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A maths test, a white witch and the dark art of diabetes

A maths test, a white witch and the dark art of diabetes | Diabetes Now | Scoop.it

Anne Cooper (@anniecoops) writes:

 

Since I’ve been thinking more about my diabetes I have come to realise that its a lot more complicated than I lead people to believe. As someone once said to me ‘diabetes is a dark art’.

 

Its not just as straightforward as taking insulin to cover the food you eat, even if that’s what many nurses learn. Well, of course at the very simplest level it is, but there are so many other factors to think about.

 

I found out from my sensor that I am more insulin resistant in the morning than the evening so need a different carbohydrate to insulin ratio between 6 am and 12 pm, so not only do you have to be good at sums you have to be able to tell the time too. And of course there are some foods that just don’t seem to work out; for me pastry and fish and chips just guarantee a hike in blood glucose no matter what I seem to do. Other people complain about pizza or pasta which I seem to manage fine – its so individual and therefore there are few hard and fast rules and its a lot of personal learning.

 

I also discovered that I was hypoing at night and getting a resultant rise, which meant I was sometimes waking with an unexplained (till now) high blood glucose. I also have some dawn phenomena, a rise in blood glucose caused by the normal production and release of growth hormone which results in a rise in blood glucose in the mornings. Its common but means that the basal (base amount of insulin given continuously via pump) has to be adjusted to different rates over the day. I currently have a pattern that delivers 5 different amounts in the day. Confused yet?

 

If I am doing something stressful at work then, counter-intuitively (you expect a low blood glucose) I need to take extra insulin. If I am running a workshop all day for example I would increase my basal rate by 25% overall. I’m doing a big presentation this week so I will need to test quite a bit and probably adjust to take account of a probably high otherwise I will feel poorly.

 

There are so many things to think about. It really is, as I’ve said before, very complicated and no one person with type 1 diabetes is completely like another. I don’t think about it all the time but neither can you have a day off. So, I’ve decided that I am really a white witch who struggles to manage the dark art of diabetes. I quite fancy myself as the white witch from Narnia, slaying the dark monster diabetes.

 

[AS: Click on the title link above to read Anne's full post on her anniecoops.com blog]

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C8 MediSensors Company Profile

This video explains how C8 MediSensors was founded, offers insights into its core technology, and describes the company's mission to introduce a non-invasive continuous glucose monitor to improve the lives of people with diabetes.

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Diabetes action plan consultation for Wales

Diabetes action plan consultation for Wales | Diabetes Now | Scoop.it

An action plan to help deal with the growing problem of diabetes in Wales is to go out to consultation.

 

Together for Health - A Diabetes Delivery Plan will ask for opinions on the delivery of diabetes care in Wales.

 

The Welsh government said tackling the disease was a key priority with around 7% of adults in Wales being treated for it.

 

Diabetes UK in Wales has called the condition a "ticking time bomb", costing £500m a year in health care.

 

Only last month, the charity warned of a growing problem in Wales.

It said there had been an increase of 35,000 people with the condition over the past five years, taking the national total to 160,000 - a rise of 28%.

 

Health boards will be expected to have plans in place by June next year.

The framework sets out expectations for health managers, including the aim of cutting incidences of type two diabetes - often blamed on poor lifestyle - and improving standards of care for people suffering from both type one and two.

DIABETES FACTFILEAround 7% of adults in Wales are being treated for diabetesThe incidence of diabetes is increasing as the prevalence of obesity has risenDiabetes among adults in Wales is predicted to rise to 10.3% in 2020 and 11.5% by 2030Services for diabetes accounts for 10% of all NHS expenditure in the UK, or £500m in WalesPoor diet, lack of physical activity and a sedentary lifestyle are major contributors to obesity and type 2 diabetes.Source: Welsh government: Together for Health - A Diabetes Delivery Plan

Health Minister Lesley Griffiths said it would build on progress already made and was kept "deliberately short" to focus concentrate on essentials.

 

"The clear aim of the Welsh government is for the people of Wales to have every possible chance of minimising their risk of developing diabetes by encouraging healthy lifestyles," she said.

 

"However, when needed, they must have access to diabetes services of the highest quality regardless of where they live, or how these services are delivered in the community, in primary care or in hospitals."

 

The Welsh government said the plans was designed to "support and inform NHS efforts to prevent and treat diabetes and tackle its consequences across Wales".

 

The aims include:

Reduce the incidence of type 2 diabetesSignificantly improve the numbers getting diabetes education within a year diagnosis, especially childrenReduce the number of emergency admissions to hospital and readmissionsA fall in number of diabetes-related eye, foot, kidney and vascular complicationsImprove glycaemic control, especially for children with diabetesReduce glycaemic emergencies as a result of diabetesEnsure the public is able to access regularly updated information on the effectiveness of diabetes services
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Spotting heart risk in diabetes

Spotting heart risk in diabetes | Diabetes Now | Scoop.it

Diabetes boosts the risk of heart disease. But how can doctors spot which diabetes patients are most at risk of heart disease and its complications? According to a recent study, one tool may help.

