diabetes week - research

i thought i'd write a bit about how research has helped me in honour of diabetes week. As most of my readers know i was diagnosed as a type 1 diabetic at the age of 2 in 1997. I was diagnosed before the basal insulins lantus (approved in 2000) and levemir (2004 from what i could find) had even been invented. I was on the free mixing regime with syringes but i was lucky to even have insulin thanks to the work and research of  many many scientists who spent much of the late 19th and early 20th century studying diabetes mellitus. Paul Langerhans found the islets of langerhans in 1869 , the cells that produced insulin but it wasn't until in 1901 Eugene Lindsay Opie discovered a clear link between the pancreas and blood glucose regulation then 20 years after this Banting , inspired by the work of Opie amongst others,  and Charles Best extracted and purified insulin as a medication. This was the fate of children diagnosed with diabetes before 1921... 

At best a child would survive a year on the starvation diet. it was inevitable the child would die from it. There is a remarkable story of when insulin was first discovered children diagnosed with diabetes were kept on wards of up to 50 most of them comatose and families waiting for their child to die, when insulin was first purified and extracted Banting, Best and Collip went round injecting children with the insulin as they got to the last children the first were waking up from a coma. this was the same child in the previous picture after insulin treatment.

Thanks to researchers our means of testing bloodsugar has gone from testing sugar by boiling urine and adding a few chemical and measuring it  against a colour chart, to urine strips to the 1990s when home bloodglucose meters became widespread that often took a minute or so to read which is the meters i started on , to the meters now that can work out your dose, remember carbs , insulin & bg and meters that bluetooth to pump or connect to smartphones.

our means of injecting insulin has gone from glass syringes where the needles had to be sharpened manually to disposable syringes to pens such as the novopen echo which remember doses.

even the method of insulin has changed from using animal extracts to using dna and bacteria which are able to be altered more to create the long acting or the rapid acting insulins.

pumps have gone from this in 1978- 

            

to this in 2012... pumps which give minute doses of insulin mimicking the pancreas. pumps that bluetooth. pumps that have lists of carbs and you just click on the food you're having and it works out doses. pumps that are waterproof. pumps that change lives. 

and this is what  pumps will hopefully do in the future.... https://www.myglu.org/articles/day_1_bionic_pancreas_study

a bionic pancreas is my hope eventually. Even if it means being connected to multiple infusion sets the bionic pancreas which is already in human trials will take away all the worry that we currently experience. the freedom of not having to plan ahead, not having to worry about hypos or hypers and not experiencing the symptoms and long term complications of these is something i can only dream about at the present time.

i have been lucky enough to hear the Diabetes uk head of research talk twice now. they spend £6,000,000 annually on diabetes research pretty much half and half on type 1 and type 2 . They were heavily involved in the invention of insulin pens. So to them, to JDRF to every scientist and health professional who are or were involved in research from the bottom of my heart, thank you! 

research gives me:

So a conversation on twitter sparked this blog post and its about should gp's treat all diabetes?

The conversation was triggered by Partha's blog post in which he recalled a meeting where gp's said they could treat all kinds of diabetes that 'there was no need for a diabetes base in hospital'. It kind of reminded me of this photo...

In my opinion we should be playing to the strengths of the GP and of the specialist. I want to start off by saying i like both my GP and my consultant. My GP has been my family's GP for over 30 years and mine for 18 years, he was the one who diagnosed my diabetes straight away. He's a great GP and oversees the management of all my chronic conditions and regularly asks how my diabetes is and is the one who thought outside the box and put me on the mini pill to stop the havoc my bg was going through monthly but he doesn't know the intricacies of dealing with type 1 especially a type 1 on the pump.

I'll give you one example of why i refuse to let my GP treat my diabetes and I why I hate QOF. Last December i got a phone call telling me to come into my GP. When i got there it was to be told my hba1c was 'very high' at 8.5 % and I had protein in my urine and he thought I should go on ACE inhibitors because of the protein and my blood pressure which was 120/80. My hba1c was actually that high cause I had hypounawareness and all 4 members of my team had said the priority was to get that back, when I'm the only type 1 in the practice my GP mainly deals with type 2's who would never really have the severe hypos i was having which were often 3 or 4 a day and in the ones. Plus it was Christmas and whose hba1c doesn't go a little higher at that time!  My consultant figured out the protein just by looking at the time it was taken which was just after a meal... it turns out it was a false positive and all 3 of my next tests came back as trace and also because my consultant is able to spend a lot more time with me than my GP does he knows how stressed i get by appointments which explains the slightly raised bp. 

I doubt my GP could give me the time i need in appointments to manage my diabetes or have the knowledge to figure out these bg...

or look at this graph and figure out whether i need to increase lunch ratio and decrease tea ratio or increase basal mid afternoon and reduce it in the evening where there's been a few hypos or were the hypos caused by chasing numbers in the afternoon or do i need a slight increase across the board to bring the average of 8 down slightly to get my hba1c below the 7.5 without causing too many hypos.

This is where my consultant and dsn come in. People who are trained specifically in type 1 diabetes who have years of experience (think they'll both kill me if I say how much...) and help me make the adjustments to achieve optimal control. Lets play to that strength of knowing type 1 and its regimes and equipment inside out. They know my case , they know me and they can give me the extra time I need to manage my condition which at the moment is fortnightly appointments with the nurse and monthly contacts with the consultant because lets face it :

and leave the GP to do what he does best for me overseeing all my treatment and diagnosing and treating the minor illnesses i have and leaves him free to deal with other patients who would get a lot more out of appointments than i would and who need the appointment a lot more than i do. This is why i refuse to do GP appointments about my diabetes cause it is a waste of their time and its a waste of mine.