Brexit and Insulin Shortages

a plstic box c ontaining insulin on The Diabetes DietInsulin shortages and low-carb dishes—no obvious connection, I grant you but bear with me.

The first relates to a news item on Channel 4 last night, which warned of insulin shortages post-Brexit in the UK as the country produces little to no manufactured insulin (apart from a factory which makes the stuff derived from pigs).

Sir Michael Rawlins, the chair of the Medicines and Healthcare products Regulatory Agency, told the Pharmaceutical Journal last Friday that, “We make no insulin in the UK. We import every drop of it. You can’t transport insulin around ordinarily because it must be temperature-controlled. And there are 3.5 million people [with diabetes, some of whom] rely on insulin, not least the Prime Minister.”

412,000 people on insulin

Strictly speaking, that’s no true as the Channel 4 story pointed out. Wockhardt UK produces the animal insulin, but its products are used by some 1,500 to 2,000 patients every year. And that’s less than 0.5 percent of the estimated 421,000 people in the UK who rely on insulin.

Channel 4 News spoke to the major manufacturers, Sanofi, Novo Nordisk and Lilly. All of them make insulin in Europe.

The Healthcare Distribution Association (HDA) UK which represents medical suppliers in the UK wrote to the UK Government post the referendum in 2016 to warn of serious upsets to the supply chain should Brexit negotiations go wrong.

Buffer stocks

HDA UK said the UK medicines supply chain had “inbuilt resilience” and “flexibility”, and that they were aware of proposals by the government and manufacturers to develop plans for a buffer stock of all medicines.

A spokesperson for the Government said they were confident of reaching a deal, there were contingency plans in place to ensure no disruption to supplies.

Channel 4 News’ fact check conclusion is that as the companies and the Government don’t anticipate shortages, we should be okay.

Back to low-carb recipes and my tenuous attempt to link the two. If you follow a low-carb diet and you use insulin, in general you don’t need to take as much insulin. If shortages come, you’ll have more time to use your insulin while the powers-that-be attempt to sort out this almighty mess.

Cue plug for this blog and The Diabetes Diet! Is that distasteful of me?! Probably.

 

 

 

Thrity-One-Year-Old Claims Cure for Type 1 Diabetes

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLES

A PICTURE OF BLOOD TESTING EQUIPMENT AND NEEDLESGoogle alerts frequently pairs ‘diabetes’ and ‘cure’ together, but most of the time the words don’t capture my attention. Even when ‘type 1 diabetes’ and ‘cure’ make the same sub-heading, I’m not jumping up and down.

Yeah, yeah, heard it, bought the tee shirt, and no impact on my life so far…

But The Sun newspaper carried a story this week about a 31-year-old who claims to have cured his type 1 diabetes with diet and exercise alone. Again, that approach can achieve results with type 2 diabetes but it’s the first time I’ve seen it accredited to a cure for type 1.

Exercise and diet

Daniel Darkes’ regime isn’t for the faint-hearted. He eats a diet high in zinc (nuts, oily fish and veg) and runs more than sixty miles a week.

But before you dig out your trainers and start stock-piling the Brazil nuts, Daniel’s type 1 diabetes has some qualifications. He has a rare, abnormal gene, which doctors believe might have restarted his pancreas.

The 31-year-old from Daventry in Northants developed diabetes eight years ago and stopped giving himself insulin last January (2017)*. He started cutting down on insulin after experiencing hypos in 2016. He travelled to the US in March 2017 to find out more. Doctors ran further tests to find out what we happening to his body.

Brain sending messages to pancreas

He was put on a fasting diet and exercised at the same time. The medical staff noted his brain had begun sending new signals to his pancreas, and he hasn’t injected himself with insulin ever since.

Daniel told The Sun that doctors believed his abnormal gene combined with exercise is the reason he’s been able to cure himself—it’s as if the gene acts as a back-up immune system and has recharged his pancreas.

He is still being monitored at Northamptonshire General Hospital.

Abnormal genes

I’m fascinated by this story—as I suspect most type 1s will be. I’m no medical expert so my opinions are qualified, but I suspect that Daniel’s abnormal gene plays a huge part in his ‘cure’ (and this won’t be regarded as such until he reaches the two-years-without-insulin mark). It’s also interesting that the description of his diet (scant as it is) sounds like a low-carb diet.

The article said that Daniel’s case “could provide a revolutionary new approach to treating type 1 diabetes”, while Diabetes UK said it couldn’t speculate on whether Daniel had ‘cured’ his diabetes or not, and that there was “no clear cure for type 1 or type 2 diabetes”.

 

*DISCLAIMER – please, for the love of all things injectable, do not skip your insulin injections if you have type 1 diabetes…

 

Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

#TalkAboutDiabetes – Diabetes Awarness Week June 2018

What do you struggle with when you’re talking about diabetes? It’s Diabetes Week 2018 (June 11-18) and the theme of this year’s awareness-raising seven days is the stuff we find awkward, embarrassing, difficult or even funny to mention.