 

Researchers found that coronary calcium scoring (a measure of calcium buildup on the walls of the heart's arteries) may predict the risk of death from heart disease in patients with type 2 diabetes.

 

Results showed that patients with the highest coronary calcium score had more than 11 times the odds of dying from heart disease, compared to those with the lowest scores.

 

Diabetes boosts the risk of heart disease. But how can doctors spot which diabetes patients are most at risk of heart disease and its complications? According to a recent study, one tool may help.

 

No matter who you are, diabetes can increase your risk of heart disease. However, not every diabetes patient has the same risk. Due to limited resources, doctors try to focus on the highest risk patients. So, how do doctors determine a patient's risk of heart disease?

 

In their study, Donald W. Bowden, PhD, of Wake Forest School of Medicine, and colleagues wanted to see what information coronary calcium scores could provide about the risk of death from heart disease in patients with type 2 diabetes.

 

Coronary calcium scoring is a way to measure heart disease risk. A score of 0 means there is no calcium buildup in the arteries and thus no heart disease risk. A score over 100 typically means a patient has heart disease.

 

The researchers found that diabetes patients with higher coronary calcium scores had higher odds of death from heart disease than those with lower scores.

 

Compared to patients with a coronary calcium score of 0 to 9, those with a score of:

10 to 99 had 2.93 times the odds of dying from heart disease100 to 299 had 3.17 times the odds of dying from heart disease300 to 999 had 4.41 times the odds of dying from heart disease1,000 or more had 11.23 times the odds of dying from heart disease

According to the authors, these findings suggest that coronary calcium scoring could be used to categorize risk in patients with type 2 diabetes, a population already at increased risk of heart disease.

 

The study included 1,123 patients with type 2 diabetes aged 34 to 86 years. The study was published December 10 in Diabetes Care, a journal of the American Diabetes Association.

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Self-management experiences among men and women with type 2 diabetes: a qualitative analysis

Self-management experiences among men and women with type 2 diabetes: a qualitative analysis | Diabetes Now | Scoop.it

The purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM). 

Methods: 35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and women's diabetes self-management experiences. 

Results: The average age of participants was 57 years and just over half (51.4%) were female.

Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings.

Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations.

Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management. 

Conclusions: Our findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support.

Author: Rebecca MathewEnza GucciardiMargaret De MeloPaula Barata
Credits/Source: BMC Family Practice 2012, 13:122

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Coaching programme reduces BMI in diabetes patients

Coaching programme reduces BMI in diabetes patients | Diabetes Now | Scoop.it

A 12-week diabetes prevention programme can reduce body mass index in pre-diabetes patients in primary care.

 

The US trial data found that patients randomised to a coach-led intervention programme experienced significantly greater reductions in mean BMI at 15 months, compared with those on a self-directed version of the intervention and usual care – with decreases of 2.2, 1.6 and 0.9 respectively.

 

Weight loss was also significantly greater in the coach-led intervention group than those in the self-directed group or those receiving usual care, with reductions of 6.3kg, 4.5kg and 2.4kg respectively.

 

Self-directed participants showed significantly greater reductions in weight and BMI than those getting usual care.

 

The trial involved 241 patients, with the prevention programme consisting of 12 face-to-face classes  for the coach-led group and a home-based DVD for the self-directed patients.

 

The US researchers concluded: ‘Successful adaptation of proven lifestyle interventions such as the diabetes prevention programme for multiple channels of delivery, all populations at risk and primary care settings will be critical to stem the tide of obesity and lessen its disease burden.’

 

Arch Intern Med 2012, available online 10 December

http://archinte.jamanetwork.com/article.aspx?articleid=1485081

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Rethinking diabetes management and care

Rethinking diabetes management and care | Diabetes Now | Scoop.it

Late last month, a group of people with a big interest in diabetes – patients, advocates, designers, company representatives and FDA officials – gathered at Stanford for the DiabetesMine Innovation Summit. The second-annual event was the brainchild of DiabetesMine founder and patient advocate Amy Tenderich (@AmyDBMine, pictured), who is well-known for kick-starting a movement “to help revolutionize the design of diabetes devices for the nation’s 24 million diabetics.”

 

In a recap of the summit on her blog, Tenderich explained that this year’s event was less about product design per se and more about “’breaking the ‘gridlock’ in the diabetes industry” – ensuring that stakeholders understand patients’ needs and encouraging the industry to work more closely together so that great ideas are actually delivered to the patient.

 

 

C8 MediSensors UK's insight:

Read the full article by clicking on the title link above.

