Category Archives: Good Medicine

Gut Instincts & Food

Melinda Seed writes for Twice Diabetes

Way back in 2016, I reported on a small study that showed glyceamic responses to food varied markedly between individuals, and raised a number of questions about what that means for those of us who count carbs, factor in the glycemic index to calculate a bolus and are taught to expect results in accordance with the published data on glycemic load.

One of the researchers involved in this study, Eran Elinav from Weizmann Institute of Science was a presenter at this year’s Australasian Diabetes Congress. It was great to hear from the presenter directly, essentially this confirmed and elaborated on the study published back in 2016, in summary:

In line with few small-scale studies that previously examined individual PPGRs (post-prandial glycemic response) (Vega-López et al., 2007Vrolix and Mensink, 2010), we demonstrate on 800 individuals that the PPGR of different people to the same food can greatly vary. The most compelling evidence for this observation is the controlled setting of standardized meals, provided to all participants in replicates. This high interpersonal variability suggests that at least with regard to PPGRs, approaches that grade dietary ingredients as universally “good” or “bad” based on their average PPGR in the population may have limited utility for an individual.

https://www.cell.com/cell/fulltext/S0092-8674(15)01481-6?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867415014816%3Fshowall%3Dtrue

Dr Elinav seemed to have the glycemic index in his sights, he noted that the glycemic index that has been calculated for foods is based on the glycemic responses of, in many cases, only about 10 people, these responses are then averaged out to lable the food as high, medium or low GI.

To summarise the work from the Weismann institute, it showed that for 800 participants and 1000s of meals, glycemic response to the same food is markedly different between people. It is consistent within an individual, but what spikes one person’s blood sugar does not necessarily spike another’s. As an example, I understood from Dr ELinav’s presentation that breads are usually ranked according to their glycemic index and yet this ranking didn’t hold true for individuals, some people’s blood sugar spiked more from sourdough bread than white bread, more from wholemeal than white.

So foods could be divided into ‘good’ and ‘bad’ for individuals but NOT in any generalised way. So those confident lists of good and bad, of high and low GI, of glycemic load etc-can be taken with a bit of a grain of salt.


It appears that glycemic response is influenced by gut microbiome but how much your microbiome is influenced by what you eat versus is innate is still debatable-it’s apparently not as simple as taking probiotics. For example, when people who are obese lose weight all their biochemical indicators improve EXCEPT gut microbiome markers for obesity remain. Apparently fecal transplantations have been observed to ‘cure’ obesity! This is not available as a treatment yet-but (don’t try this at home folks) there are people trying DIY versions of this. Uck I’m all for DIY in D tech but this seems a step (or two) too far.

My takeaways from the session were:

Watch this space there is SO much we don’t know about diet -glyceamic responses, weight gain and loss, how gut health influences and is influenced our responses to food. As yet we are not at the stage of being able to offer individualised WEIGHT LOSS diets-so don’t rush off and pay lots to get this done-yet! I’m hoping there will be a lot more research done to help us get a bit further in untangling the complexities of metabolic responses to food-it’s not as simple as traffic light cook books and ticks on packaged food.

Mostly though I just thought, this seems like the same old same old, we’re pretty much on our own and it’s all trial and error. CGM appears to be a really useful tool to monitor your own glycemic response-so trust your CGM or your finger pricks to give you information to act on re your responses to food.

My D Team: Me, Myself and I

The only player on the D mgt court!

The other day somebody innocently tweeted that diabetes management was a team effort.That got me thinking and although it’s dangerous to push metaphors too far I don’t believe thinking of diabetes management in terms of a team is appropriate or helpful.

The team analogy implies that everyone has a role to play at all times and most importantly that everyone shares the joys of victory or the bitterness of defeat. This is simply not true. It is me and me alone who feels the hypos, the highs, the fear and reality of complications.  Every finger prick, every needle, every blood test, dilated pupil exam or pump site change is felt by me alone. It is me who savours the ‘victory’ of a straight line on the Libre after eating pasta or the relief of a ‘clear’ complication screening.  The closest I come to sharing this is the empathy  in the diabetes community when rejoicing or commiserating with those of us who know exactly what it’s like. Continue reading

A New Pump on the Aussie Block: Ypsomed!

A new pump is available in Australia, right now. The Ypsomed (pronounced ipsomed) has been TGA approved and will be reimbursed by your health fund and the consumables are on the NDSS.  I was invited to attend a soft launch of the product and provided with a loan pump to ‘test-drive’. Ypsomed covered my travel and accommodation expenses to attend this event and lent me a pump to test drive. I have not been paid or expected to  write about or comment on this or any other product.

