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Jun 17, 2011
deanna
8 posts
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Topic: General Discussion / Advice if possible. Thanks Garry, im trying to keep at it, i usually do notice differences in my BG when im sick but at the moment i (or the doctors) dont know whats causing what first, the sickness affecting my diabeties or my diabeties resulting in my sickness Oh and while ive got you, do you have any idea why exercise wouldnt be lowering me BG significantally as it has in the past. I have noticed this over the past couple of weeks and i cant think of any reason for it. hi dafne-dude i think your morning increasing in insulin could be like mine any many others ive heard from. Hormones on the morning that wake you up and get you started, interfere i think is the right word, with your insulin intake. not sure theres much else it could be but id still ask around if it worries you. The weekend variations could be something as simple as you sleeping in latter or your body jst knowing, dont ask me how  that your not going to work that day. The burning - the only way i can describe it to others is like, if you have ever accidently touched your hand to something burning hot like an oven. That is how it feels to me  Its not the needles but the insulin when it enters, and it sometimes doesnt even go by high doses like ive given myself too much at one time, as this can happen. Ive tried 3 QA insulins now in less than a year with varying affects. Ive now devised as somewhat successfull method for injecting myslef. Insert needle, inject 3-4 units, hold, count to 5, and so on etc. Seems to work for the most part. x |
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Jun 16, 2011
Carolin
83 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Hi JWoIt's a bit complicated, but in simple terms when you exercise your liver needs to release glucose into your bloodstream from the glycogen stores. It's thought that the analogue BIs suppress this to a greater extent / for longer than NPH. There may be more detail on the www.runsweet.com website Or you could try to Google E Perry/I Gallen as they're the docs who have done the studies. Carolin |
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Jun 16, 2011
JayBee
587 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Why is Lantus not suitable for Type1s who exercise regularly? Is it because it responds stronger to exercise compared to the other two?That might explain the trouble I had possibly... it's weird how a very busy working environment can affect your body without you realising. 
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Jun 16, 2011
Welshmapleleaf
19 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Yes, on my DAFNE course last week, they explained Lantus was less suitable to those who exercise regularly, and indeed one of the other delegates had changed to levimir for that very reason. It was also deemed to be better for those who found that the effectiveness of Lantus was running out too early every day. |
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Jun 16, 2011
chrisinbrum
41 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
Thanks Carolin - that's really interesting and helpful! I'd not heard anything like that before about hypos and exercise. On my DAFNE course, and i think in the course manual, it just says that hypos might be a problem after exercise, but doesn't link that to any particular insulin so i assumed they were all the same. The manual also says that Lantus users might manage better with twice daily Isophane or Levemir. |
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Jun 16, 2011
Carolin
83 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP 1. is there research evidence of an improved safety record for analogues compared with old NPH/soluble insulins, from the DAFNE database? [one for DAFNE top brass!]I can tell you that an audit of the DAFNE database around 4yrs ago asked just that question. And the reuslts?....... Traditional NPH (Humulin I or Insulatard) used twice daily as per DAFNE regimen resulted in better HbA1c than the modern analogue Background Insulins, however ANY type of BI taken twice daily was better than analogue taken just once daily. There was no difference in terms of severe hypos (needing 3rd party assistance), however analogue BI showed a trend towards slightly lower rates of minor, symptomatic hypos. The DAFNE stance therefore is still to default to NPH twice daily as it is still a very effective and proven insulin and this has nothing to do with cost! If people have problems with night-time hypos and/or uncontrollable Dawn Phenomenon on NPH, twice daily Levemir or Lantus is an option. In addition, much of the work done by Dr Ian Gallen's team at Wycombe has shown an increased risks of prolonged hypos during/following exercise with analogue BIs and they recommend switching back to NPH or using a pump if you're a serious exerciser. Hope this info helps? Carolin |
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Jun 16, 2011
chrisinbrum