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NHS Diabetes care areas

NHS Diabetes care areas | Diabetes Now | Scoop.it
'Diabetes affects every area of life and every area of the NHS'

An NHS Diabetes resource featuring information regarding prevention, risk management, diagnosis and ongoing care focusing on diabetes and:

* Cardiovascular care
* Learning difficulties and mental health
* End of life care
* Kidney care
* Services for older people
* Inpatient and emergency
* Footcare
* Eye services
* Neuropathy care
* Children and young people
* Pregnancy

Click on the title link above to be redirected to the site.

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GB DOC's curator insight, December 19, 2012 3:45 AM

Something all PWD in the UK should know about!!

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Final days of rugby hero with diabetes to be shared by his family to promote awareness

Final days of rugby hero with diabetes to be shared by his family to promote awareness | Diabetes Now | Scoop.it
The poignant last days of Welsh rugby hero Ray Gravell as he coped with complications brought about by diabetes are to be shown in an unfinished documentary abandoned after his death.

The documentary makers behind Grav: Sdim Cywilydd Mewn Llefain (There’s No Shame in Crying) followed the Welsh Grand Slam winner and broadcaster in the summer of 2007 with the aim of charting his recovery.

But when he died of a heart attack on holiday in Spain on October 31, 2007, the programme was shelved.

Now, the much-loved rugby star’s wife Mari has given permission for it to be broadcast on S4C on New Year’s Day in order to raise awareness of diabetes.

The programme features Gravell taking his first steps on a prosthetic right leg after his own was amputated below the knee because of his diabetes in April 2007.

Gravell’s widow says that before his heart attack the programme helped her husband’s recovery because he believed it would help improve understanding of diabetes.

“It was a terribly difficult time, but it was something that Ray wanted to do,” she said. “It was therapeutic for him. He was doing something positive in a difficult situation.

“Of course there were times when he was very low. But somehow, talking about things made him feel better.

“For the whole family of course it was a difficult time, but we were lucky that we got along well with the film crew, and we are glad that we did it now.”
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Defining diabetes

Defining diabetes | Diabetes Now | Scoop.it
Firstly, diabetes mellitus and diabetes is one and the same thing, expect that colloquially we say diabetes. Diabetes mellitus is a condition where the blood glucose or sugar level is high. In some cases of a diabetes mellitus patient, the pancreas fails to produce insulin that carries the glucose to the cell which in turn produces energy. In other cases the person going through diabetes mellitus does not use insulin well.

There are two types of diabetes mellitus:

Type 1 diabetes mellitus
Here diabetes mellitus is hereditary. It is known as insulin-dependent or childhood-onset diabetes, which is characterized by a lack of insulin production.

Type 2 diabetes mellitus
This is caused by lifestyle changes like regular consumption of unhealthy food plus sedentary life and increase in weight. It is also called non-insulin-dependent or adult-onset diabetes. Diabetes mellitus is caused by the body's ineffective use of insulin.

What is pre-diabetes?
Dr. Shalini Jaggi, Senior Consultant with Action Diabetic Centre explains the term pre-diabetes, "When one's sugar levels are higher than normal but not as high to be treated as diabetes that is known as pre-diabetes. People who have a fasting plasma blood glucose in the 100-125 mg/dl range are defined as having impaired fasting glucose and a post prandial blood sugar between 141-199 are defined as having impaired glucose tolerance. These together are defined as pre-diabetes."
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Oyster mushrooms: an aid to type 2 diabetes management?

Oyster mushrooms: an aid to type 2 diabetes management? | Diabetes Now | Scoop.it
Oyster mushrooms may be beneficial for people with type 2 diabetes, according to researchers in Asia.

Medical experts from the Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders(BIRDEM), in Dhaka, found that the plant helps lower blood sugar levels and cholesterol in type 2 diabetes patients.

For their clinical study, the researchers put 89 middle-aged men and women on a special diet plan that involved eating oyster mushrooms for one week followed by a seven day break and then a further week of mushroom dietary intervention.

During the first seven days, they noted significant drops in systolic and diastolic blood pressure, serum glucose, total cholesterol and triglycerides.

Levels increased over the following week before falling again in the second week of oyster mushroom consumption.

The researchers concluded that oyster mushrooms "significantly reduced blood glucose, blood pressure, triglycerides and cholesterol of diabetic subjects without any deleterious effect on liver and kidney function".

Found in most supermarkets, oyster mushrooms have a naturally occurring statin called lovastatin, which explains its cholesterol-lowering effect. However, the mechanisms behind the plant’s hypoglycemic effect are not fully understood.

The study was published in the peer-reviewed Mymensingh Medical Journal.
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Poor choice of words

Poor choice of words | Diabetes Now | Scoop.it
Scott writes:

When I start up a new CGM sensor, I’m required to give it two hours of “warm-up” time before calibrating it with a fingerstick blood sugar reading. But immediately after the two-hour period is up, I am admonished for doing something wrong.