Here are mine:

  • I don’t like telling people in general. I’m not ashamed or embarrassed; I just don’t like drawing attention to myself.
  • Jelly baby etiquette. When you eat sweeties in front of someone, politeness dictates you offer them around. But they’re the medicine that corrects low blood sugars*, so stinginess is understandable.
  • Explaining a hypo when you’re in the middle of one. Most of my low blood sugar episodes are manageable. But I can be in the middle of a conversation and my mind goes blank. “Bear with me! My mind’s distracted. It’s screaming ‘SUGAR, SUGAR, SUGAR’ at me. My word power will return in a few minutes,” is what I should say.
  • Or don’t talk to me. When I’m high, conversation is too much effort. Please don’t take it personally.
  • I don’t talk much either when I’m high because I’m conscious of the nasty taste in my mouth and am reluctant to impose halitosis on anyone.
  • And don’t take the grumpiness low blood sugars produce personally either. First aiders once told me about diabetics who punched people when they were low, so grumpiness seems moderate in comparison.
  • Please know that managing diabetes is like having a part-time job that you do on top of everything else.
  • If you manage to work out I’m hypo long before I do, be aware I’ll deny it in an exasperated fashion. “Flip’s sakes, no I’m not. Look I’ll even do the blood test to show you and here it…oh. Alright then.”
  • Sometimes when I say I can’t do something because of the diabetes, I might be using it as a fab, ready-made excuse. It’s not me, it’s you. OH NO! I’ve just given away diabetes’ best-kept secret!

*I told a little girl my jelly babies were medicine once. She gave me one of those, ‘why do adults lie to me?’ looks.

Celebrate the NHS 70th birthday with tea and cakes?

On the 5th of July the NHS celebrates its 70th Birthday.  There is a concerted effort to celebrate this with tea parties and people are meant to contribute the proceeds to an NHS charity of their choice. Diabetes UK perhaps?

The trouble could be the cakes, sandwiches, scones and stuff that is likely to be scoffed along with the tea and coffee.

My practice has been gifted a hamper to celebrate the event.

This is what it contains:

plain and fruit scones

Clotted cream

strawberry jam

tea

Fudge oat crunch cookies

strawberries and cream shortbread biscuits

If you are having one of these events at your workplace, there are many low carb alternatives you can bring instead.

It is a pity the event didn’t feature something that emphasised good health promotion instead of bad health promotion. Going for a 30 minute walk for instance.

https://nhsbig7tea.co.uk/

More Thrush Ladies?!

a picture of canesten cream on The Diabetes DietCould I live with more thrush? Ladies who live with diabetes, you’ll join me at wincing at this one. No thanks, eh? Who wants to spend their days wishing they were sitting in a bath of calamine lotion?

I ask because I filled in a survey last week which asked me if I’d take a tablet to help with my blood sugar control despite initial findings where the control group suffered thrush as a side effect. That wasn’t the only reported side effect—weight loss is another one—but the benefits reported are exciting.

The drug is sotagliflozin (marketed as Zynquista), made by Sanofi and Lexicon, and it’s a dual SGLT1 and SGLT2 inhibitor. At present, it’s about to be reviewed by the US Food and Drug Administration, as diabetes.co.uk reported.

The SGLT1 bit works to delay glucose absorption in the intestines which helps with blood sugar spikes after eating. The SGLT2 inhibitor makes the kidneys better at getting rid of excess sugar in the blood.

Zynquista had undergone clinical trials. People who took the drug achieved better HbA1c levels without increasing the risk of severe hypos. But one group of trial participants taking sotagliflozin developed diabetic ketoacidosis, compared to just 0.6 percent taking a placebo.

Participants on the trial lost 2.98kg compared to those not taking the drug.

Would I take it? Heck, yes, even if it means stockpiling the clotrimazole creams beforehand. All addition help in the blood sugar battle is always welcome.

 

 

Office Etiquette with Diabetes

person holding jelly babies at The Diabetes Diet
Mine, all mine!!

I waved goodbye gaily to office life in 2013, glad to embark on new adventures in freelance world.

There’s a lot to be said for freelancing, not least the ‘free’ bit. I love being in charge of my own scheduling. But the pay… ah, the moolah just isn’t to be found, folks. You’re undercut all the time by global competitors who can afford to write for tiny sums or people in your own country who do it for free as a hobby. Argh.

Anyway, I started a new part-time job in April, working in a communications role on a project at Glasgow University—a worthwhile project and the chance to add a regular income. The equal opportunities form asked if I had a disability. I ticked the ‘no’ box. It also asked if I had a chronic health condition. Er…no?

Okay, I get that I do, but until my thirties, I thought all I had was diabetes. When someone pointed out it is a chronic health condition, I was stunned. No, really. I know that sounds like a “duh” moment, but diabetes hadn’t caused me much hassle. Calling it a chronic life condition felt a bit like I was straying into hypochondriac territory.

Back to my new office job. I decided to be a grown-up and tell my colleagues about my condition, instead of sneakily eating jelly babies at my desk and hoping they didn’t notice. It’s not that I don’t want to tell folks; I just I hate drawing attention to it.

I introduced the subject at a team meeting in a round-about way. Did my new colleagues know of anywhere on the campus where I could offload spare medical gear , I asked. (And benefit others at the same time by recycling my stuff. See what I did there?)

They suggested places. I’d told them I was a diabetic by default.

Job done.

Next up—the hypo talk, where I explain what a hypo looks like and why I’m a stingy jelly baby hogger, instead of offering them around.