41 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I think it's useful to remember that a lot of the clinical information and other info online might originally come from the companies that make insulin, so they might be putting their 'spin' on the findings they publish, and just because a large trial shows lower risk of hypo with insulin A rather than insulin B, it doesn't mean that it's the same for everyone. I think it's just safe to say that different peope react differently to different types of insulin, and we should all be allowed to decide which one we want to use, with support and advice from GPs and other diabetes specialists.Brum-taffy, i'm in South Birm PCT, which one are you in? QIPP stands for Quality, Innovation, Productivity and Prevention...so any QIPP plan from a PCT would need to consider all of these areas and they're not just about saving money in the short-term. So if there is evidence that newer analogue insulins reduce hypos and complications, improve control and reduce weight gain (for example) that would all support the widespread use of newer insulins - this could make people that prefer older insulins unhappy! I know that asking your local PCT for their plans isn't going to make them suddenly think about reducing people's access to insulin, that's not how it works (luckily!). |
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Jun 16, 2011
JayBee
587 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP
I find this bit particularly interesting because I chose to change to Levemir because I was suffering from hypos a lot more on Lantus! I don't know about the whole Hypo arguement, but considering the more up to date insulins work a lot more effiently in comparison to the older types (in terms of timing - particularly how long it takes for them to start working and how long they last for), it does make sense to move on from them. Edit: Almost feels like the hypo arguement is just them looking for excuses to me... I mean, hypos can be influenced by so many different life effects not just insulin alone. |
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Jun 16, 2011
Brum_Taffy
13 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Thanks for those last 2 posts- I'm aware there is scant 'hard' evidence in this area.Personal experiences and anecdote/stories are what I am keen to hear. It's an area where cost:benefit is not easy to calculate. I suspect the traditional way of calculating this (quality adjusted life years) does not do justice to issues like fear of hypoglycaemia and confidence in your medicines/treatment plan. DAFNE originally had higher target ranges, especially overnight, because of greater worry about hypos with older insulins. I'm hoping DAFNE data will tell us if there is any difference in the experiences of people on analogs vs. human insulin. Please keep the stories and experiences coming!
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Jun 16, 2011
JayBee
587 posts
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Topic: General Discussion / Carbs v Cals I agree! I don't see veganism as a diet either because it's more based on how you want to live, rather than something you're doing just to "lose weight only" like a lot of diets are. Temporary food courses are not a good way to go if you want long term benefits. I find it absolutely amazing/horrifying what some of these diets suggest you do!This is now reminding me of my partner. He's Pescetarian because he just simply hates the taste of all meat! ^_^; Considering I'm happy to eat most stuff, I don't know what I am... omnivore of some kind? lol. It's like with DAFNE this weight loss stuff really, it's very easy to get frustrated when you're trying so very hard to get results as quick as you can.
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Jun 16, 2011
Welshmapleleaf
19 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP But on the other hand, Lantus IS apparently better for you....International clinical studies have confirmed the advantages of insulin glargine in the treatment of heavy hypoglycaemia compared to standard NPH insulin. Insulin glargine reduces the risk of severe nocturnal hypoglycaemia. Extensive clinical studies (ACCORD) have confirmed the higher risk of mortality with higher incidence of severe hypoglycaemia.[3][4] A comparison trial of insulin detemir and glargine proved that subjects randomized to detemir used slightly higher daily insulin doses, but gained less weight on average than glargine-treated subjects.[5] Other systematic reviews corroborate the results of benefit of insulin glargine regarding lower incidence of severe hypoglycaemia.[6] On June 13, 2009, Diabetologia, the journal of European Association for the Study of Diabetes (EASD), published the results of a 5 year long-term observational, retrospective analysis. During the study no other safety issues, such as unexpected adverse events for either insulin emerged. However, insulin glargine was associated with a lower incidence of severe hypoglycaemia compared with NPH insulin. I guess there's two sides to every argument and you can make it fit your own standpoint. Personally, I think that analogues were developed as a result of a progression in Diabetic research, and I for one would prefer the latest available drugs that treat my disease. |
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Jun 16, 2011