I am totally following the rules when it comes to putting in a new sensor (well, except for my choice of sites). You told me that I have to wait for two hours before I could do anything, and I did.

Now I’m 'Overdue'?

That word, overdue, tells me that I’m delinquent. That I’m not paying enough attention to what diabetes asks of me. That I don’t care and am putting it off ’til later.

Overdue is when you don’t submit your homework assignment on time, or when you keep a library book out for more than two weeks. Overdue is what they call it when you neglect to pay your bills or your child-support payments.

I do none of those things. I am doing just what I should, when I should. Yet I’m still being admonished for being late.

Couldn’t you just say that my next calibration should be 'Now'?
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Race against type 1 diabetes must not end with a red flag

Race against type 1 diabetes must not end with a red flag | Diabetes Now | Scoop.it
Ryan Reed writes:

As a professional race car driver, I've faced my fair share of barriers and close calls. Whether it's competing in a high-stakes race or avoiding a high-speed crash, I'm able to overcome many challenges through hard work and determination. But no amount of hard work could have prepared me for my biggest challenge yet: being diagnosed with Type 1 diabetes just as my racing career was taking off.

The first doctor I consulted thought my Type 1 diabetes (T1D) diagnosis would end my racing career, but I didn't give up. I found ways to cope with the disease. Every day, I battle to manage my blood sugar levels while competing. If my blood sugar rises too high, I can have blurry vision, fatigue, thirst, dizziness or confusion. If it falls too low, I can have headaches, trembling, and could go unconscious or have a seizure. Racing makes these risks even more dangerous since everything happens at a much higher speed. A few seconds of dizziness could mean the difference between crossing the finish line and crashing my car into the wall. To stay safe, I have to monitor my blood sugar levels at all times. By keeping a glucose monitor on my steering wheel and an insulin shot in the pit area, I've been able to stay ahead of my fiercest opponent, T1D.
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#gbdoc archive for 12 December

#gbdoc archive for 12 December | Diabetes Now | Scoop.it
Wednesday 12 December 2012 saw the convening of the eighteenth meeting of the UK's diabetes online community tweetchat using the hashtag #gbdoc.

The conversation convenes every Wednesday at 9pm UK time, and is chaired by @theGBDOC.

This week's chat focused on 'my favourite d-things'. The questions were:

* What is your favourite #dtech?
* Your most wanted piece of #dtech is... because...
* Your favourite d chill-out is... because...
* How do you like to manage your d and 'stay sane/calm/well-rounded/almost normal' (light-hearted)
* Your d guilty pleasure is... because...
* Your 'funniest' d moment was... because

This week's #BGBingo number was 6.2 and as far as I can discern... there was no winner!

[AS: Click on the title link above to review the complete transcript c/o Symplur.]
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Social PWD: keep doing what you do

Social PWD: keep doing what you do | Diabetes Now | Scoop.it

Kelly Kunik (@diabetesalish) writes:

 

Sometimes I/we wonder if our blogging, tweeting, facebooking, instagraming, etc., of all things diabetes makes a difference to people in our lives sans diabetes. 

 I mean I know it makes a huge difference in PWDs (people with diabetes) lives and I know it makes a huge difference in my life as a person living with diabetes. 
I know it makes a huge a huge difference in people who have loved ones living with diabetes. 
And I also know that Diabetes Orgs and Pharma are paying attention - And rightly so.
I know that other empowered patients read what we write and we read what other empowered patients write - And we learn from one another. 
And ever so slowly (VERY SLOWLY,) the media is starting to pay attention to diabetes realities.
But what about people in our lives without diabetes/a loved one with diabetes or who aren't working in the diabetes world? Does what we do/say/write/tweet make a difference, or does it become white noise to friends and family members who don’t live with diabetes on a daily basis? 

Personally, I know we make a difference - SO KEEP DOING WHAT YOU'RE DOING PEOPLE.
C8 MediSensors UK's insight:

Click on the title link above to read Kelly's full post on the Diabetesaliciousness blog.

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Meds adherence self-report valid in type 2 diabetes

Meds adherence self-report valid in type 2 diabetes | Diabetes Now | Scoop.it

Self-reported measures of medication adherence in adults with type 2 diabetes are valid, although some self-reports are moderated by depression, according to a study published online Nov. 30 inDiabetes Care.

 

Jeffrey S. Gonzalez, PhD, from Yeshiva University in Bronx, NY, and colleagues assessed the validity of self-reported measures of medication adherence in 170 adults with type 2 diabetes (57% male) treated with oral medications. Patients were also interviewed for depression and provided blood samples. Medication Event Monitoring System (MEMS) bottle caps were given to patients with clinically significant depression and hemoglobin A1c (HbA1c) ≥7.0%.

