World Diabetes Day

Today is World Diabetes Day – happy diabetes day to my fellow (and female) diabetics the world over. May your blood sugars be stable for today at least. No hypos or hypers are allowed…

Who knows what the next year will bring? There have been lots of exciting developments in the diabetes world over the last 12 months – from the first hybrid insulin delivery system to the NHS’s decision to offer flash glucose monitoring, to the identification of a new biochemical ‘signature’ as a potential early indicator of type 1 diabetes onset, we edge closer than ever before to understanding and properly managing this condition.

One piece of news I spotted recently that has implications for all of us (and is relatively easy to do) was research that has shown that people with type 1 diabetes who are more active have a lower risk of premature death than those who don’t exercise.

Diabetes.co.uk reported that the Helsinki study. It followed 2,639 people with type 1 diabetes, 310 of them had diabetic kidney disease. They were followed up eleven years later. During the course of the research, some 270 people diets. In the least active group, the death rate was 14.4 percent. Only 4.8 percent died in the group who performed more exercise. Activity seemed to benefit patients who had kidney disease and those who didn’t.

The lead study author, Der Heidi Tikkanen-Dolenc from the University of Helsinki and Helsinki University Hospital, said: “Doctors have always prescribed physical activity for their patients with type 1 diabetes without strong evidence. Now we can say that in patients with type 1 diabetes, physical activity not only reduces the risk of diabetic nephropathy and cardiovascular disease events but also premature mortality.”

Keeping active is a challenge in this day and age. Our governments and big business have unwittingly conspired to create a world where the default way to live is a sedentary one where cheap, nasty junk food is all-too-readily available. Being active and exercising often takes a lot of effort, unlike populations who lived years ago who were active because they had to be.

But the message that exercise can help prevent premature death IS a powerful one. Let’s celebrate World Diabetes Day with a walk!

Pic thanks to maxipixelfreepictures.com

 

Hypo or Not?

A “serious and important” hypo.

When do you feel the symptoms of a hypo?

The November/December issue of Balance, Diabetes UK’s magazine, reported that researchers have proposed that we need to take a fresh look at defining low blood glucose levels.

At present, a ‘hypo’ (low blood glucose level) is 3.9mmol and below (70.2mg/dL in the US), which the researchers feel isn’t all that low.

A severe hypo is one where someone needs help from another person to recover, something that rarely happens in clinical trials. Rightly so, as letting someone go so low without help wouldn’t be ethical.

Researchers suggest that there should be three levels of hypo – low, lower and oh f*****g shit. I’m kidding, obviously, but they are looking for the level that, below this point, a person’s health is seriously affected, i.e. where their brain, blood and cardiovascular systems are compromised, the risk of death begins to rise, and the level that has an impact on mental health.

Current research suggests these begin to take effect at about 3.0mmol (54mg/dL in the US). The team’s three definitions are:

  • Level 1: 3.9mmol or less –a hypo alert
  • Level 2: less than 3.0mmol – serious and important hypo
  • Level 3: serious hypo, requiring external assistance, even if none is available.

Like all of us, hypos are individual. One person’s “I’m fine at 3.9” is another’s “oh shit”. I sometimes feel the symptoms of a hypo coming on at 4.6, say. Other times, I’ll prick my fingers, get a 3.9 and wonder where it’s come from.

As you can see from the picture, I had a “serious and important hypo” this morning, thanks to undereating and walking too enthusiastically yesterday. Oof. It happens.

Keeping your blood sugar levels stable without going too low is a huge challenge. One of the reasons we promote low-carb eating for type 1s in particular is that the risk of hypos can be reduced because you don’t need to take as much insulin.

If the researchers could include advice about how to avoid hypos, while also achieving good HbA1c results in the long-term, we will cheer them on…

 

*Some good news! The NHS has approved flash glucose monitoring technology – i.e. systems such as the FreeStyle Libre. I’m off to investigate the possibilities of getting one. Also, big love to the NHS, a wondrous, wondrous institution.

 

 

Tired, Tired, Oh So Tired…

I don’t usually use the blog as a one-person pity party, but this week I want to whinge about tiredness…

If there were one thing I could miraculously make disappear about life with diabetes, it would be the tiredness. Don’t get me wrong – with careful care of your medications, diet and exercise, you can minimise this aspect of the illness, but heck. Many’s the afternoon I spend fighting the urge that makes want to crawl under the covers.

And that makes me resentful from time to time.

Tricks for Small Children

I can live with the endless blood tests and injections. Hey, they’re not so bad. Last week, I managed to entertain my cousin’s young children with my lancet. They were wide-eyed when I let them push the button, and they saw they’d made me bleed. I’ve never yet met a small child who didn’t love this. Once they’ve figured it out, though, they’ll want to try it out on you endlessly. You have been warned.

The injections are rarely painful, and you get used to doing them discreetly in public, while no-one bats an eyelid.

The organisation needed for diabetes (have I got all my equipment, do I need to order and pick up repeat, when are my hospital appointments, is my medication matching my insulin intake, etc.) can be seen as a transferable skill. I often feel I should add it to my CV: Emma Baird, Type 1 Diabetic, Organiser Extraordinaire.