Welshmapleleaf
19 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Found this on Wikipedia re Analogue Insulins......'A meta-analysis of numerous randomized controlled trials by the international Cochrane Collaboration found "only a minor clinical benefit of treatment with long-acting insulin analogues (including two studies of insulin detemir) for patients with diabetes mellitus type 2"[6] while others have examined the same issue in type 1 diabetes. Subsequent meta-analyses undertaken in a number of countries and continents have confirmed Cochrane's findings. In July 2007, Germany's Institute for Quality and Cost Effectiveness in the Health Care Sector (IQWiG) reached a strikingly similar conclusion. In its report, IQWiG concluded that there is currently "no evidence" available of the superiority of rapid-acting insulin analogs over synthetic human insulins in the treatment of adult patients with type 1 diabetes. Many of the studies reviewed by IQWiG were either too small to be considered statistically reliable and, perhaps most significantly, none of the studies included in their widespread review were blinded, the gold-standard methodology for conducting clinical research. However, IQWiG's terms of reference explicitly disregard any issues which cannot be tested in double-blind studies, for example a comparison of radically different treatment regimes. IQWiG is regarded with skepticism by some doctors in Germany, being seen merely as a mechanism to reduce costs. But the lack of study blinding does increase the risk of bias in these studies. The reason this is important is because patients, if they know they are using a different type of insulin, might behave differently (such as testing blood glucose levels more frequently, for example), which leads to bias in the study results, rendering the results inapplicable to the diabetes population at large. Numerous studies have concluded that any increase in testing of blood glucose levels is likely to yield improvements in glycemic control, which raises questions as to whether any improvements observed in the clinical trials for insulin analogues were the result of more frequent testing or due the drug undergoing trials. More recently, the Canadian Agency for Drugs and Technology in Health (CADTH) found in its 2008 comparison of the effects of insulin analogues and biosynthetic human insulin that insulin analogues failed to show any clinically relevant differences, both in terms of glycemic control and adverse reaction profile' |
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Jun 16, 2011
JayBee
587 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I haven't a clue for the first question lol.
With the lack of education I had when I was on Humalin I before DAFNE, it is difficult for me to compare it now. That was a very very long time ago.With how well Lantus and Levemir respond though in comparison to some of the results I've seen from other diabetics on this forum, I feel that it would be a good thing to move on from the older insulins because they don't seem to perform as well as more up to date insulins (which makes sense really). The key thing that gets in the way of this logic is knowing that if someone has found something works for them, then they do - no, should - have the right to stick at it if they want to.
Freedom is very important to me. I would not be a happy bunny if my medication was changed just because it suited the funds better now. I have changed insulin at least once since starting DAFNE (changed from Lantus to Levemir). It was not a straight forward change for my condition's control but very worthwhile - but it was a choice I made, not something that was forced on me. As for soap stuff... well, I'd give it a go lol. That example just doesn't compare well really for me. ;) |
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Jun 16, 2011
Brum_Taffy
13 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP I guess they should be public. As it is a gov agenda such plans could be said to be 'only following orders'.Which PCT do you come under? On my patch (west of Brum) I have heard rumblings that restrictions may be coming, but have seen no documents to that effect. I have taken the view it is better not to ask, in case this moves into the cross-hairs! |
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Jun 16, 2011
chrisinbrum
41 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP Are PCT QIPP plans publically available documents or would you need a freedom of information request to get hold of them and check what's going on? |
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Jun 16, 2011
Brum_Taffy
13 posts