 

The researchers found that adherence self-reports correlated significantly with lower HbA1c. In the subsample of 88 patients receiving MEMS, all self-reports correlated significantly with MEMS-measured adherence. The relationship between three of six self-reports and HbA1c was significantly moderated by depression. At high levels of depression, the correlations with HbA1c were no longer significant.

 

"Results support the validity of easily administered self-reports for diabetes medication adherence," the authors write. "One-week self-ratings and measures that require respondents to record the number of missed doses appear to be vulnerable to bias from depression severity."

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The role of the innate immune cells in the development of type 1 diabetes

The role of the innate immune cells in the development of type 1 diabetes | Diabetes Now | Scoop.it

Julien Diana and Yannick Simoni of the "Immune Mechanisms in Type 1 Diabetes," Inserm/Université Paris Descartes, directed by Agnès Lehuen, have just published the results of their work on type 1 diabetes in the Nature Medicine journal.

The researchers reveal the role of the innate immune cells, especially the dendritic cells, that cause the activation of the killer T-lymphocytes whose action is directed against the p pancreatic cells. The results obtained in mice make it possible to consider new ways of regulating the auto-immune reaction generated by the innate immune cells.

These results show, for the first time, the important role played by innate immune cells in the sequence of events leading to the onset of Type 1 diabetes. Researchers continue to strive to understand how to regulate the auto-immune reaction produced by dendritic cells without compromising the innate immune system, an essential one in cases of infection. Several routes are being taken to attempt to regulate the production of the INF α alarm molecule that precedes activation of the killer T-cells, for example, by specifically targeting certain activation routes for the pDC dendritic cells.


"These therapeutic approaches are currently being tested in other auto-immune diseases such as lupus and psoriasis. Such innovative treatments could be useful in the prevention of Type 1 diabetes. It will first be necessary, however, to perform studies in diabetic and pre-diabetic patients to be able to better understand how the innate immune cells function, something that has not been studied until recently in auto-immune diabetes," concludes Agnès Lehuen.

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#gbdoc archive for 19 December

#gbdoc archive for 19 December | Diabetes Now | Scoop.it

Wednesday 19 December 2012 saw the convening of the nineteenth meeting of the UK's diabetes online community tweetchat using the hashtag #gbdoc.

The conversation convenes every Wednesday at 9pm UK time, and is chaired by @theGBDOC.

This week's chat focused on the community's experience of the transitional period from paediatric to adult care as people with diabetes.


In a change from the norm, this week's #gbdoc chat took the form of a general dialogue between participants, rather than being structured around questions.


* What is your favourite #dtech?
* Your most wanted piece of #dtech is... because... 
* Your favourite d chill-out is... because... 
* How do you like to manage your d and 'stay sane/calm/well-rounded/almost normal' (light-hearted)
* Your d guilty pleasure is... because... 
* Your 'funniest' d moment was... because

This week's #BGBingo number was 6.7 and the winner was @ladykatew with 6.8

C8 MediSensors UK's insight:

Click on the title link above to read the full #gbdoc chat transcript c/o Symplur

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Diabetes awards recognise Swindon volunteers

Diabetes awards recognise Swindon volunteers | Diabetes Now | Scoop.it

A diabetes awards ceremony has recognised the work of volunteers in Swindon who give their time to help individuals suffering from the blood sugar disease .

The Diabetes UK Swindon Voluntary Group came away with the prize for exceptional and outstanding work by a voluntary group at the South West Diabetes UK Inspire Awards, the Swindon Advertiser reports.

Held in Taunton, the event saw the organisation praised for the many awareness-raising activities it has held down the years, as well as its active support for Diabetes UK - including donations to the charity worth more than £77,000.

In addition, the group is held in high regard by healthcare professionals and has a proven track record with regard to NHS engagement.

Regional manager for Diabetes UK South West Graham Cooper described the Diabetes UK Swindon Voluntary Group as a worthy winner of the award.

Mr Cooper stated: "The voluntary groups are vital to our work as a charity and I am delighted that the selfless hard work and dedication of the volunteers in Swindon has been recognised."

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Spotlight on diabetes in Sheffield

Spotlight on diabetes in Sheffield | Diabetes Now | Scoop.it

More than a third of people with diabetes in Sheffield are at greater risk of developing potentially serious complications because they have high blood glucose levels, according to new analysis by Diabetes UK.

 

The analysis shows 38.2 per cent of people with the condition in Sheffield are not achieving their target blood glucose level.

 

That means many thousands of the estimated 32,684 people in Sheffield with diabetes are at greater risk of developing complications such as amputation and blindness.

 

Spokeswoman Linda Wood said: “It is shocking that over a third of people with diabetes in Sheffield have high blood glucose levels that are putting them at increased risk of devastating health complications such as blindness and amputations.”