The hospital appointments give you an afternoon or morning off and, with any luck, the waiting room will be full of trashy magazines to read.

And – it’s an ego thing – but I quite like being different from the general population. We all like to think of ourselves as unique little snowflakes after all…

The Pull of the Afternoon Nap

But the tiredness. Of late, I have been tired. Tired in the mornings, tired in the afternoons. Getting up in the morning and promising myself an early night, or an extended afternoon nap. Sometimes, it’s because my blood sugar levels aren’t right, at times it’s just because.

People with diabetes need enormous amounts of willpower, as the tiredness can be all-consuming. When you’re tired, everything is an effort – from getting up in the morning, to doing work* that brings the money in, forcing yourself to go for a walk because you’ll feel better afterwards, and making the right choices about what to eat. Luxuries like meeting up with friends sometimes fall by the wayside because the effort it entails feels as if it will be too much.

Tiredness makes you prone to negativity too. Don’t ever open your social media accounts when you’re exhausted. Envy, discontent, paranoia, dissatisfaction – all will surface too readily.

So, yes. I’ll keep diabetes. I made my peace with it a long time ago, but if you can find a permanent, works-all-day way of ridding me of the bone-crushing weariness, I’ll take that, thank you very much.

 

*I don’t agree with her politics, but I admire Theresa May hugely for managing to pull off diabetes, run the country AND manage the Brexit negotiations at the same time. (Though, many might argue that she doesn’t…)

Photo thanks to Jessica Cross on flickr. Entry for Canon Photo5 2009 Brief 4: Spectacles Portraiture. Picture recreated thanks to Creative Commons Attribution 2.0 Generic.

 

Diabetes in the News

What’s new in the world of diabetes? We’ve rounded up the news for you…

The BBC reported that a pioneering therapy is safe for type 1 diabetics. The therapy retrains the immune system, and it was tested on 27 people in the UK. It showed signs of slowing the disease. Like many of these kinds of treatments, though, it only works on people who have been diagnosed recently – it’s unlikely to help those who’ve had the condition for years.

Another BBC report focused on the rise of Type 2 diabetes in children. More than 600 children and teenagers in England and Wales are being treated for the condition. A report from child health experts found 110 more cases among the under-19s in 2015-16 than two years before. Local councils have warned this is a “hugely disturbing trend” – and that urgent action to tackle childhood obesity is needed.

Bedfordshire News reported on a new approach to type 2 diabetes treatment the University of Bedfordshire and the local branch of Diabetes UK is trying out. The university is hosting weekly exercise sessions so people can take advantage of regular exercise sessions and support to help them make changes to their lifestyle. One 70-year-old told the newspaper the clinic had made a huge difference to his strength and energy levels.

How do you feel about your diabetes? Amy Mercer thought she’d come to terms with her condition a long time ago, but a chakra reading revealed pent-up anger and frustration. Amy wrote an interesting post on what she learned from the reading on Diabetes Self-Management.

Finally, it’s not a week if there isn’t at least one article purporting a ‘cure’ for diabetes… Clinical trials have begun for ViaCyte’s PEC-Direct – an implant that grows insulin-producing cells from stem cells, according to futurism.com. ViaCyte’s president, Paul Laikind, said he thought the PEC-Direct product had the potential to transform the lives of people with type 1 diabetes.

 

 

Blogging About Diabetes

Medical News Today summed up ten of the best diabetes blogs. Sadly, we weren’t one of them (there’s no justice in this world), but they did make some great suggestions that I want to check out.

Why blog about diabetes? When I was first diagnosed, there were few opportunities to meet other people with diabetes. Weirdly enough, I grew up in a tiny town (population sub 2,500), and five of us were diagnosed with type 1 in a short space of time. I did have other diabetics around me, and my mum ended up developing a close friendship with the mother of one of them.

That said, though – we didn’t have that much information at our fingertips and in those days, the GP, the consultant and the diabetic nurse were autocratic figures. No-one challenged them or the recommendations they made.

Fast forward thirty-odd years and millions of people share their experiences of living with diabetes, types 1 and 2. Obviously, we don’t all have medical qualifications, and can’t and shouldn’t offer medical advice but we can tell stories about what has worked for us.

We can share our experiences of how we exercise, what we eat, what we do to prepare for holidays – it’s all about how we live as well as we can with the ol’ sugar curse! Online friendships and communities can’t replace real-life meetings and connections, but they do go some way to making you feel less alone with your diabetes.

So, here are some of Medical News Today’s best blogs about diabetes that I’m going to be investigating…

Bitter-Sweet – Karen Graffeo was diagnosed at the age of eleven and remembers daily insulin injections, a strict exchange diet and sugar monitoring involving urine and glass test tubes. (Me too!)

She started Bitter Sweet in 2008, tagline “life with diabetes isn’t all that bad”.