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Topic: Questions for HCPs / Newer Insulins under pressure from QIPP A government programme aimed at cutting costs (Quality Innovation Prevention and Productivity, or QIPP) means that many PCTs and commissioners are scrutinising the use of insulin analogues.In particular, the use of Lantus in type 2 diabetes is under the microscope- the suggestion is that professionals should use older, cheaper long-acting insulin and then only switch to the more expensive choice if/when people get hypoglycaemia. This could have knock on effects for people with type 1 diabetes- we know not all 1e care teams think differently in type 1 vs type 2! I've observed published safe DAFNE target levels coming down over the years, I believe because modern analog insulins are more 'predictable' [some may say as predictable as a teenager, rather than old NPH being as predictable as a toddler  ].My questions are: 1. is there research evidence of an improved safety record for analogues compared with old NPH/soluble insulins, from the DAFNE database? [one for DAFNE top brass!] 2. do people with type 1 diabetes generally believe/feel they get extra benefits with modern analogues, compared to older human and/or animal insulins? What is your experience? 3. If someone tried to take away your 'Daz' and give you 2 packets of another soap powder, how would you react? How important is choice of insulin to you?  Each PCT has a QIPP programme- attacking analog insulins may not feature in them all, but if you have had your choice of insulin questioned, it would be interesting to hear about it. Ta |
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Jun 16, 2011
Michaela
13 posts
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Topic: General Discussion / Carbs v Cals All very sensible JWO. For me veganism isn't a diet like say low-carb was. It was a little bit of a lifestyle change but actually it hasn't changed much except what I eat and how I feel. Which is the important part. It seems to fit in with my lifestyle so far. And because I am not doing it as die-hard as people who might do it for the animal reasons I am a little bit more flexible.However, I do stick to the principles as much as possible because I do actually believe that there is too much industrialisation, environmental damage and cruelty in our food production these days. Even though it wasn't my main reason for going vegan. That was to help my health. The weight loss is an added bonus. I don't see it as a diet at all. It's a 'way of eating' and as I've said before I am not deprived. I have a much healthier relationship with food in general than I did many years ago and it's because of the right mindset I am able to do it without it being a chore or difficult for me. If you have food issues any change is going to cause you problems. |
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Jun 16, 2011
novorapidboi26
1,819 posts
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Topic: Questions for HCPs / DAFNE and Retinopathy I hope so too.......Well explained Simon..... |
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Jun 16, 2011
Welshmapleleaf
19 posts
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Topic: Questions for HCPs / DAFNE and Retinopathy Thanks Simon. It's almost a week sice I graduated, and although I can't say all my readings are within target yet, they will most certainly be lower than pre-DAFNE, hence my concerns. Hopefully in the longer term, sticking to DAFNE principles will preclude the need for further treatment.
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Jun 16, 2011
novorapidboi26
1,819 posts
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Topic: Carbohydrate Counting / Jacket Potato I thought the OP was having problems with hypos early on after eating one............as opposed to counting the CPs, thats the easy part.....
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Jun 16, 2011
Simon Heller
46 posts
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Topic: Questions for HCPs / DAFNE and Retinopathy Diabetic eye disease may worsen temporarily if someone improves their blood glucose control dramatically over a short time period. It is probably because high blood glucoses tend to lead to increased blood flow to various part of the body. Since improving control will result in reduced blood flow (a good thing in the longterm) this reduced oxygen delivery and so the affected area loses oxygen which can aggravate diabetes eye trouble. So if you have eye changes to start with they can get worse. By 12 months the good effect is outweighing the short-term bad effect. So the message is that it only affects people who already have significant changes and by 12 months the worsening effect has worn off and the trend towards progressive changes can be reduced or perhaps even reversed.ATB Simon |
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Jun 16, 2011
Simon Heller
46 posts
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Topic: Questions for HCPs / Metformin /Type 1 The evidence that metformin makes a difference in Type 1 diabetes is not strong but some professionals use it to reduce insulin dose, weight gain etc There is some evidence of benefit for PCOS. It appears to be very safe but with some pretty unpleasant side effects of diarrhoea, abdo pain and anorexia for some people! The slow release preparation is better tolerated generally.Simon |
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Jun 16, 2011
Garry
328 posts
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Topic: Questions for HCPs / Metformin /Type 1 Don't get me wrong, Metformin hasn't had any laxative effect on me. But they do have another pretty common side effect.....they are nicknamed 'Metfartin' for good reason.Regards Garry |