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NICE approves plans to develop diabetes QOF indicator 'bundle'

NICE approves plans to develop diabetes QOF indicator 'bundle' | Diabetes Now | Scoop.it
NICE has agreed to develop various ‘options’ for a composite QOF indicator that will require practices to carry out a number of checks in patients diabetes before they are awarded points.

Under the proposed plans, practices could lose over £5,000 if they fail to invite a diabetes patient to eight annual care checks, but NICE has stopped short of recommending the bundled indicator to include all nine recommended annual checks for diabetes patients, as the ninth test – a retinal screen – was deemed to be out of GPs’ control.

The development of a bunded indicator was approved for development by the Primary Care QOF Indicator Advisory Committee last week, and is likely to include current indicators for measurement of HbA1c, cholesterol, blood pressure and foot checks. Practices would have to carry out all the specified checks in each patient before they are awarded the points for the indicator.

Pulse revealed in July that ministers had written to NICE to ask it to explore the practicality of raising QOF thresholds and creating a ‘composite’ indicator in QOF for diabetes.

The GPC has said bundling diabetes indicators will be ‘demotivating’ to GPs, but was backed by the influential House of Commons Public Accounts Committee last month.

NICE said it was unable to say at this stage which indicators might be included in the bundled indicator and whether it would replace or supplement the existing diabetes indicators.

A NICE spokesperson said: ‘There is a lot more work to be undertaken over the next 16 months before any potential indicators to be considered for development could enter the QOF.

‘Some stages of this work will include piloting in general practice, and full public consultation to provide the opportunity for everyone with an interest to contribute to the development of indicators.’

NICE’s indicator development team will report back to the committee in June, and if approved the indicator will be piloted in GP practices for at least six months. The earliest such an indicator could enter the QOF would be April 2015.
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If you have diabetes, get flu-safe

If you have diabetes, get flu-safe | Diabetes Now | Scoop.it
Health officials in Shropshire, and Telford and Wrekin, are urging those with diabetes to protect themselves and get their seasonal flu immunisation as soon as possible.

Flu immunisation clinics are now well under way in GP surgeries and people with diabetes, along with those aged 65 and over and pregnant women, are among the priority groups for the free immunisation.

Dr Irfan Ghani, Shropshire County PCT’s Consultant in Public Health, said:

“People should not underestimate the effects of seasonal flu. It is not the same as getting a cold. It can seriously affect your health, and the risks of developing complications are greater if you have certain pre-existing medical conditions such as diabetes.
“This can be prevented by having the immunisation, which is being provided free at GP surgeries across Shropshire and Telford and Wrekin for people most at risk.”
Leading health charity Diabetes UK is also encouraging people with diabetes to get the flu immunisation.

Cathy Moulton, Diabetes UK Clinical Advisor, said:

“People with diabetes are a high-risk group when it comes to getting flu, so it is crucial that they are vaccinated as soon as possible this winter.
“Having flu can really upset diabetes control and cause blood glucose levels to fluctuate. This can leave people with diabetes open to many health problems, including complications of flu such as pneumonia and bronchitis.
“If you haven’t already been invited for a free flu jab, contact your GP surgery to find out when they are holding clinics and make sure you look after yourself during the cold weather.”
More information on flu immunisations is available at www.nhs.uk/flu.

To find out more about the importance of the flu immunisation follow us on Facebook www.facebook.com/flufightersstw.

There are additional ways people can protect themselves and those around them. Good hand hygiene – the ‘catch it, bin it, kill it’ technique – reduces the spread of germs. This means carrying tissues, covering coughs and sneezes with a tissue, disposing of the tissue after one use, and cleaning hands as soon as possible with soap and water or an alcohol hand gel.
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Study examines link between breast cancer and diabetes

Study examines link between breast cancer and diabetes | Diabetes Now | Scoop.it
Postmenopausal breast cancer survivors are at increased risk for developing diabetes and should be screened for the disease more closely, a new study suggests.

Researchers analyzed data from 1996 to 2008 from the province of Ontario, Canada, to determine the incidence of diabetes among nearly 25,000 breast cancer survivors aged 55 or older and nearly 125,000 age-matched women without breast cancer.

During a median follow-up of more than five years, nearly 10 percent of all the women in the study developed diabetes. Compared to those who had not had breast cancer, the risk of diabetes among breast cancer survivors was 7 percent higher two years after cancer diagnosis and 21 percent higher 10 years after cancer diagnosis, the investigators found.

The risk of diabetes, however, decreased over time among breast cancer survivors who had undergone chemotherapy. Their risk compared to women without breast cancer was 24 percent higher in the first two years after cancer diagnosis and 8 percent higher 10 years after cancer diagnosis, according to the study, which was published Dec. 12 in the journal Diabetologia.

“It is possible that chemotherapy treatment may bring out diabetes earlier in susceptible women,” study author Dr. Lorraine Lipscombe, of Women’s College Hospital and Women’s College Research Institute in Toronto, said in a journal news release. “Increased weight gain has been noted [after receiving] chemotherapy for breast cancer, which may be a factor in the increased risk of diabetes in women receiving treatment.”