The College Diabetes Network sounds useful for anyone (or the parents of anyone) about to go off to college/university. It can be scary for both prospects, and the site provides the tools and resources that can help people with diabetes live well as students. Categories include clinics, student rights, job opportunities, dining hall eating, relationships and more.

The FitBlog is run by husband and wife team, Tobias and Christel Oerum. Christel has type 1 diabetes, and the site is for people to find out more about exercising safely and efficiently when you have diabetes.

 

 

 

 

 

 

Study Finds Some Type 1s DO Produce Insulin

Free stock photo of health, medical, medicine, prickAn article in Medical New Today caught our eye this week – research recently found that people with type 1 diabetes produced some insulin.

Yeah, yeah, I thought, it’s the newbies again. But apparently not. The Uppsala University in Sweden’s researchers found that nearly half of patients who’d had the condition for more than ten years did produce insulin.

Type 1 diabetes is routinely described as a condition where the body doesn’t make insulin. The researchers found that the insulin-producing patients had higher levels of immune cells that produce a protein called interleukin-35 (IL-35). This is believed to suppress the immune system and reduce inflammation in the body.

The findings were reported by the study’s co-author, Dr Daniel Epses, in Diabetes Care.

Type 1 diabetes happens when the immune system mistakenly attacks insulin-producing cells or beta cells in the pancreas.

This was believed to lead to a complete loss of insulin production in type 1 diabetics, but studies in recent years have shown that some patients still have functioning beta cells.

Dr Epses and his colleagues wanted to work out if there are any immunological mechanisms that could explain why some type 1 diabetics still produce small amounts of insulin.

The study looked at 113 patients aged 18 and over. All of them had been living with diabetes for at least ten years.

Researchers measured the levels of C-peptide in the blood – an indicator of insulin production. They also measured circulating cytokine levels, including IL-35. Cytokines are proteins that are secreted by the immune cells and they play a major role in cell signalling.

The team found that almost half the patients were C-peptide positive – in other words, they had some level of insulin production. The results also showed that patients who were C-peptide positive had significantly higher levels of IL-35 in their blood, compared with the patients who were C-peptide negative (the ones who had lost all insulin production).

Previous research has indicated that IL-35 can suppress auto-immune disease. It is possible that in some type 1 diabetics, the protein prevents the immune system from attacking and destroying beta cells.

Dr Epses and his colleagues, who are based at the Department of Medical Cell Biology at Uppsala University, couldn’t determine if C-peptide positive patients had higher IL-35 levels at type 1 diabetes diagnosis, or whether levels of the protein increased over time because of a reduced immune system attack on insulin-producing beta cells.

More study is needed to gain an understanding of how IL-35 might relate to insulin production. The researchers believe, however, that their findings show the potential of IL-35 as a treatment for type 1 diabetes. As the findings also show that almost half of patients with type 1 diabetes produce some insulin, the team thinks it might be possible to encourage regeneration of their remaining beta cells and so boost insulin production.

 

 

Scotland ‘Should Take Lead Role in Type 1 Research’

Catriona Morrice of the Juvenile Diabetes Research Foundation (JRDF) talked to the Scotsman this week about how Scotland could lead the field to cure type 1 diabetes.

The Foundation’s development manager cites bioscience expertise where Scottish institutions, scientists and charities are already working in support of this aim, but she believes Scotland’s role could be even bigger.

A child diagnosed at the age of five can need more than 19,000 insulin injections before his or her 18th birthday [incidentally, where does that put you? I’m in my 33rd year of diabetes] so there’s no doubt that a cure will be welcomed by us, if not by the insulin-production companies…

Greater Focus

Morrice says the JDRF wants the Scottish Government to encourage an even greater focus on type 1 diabetes research. Scotland has among the world’s highest rates of incidence, and the JDRF has invested nearly £4 million in projects at the Universities of Edinburgh and Glasgow.

Across the international JDRF network, Morrice says, the organisation is delivering ground-breaking work. There are three areas of work which are of particular importance – encapsulation, immunotherapy and medicinal foods. The encapsulation research being carried out in the US is looking at ways to implant insulin-producing cells in the body while protecting them from the immune system. The basic idea is that they are wrapped in a protective coating and can do the same job as the ones in a healthy pancreas.

Immunotherapy works to alter what the immune system does, retraining it to no longer attack cells such as the insulin-producing beta cells of the pancreas. In Boston, a research team is working on a technique which will ‘hijack’ red blood cells, attaching insulin fragments to them. These blood cells travel quickly through the body and don’t cause an immune response themselves, as the individual produces them.

Food as Medicine

Then, there are medicinal foods. JDRF-funded research in Australia has shown that types of bacteria in our gut can have an impact on overall health. This has opened up debate about food could be used as medicine, helping to treat or prevent type 1 diabetes without harmful drugs.

But Scotland has something almost every other country doesn’t, Morrice adds – a database of people with type 1 diabetes that allows collaboration with families affected by type 1 diabetes who want to join clinical trials. Called the Scottish Care Information – Diabetes Collaboration, Morrice says it’s a vital resource for research scientists and the Foundation’s “overwhelming wish” is for Scotland to take the lead role in type 1 diabetes research.