where the family/ patient are too stressed to learn usefully.

Resources for young people with type one diabetes:

https://www.youtube.com/user/type1uncut

http://joes-diabetes.com/pages/joes-rough-guide

http://twitter.com/OurDiabetes

Resources for health care professionals:

www.successfuldiabetes.com/working-with-diabetes-workshops/diabetes-workshops/item/111-supporting-young-adults-with-diabetes-a-one-day-workshop

www.diabetescounselling.co.uk

www.diabetes.org.uk/Professionals/Training/–competencies/Courses/Supporting-Young-Adults-with-Diabetes/

Diabetes Australia Position Statement (2011). A new language for diabetes. http://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/9864613f-6bc0-4773-9337-751e953777cd.pdf

Based on an article by Dr Emily Robinson in Practical Diabetes Nov/Dec 2015