“Estrogen suppression as a result of chemotherapy may also promote diabetes,” Lipscombe added. “However, this may have been less of a factor in this study where most women were already postmenopausal.”

The study authors suggested that there may be other factors involved for women who received chemotherapy, including glucocorticoid drugs, which are used to treat nausea in patients receiving chemo and are known to cause spikes in blood sugar. In addition, breast cancer patients undergoing chemotherapy are monitored more closely and thus are more likely to have diabetes detected, they noted.

The researchers said it is unclear why diabetes risk increased over time among breast cancer survivors who did not receive chemotherapy.

“There is, however, evidence of an association between diabetes and cancer, which may be due to risk factors common to both conditions,” Lipscombe said. “One such risk factor is insulin resistance, which predisposes to both diabetes and many types of cancer — initially insulin resistance is associated with high insulin levels and there is evidence that high circulating insulin may increase the risk of cancer.”

“However, diabetes only occurs many years later when insulin levels start to decline,” she said. “Therefore, it is possible that cancer risk occurs much earlier than diabetes in insulin-resistant individuals, when insulin levels are high.”

Overall, the “findings support a need for closer monitoring of diabetes among breast cancer survivors,” Lipscombe concluded.

Although the study found an association between diabetes and breast cancer, it did not prove a cause-and-effect relationship.
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Vitamin K intake may reduce risk of diabetes in the elderly by 50 percent

Vitamin K intake may reduce risk of diabetes in the elderly by 50 percent | Diabetes Now | Scoop.it
New cases of diabetes continue to increase exponentially every five to ten years. The toll this disease takes on millions of unsuspecting children and adults places the illness in a class by itself as it is the primary cause of death from diabetes and cardiovascular disease. Excess glucose in circulation slowly damages virtually every cell and molecular structure in our body as it makes critical proteins, enzymes and fats dysfunctional and significantly increases the risk of arterial plaque development.

Fortunately, there are a handful of natural compounds that help negate the deadly effects of excess sugar. Vitamin K is one such agent, as it is shown to lower the risk of developing diabetes in an elderly cohort by more than 50 percent. Researchers publishing in the American Journal of Clinical Nutrition have determined that individuals with the highest circulating levels of vitamin K1 have a total diabetes risk reduction of 51 percent as compared to those with the lowest levels.

A team of Spanish scientists noted "The results of this study show that dietary phylloquinone intake is associated with reduced risk of type-2 diabetes, which extends the potential roles of vitamin K in human health." The researchers noted that vitamin K deficiencies are prevalent in western diets due to a lack of leafy green vegetables such as lettuce, spinach, and broccoli that provide vitamin K1, the most common isomer of the vitamin. Vitamin K2 (from fermented foods and natto) is much less common in the typical diet and can be synthesized in the gut by microflora.

Researchers reviewed data on 1,069 men and women with an average age of 67 that were part of the Prevention with the Mediterranean Diet trial in Spain. None of the participants had diabetes at the start of the study. 131 had developed the disease after five and a half years. The team determined that those with the highest levels of vitamin K1 at the study's outset experienced the lowest risk for developing Type II diabetes.

The team concluded "An increase in the amount of phylloquinone intake during the follow-up was associated with a 51 percent lower risk of diabetes in elderly subjects at high cardiovascular risk after a median follow-up of 5.5 years." Though still to be determined, the researchers postulated that the risk reduction was due in large part to the metabolism of osteocalcin, a protein involved in bone mineralization and moving calcium from the blood into the bone. Nutrition experts recommend supplementing with a full spectrum form of vitamin K (1000 to 2200 mcg per day) to prevent diabetes and heart disease as we age.
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Playing diabetes doctor, for real

Playing diabetes doctor, for real | Diabetes Now | Scoop.it
WilD writes:

I’ve got my stethoscope draped cavalierly around my neck. I don’t actually need it today, but it makes me look smart. I boot up my computer and begin reviewing the case histories of the four patients in the waiting room.

Delia P. is a 65-year-old white female who “presents for follow up of poorly-controlled type 2 diabetes.” Charles T. is described as a 53-year-old man who has come in for an initial visit to “establish care” after not having seen a clinician for over a year. Jorge R. is a 58-year-old obese Latino male with a 4-year history of type 2 diabetes, hypertension, and dyslipidemia. And lastly, Caroline G. is a 58-year-old African-American widow who’s come in for a routine assessment of her type 2 diabetes and hypertension.

Thinking about which patient to take on first, I take a drag on my cigar and down a deep swig of Evan Williams cinnamon whiskey. Hell, why not? I’m only playing doctor today, and I’m working from home, to boot.

Don’t worry, I’m not practicing medicine without a license.

