Before you fly print out your Medical Devices awareness card

The Civil Aviation Authority are asking that all passengers who have medical devices such as Insulin Pumps and Continuous Glucose Monitoring  systems carry a card to remind themselves and the security officer about what precautions both sides must take to travel safely and securely.

For passengers the card can be printed by clicking on the link below or simply googling Medical Devices awareness card.

You should also have a letter from your GP or hospital doctor saying that you are wearing the device.

These devices should not be put through  X ray scanners whether on your body or not. You shouldn’t be required to remove them from your body either.  You may need to check what security alternatives exist in foreign airports but the UK has other ways of determining your safety to fly.

https://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Chttps://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Content/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdfontent/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdf

BMJ: Flu jag timing matters

From BMJ May 2019: Minerva BMJ 2019;365:1993

A review in Science indicates that vaccines for mumps, whooping cough and yellow fever lose their effectiveness more quickly than those for measles, diptheria, tetanus and flu.

The flu vaccine at best only protects about 60% of the people given it in any given year. Its effectiveness also declines after just a few months. If you are first in the queue to get it towards the end of September, much of its effects will be lost by January and February which are the peak months for flu infection.

My comment: Maybe you should plan to get the jag any time from mid November to mid December  if you are very keen on getting maximum effectiveness to prevent flu?

 

Vitamin D shown to improve blood sugar control in gestational diabetes

From Ojo O et al. The effect of vitamin D supplementation in women with gestational diabetes mellitus. A systemic review and meta-analysis of randomised controlled trials. Int J Environ Res Public Health. 2019:16(10)

A meta-analysis has indicated that various factors relevant to improved blood sugar control are likely to be improved by vitamin D supplementation in  a total of 173 women with gestational diabetes.

Fasting blood glucose decreased by a mean of 0.46 mmol/L

Glycated haemoglobin decreased by a mean of 0.37%

Serum insulin reduced by a mean of 4.10 uIU/mL.

 My comment: Although the improvements are small, vitamin D supplements are inexpensive, easy to take and do not have the side effects of other medications.

 

 

Type 1s in the US dreading their 26th birthday

insuline supplies on the Diabetes Diet websiteSometimes a story pops up which serves as a timely reminder of how lucky we in the UK are (catastrophic, undemocratic political shenanigans which might lead to insulin shortages anyway notwithstanding)…

This week’s news feature that popped out to me was a BuzzFeed article about Millennial type 1s in the US, forced to come off their parents’ health insurance at the age of twenty-six. Insulin prices in the US tripled from 2002 to 2013 and a recent study found its average annual cost increased from $3,200 to $5,900 a year from 2012 to 2016. Unregulated capitalism—always a good thing, hmm?

Most Millennials, the article pointed out, have to contend with the long-felt after-effects of the 2008 financial crisis, debts left over from college or university and the gig economy where it is hard to get health insurance in the first place. Or there are jobs that don’t have insurance, the insurance doesn’t cover diabetes or the deductibles are so high, the insurance isn’t worth the paper it’s written on.

Rationing insulin

The reporter spoke with a number of twenty-six-year-olds forced into rationing insulin and using syringes and lancets repeatedly to try to keep costs down. One mentioned skipping meals so he didn’t need to take at least one dose a day, and another said her insurance didn’t cover the insulin she’d previously used. The one it sanctioned made her feel ill.

Why the age of twenty six? As the article states, outgrowing your parents’ health insurance has always been an issue for young adults with chronic health conditions. The Affordable Care Act of 2010 allowed them to stay on that insurance until they got to twenty-six—a universal deadline.

Even government-sponsored insurance is so “stupid expensive” one person quoted in the article said, it’s not worth it.

Different career path

And what about job choices? Again, those featured in the article spoke about sacrificing what they really wanted to do for a job or career path that offered sufficient financial reward or great insurance in order to get the life-saving medication they need.

Twenty-five-year old Allie Marotta told BuzzFeed she fears the approaching deadline.

“Being postgrad, figuring out your career,” she said, “all of that is crazy to begin with, and then adding the layer of worry about medical stuff and having it be a life-or-death situation, literally a life-or-death situation all the time.

“It shouldn’t be this hard. You see other countries doing it and it’s not this hard. There’s no reason for this to be the way that it is.”

Lower cholesterol may not better if you have neuropathy

From Jende JME et al. Peripheral nerve damage in patients with type 2 diabetes. JAMA Netw Open. 2019;2(5);e194798

In type two patients who had diabetic neuropathy affecting the legs, low total cholesterol and low density lipoprotein cholesterol had more nerve lesions, impaired nerve conduction and more pain and disability than those with higher cholesterol levels.

Almost all type two diabetics will be advised to take statins to keep the cholesterol level down as this is generally accepted as improving the outlook for cardiac and circulatory conditions.

One hundred participants with type two diabetes were tested using magnetic resonance neurography. 64 had diabetic neuropathy and 36 did not.

My comment: Although this was not discussed in the abstract, I wonder whether those people with more advanced complications were being more intensively treated all round and thus had more/higher doses of statins, and so the relationship between low cholesterol and neuropathy severity was simple association, or whether there is a causative factor here. I am aware that statin neuropathy is believed to exist.

Higher blood pressure is linked to LESS cognitive decline

From Streit S et al. Ann Fam Med 1 March 2019 and reported by Sarfaroj Khan UK Clinical Digest 13 March 2019

In my GP career treatment of blood pressure for the general population has become more intensive as time has gone on. This hasn’t always resulted in better long term outcomes overall. Indeed, the target systolic blood pressure, the upper measurement, has been moved from 130 to 140 in the last few years because of this.

A Dutch study of over a thousand patients over the age of 75 showed that those with a systolic blood pressure under 130 showed more cognitive decline than those with a blood pressure over 150 when they had mental functioning tests a year later.

Those with higher blood pressures had no loss of daily functioning or quality of life.

As aggressive blood pressure control in those with diabetes is standard treatment, it is worth knowing this. Perhaps further studies in this subgroup of patients would be worth doing. I have seen reports of impaired kidney function when blood pressure levels are “optimal” but low too.

Another study regarding blood pressure management reported in the British Journal of Sports Medicine indicates that blood pressure reduction of almost 9mm Hg in hypertensive patients when regular structured exercise is undertaken. This is of a degree similar to most anti-hypertensive medications. (Reported in BMJ 5 Jan 2019)