I’m test-driving the new interactive patient simulator program from the American Diabetes Association and TheraSim. It’s a Continuing Medical Education program for docs designed “to evaluate and reinforce best practices in the diagnosis and treatment of patients with diabetes.” It’s billed as the industry’s first fully-interactive patient simulator.

[AS: Click on the title link above to read the rest of Wil's post on the Diabetes Mine blog.]
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Blue Pier Project aims to turn UK piers blue for WDD 2013

Blue Pier Project aims to turn UK piers blue for WDD 2013 | Diabetes Now | Scoop.it
nqnurse2012 writes:

I joined twitter as @nqnurse2012 (https://twitter.com/nqnurse2012) with the aim of tweeting about my experiences as a newly qualified nurse.

What I very quickly noticed was that I was being drawn to the diabetic community and a growing sense that I wanted to get involved, to use what I know to benefit people like my husband.

So after ranting on for a while I decided it was time to put my money where my mouth is and actually do something proactive.

The idea for the blue pier project came to me on World Diabetes Day, November 14th 2012. I love the idea of unique ways of raising awareness so the idea of going blue really appealed to me. Unfortunately I was too late to do anything this year but I have big plans for next year.

My first goal is to get my local council on board to turn my home town pier blue, probably sounds simpler than it actually will be but hey, i like a challenge!

Then I thought why not aim a bit higher? Why not approach all the towns with piers and convince them to get on board too?

My thinking is, that doing something a bit different will get people talking, get people interested. Then I have an opening for doing more.

I do have a vision, which has been formed from talking with, and listening too the people I meet who live with diabetes. Twitter has been a great platform for this and I have found some really passionate and inspiring people who want to change the perception of diabetes and improve the care and services available for all.

I know that there are some amazing services out there already, my husband's diabetic team are brilliant and I have been lucky to be invited to become a diabetic link nurse for my area of work. Something I don't quite feel ready to take on yet but will do in the future, and in the meantime will continue to attend their meetings to get a bit of knowledge to back up my enthusiasm for the subject.

So I am starting small. I have set up a twitter account for the blue pier project (@BluePierProject; https://twitter.com/bluepierproject), I have an email address (bluepierproject@live.com) and now I have this blog too. From humble beginnings and all that!

I would like to get some guest blogs written which I can post on here, if you are interested in writing something for me, give me a shout (email/tweet).

I am also going to try and get 500 followers on twitter by the end of February. I reckon this will give me some credibility in approaching people to get involved.

I have other plans too, I would eventually like a website and have a few ideas about cool stuff to put on it.

So there you have it, nqnurse's plan to take over the world. I hope you'll join me.
C8 MediSensors UK's insight:

AS: What a novel idea! As a south coast UK resident myself, I think this is a really interesting concept, and look forward to hearing more.

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Evaluation of a diabetes management program

Evaluation of a diabetes management program | Diabetes Now | Scoop.it
An article from the NHS's National Electronic Library for Medicines:

Objective: To evaluate the efficacy of a community-based, pharmacist-directed diabetes management programme among US managed care organisation enrollees using National Committee for Quality Assurance (NCQA)-Healthcare Effectiveness Data and Information Set (HEDIS) performance measures.

Design: Randomised controlled trial.

Setting: Regional community pharmacy chain in Tulsa, OK, USA, from Nov 2005 to Jul 2007.

Patients: 52 participants with diabetes and hypertension who were enrolled in a managed care organisation.

Intervention: Diabetes management versus standard care.

Main Outcome Measures: Comprehensive diabetes care measures of glycosylated haemoglobin (A1C below 7.0%), blood pressure (below 130/80 mm Hg) and low-density lipoprotein (LDL) cholesterol (below 100mg/dL. A composite research outcome of success was created by determining whether a participant achieved two of the three HEDIS goals at the end of 9 months.

Results: 46.7% of intervention group participants achieved the A1C goal, while 9.1% of control group participants achieved the goal (P less than 0.002). More than one-half (53.3%) of intervention participants achieved the blood pressure goal compared with 22.7% of control participants (P less than 0.02). Among control group participants, 50% achieved the LDL cholesterol goal compared with 46.67% of intervention group participants. The odds of the intervention group attaining the composite goal were 5.87 times greater than the control group.

Conclusions: A community pharmacy–based diabetes management programme was effective in achieving A1C and blood pressure goals measured by NCQA–HEDIS performance standards. Programme participants were statistically significantly more likely to achieve two of three HEDIS standards during a 9-month period.
C8 MediSensors UK's insight:

AS: Interesting, but I note a) no distinction between the needs of T1 and T2 #pwd; b) A1C and blood pressure markers, critical though they are, exclude other other QoL indicators (i.e. you could be managing your disease effectively, but not managing living with your disease very well at all); c) the data is 5-7 years old, pre-dating the emergence of the social web and the extraordinary levels of focused support the #doc offers.

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