 

Size comparison, Ypsomed at top, my current pump below.

My current pump (on left) alongside the Ypsomed.

The first thing I noticed about the Ypsomed is its size. It’s small and lightweight. I REALLY like that it is much smaller and much less bulky than my current pump (which is only a few months old and yet is the biggest pump I have ever owned).

 

 

It has a large, touch screen. Despite being small, almost the entire front of the pump is the screen, so it’s easy to read and use.

The pump is made in Switzerland (which has a reputation for quality in manufacturing) but 24/7 support is local rather than using an international call centre.

I was surprised to learn that Ypsomed has a long history of involvement in diabetes devices. They were, in fact, behind the Disetronic pumps available in the 80s through to the early 2000s. The current pump has been available in Europe since 2016.

 

The pump has a glass cartridge, which appeals to me as I feel the insulin may be less likely to degrade in glass and hope that at least there will be a tiny bit less plastic diabetes waste around as a result. Here’s hoping that Novo start bringing the pre-filled cartridges into Australia (they are currently available in Europe).

It is water proof (although I haven’t tested this…yet) and takes a AAA alkaline battery (the pump won’t accept lithium batteries).

A downside at the moment is that the pump doesn’t ‘talk’ to any of the CGMs, so blood sugar readings would need to be entered into the MYLife app manually in order to calculate correction doses. Ypsomed staff assured us that they are in talks with most of the CGM and Flash manufacturers

I understand that the Ypsomed blood glucose meter talks directly to the app for bolus calcs etc.

I haven’t actually attached the Ypsomed pump yet-I plan to in the next day or two (no sense wasting the full insulin reservoir in my current pump.  I shall update this review about usability and button pushes and also the use of the app once I’ve worn it for a while.

For a couple of other early reviews check out:

Bionic Wookee

Diabetogenic

I am excited about a pump that is smaller AND the fact that more players are entering the insulin pump market. I was worried with the withdrawal of J&J that we might end up with only one pump in Australia.  I’m sure that every pump has its own pros and cons but if you are looking for a pump or an upgrade make sure you check out all available options. Some educators or endos tend to push the pump that they’re most familiar with, I’m all for choice-so make sure you see a sample of ALL the pumps in the Aussie market before you commit.

 

Assessing Information from Health Professionals: How I do it.

Melinda Seed

Inspired by some of the anxiety I have witnessed at health conferences/talks recently around filtering health information, I thought I might turn the tables a bit. Sure we all know we need to evaluate  health information on line but what about the health information we receive in consulting rooms/surgeries or hospitals. We all know it’s out there from missed opportunities to diagnose t1 diabetes (sometimes leading to death), to hospitals omitting insulin to not knowing cortisone injections will cause insulin resistance.  All this and more happens every day in the offices, consulting rooms and hospitals. How to protect yourself?

Continue reading

If Healthcare Really Were Patient-Centric

Melinda Seed writes for Twice Diabetes

Patient-centred care is a bit of a buzzword and a few sessions at #ADSADEA were devoted to it. There’s no definition of the term but it seems to refer to individual health practitioners listening to and responding to patient’s concerns during consultations. That’s all good and well but is that all there is to patient-centred care?  It got me wondering about what the health care system would be like if it was run by people with diabetes instead of the government/doctor/bureacracy mash up we see today.

Here are some ideas I had: Continue reading

There’s No One Size Fits All

Melinda Seed writes for Twice Diabetes

I recently came across a health/medical article that expressed concern about the level of variation in paediatric diabetes treatment between different paediatric endocrinologists.  I thought the assumption that there was one best practice approach interesting especially in light of the statement, Continue reading

I Want a Lawyer for my Diabetes

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

So English endocrinologist Partha Kar asked on twitter if self-administration of insulin is always appropriate.

It got me thinking, when ISN’T it appropriate? It seems to me that when you’re diagnosed with diabetes you get some fairly rudimentary education and then you’re sent home to calculate dosage and administer a potentially lethal drug.  Multiple times a day, day-in-day out we do this.

So where do health care professionals get off declaring us incompetent to do this and denying us our basic rights when we are inpatients in hospital? Continue reading

The Price of Insulin These Days…..

 

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Most of the time I take it for granted that a magic potion keeps me alive.

Insulin should be blue

If you do stop to think about it it’s scary. When you hear about the price of any lifesaving drug going from $13.50 to $750 overnight, it makes you sit up and take notice.  Continue reading

Back on the Carbs to Reduce my Insulin Doses!

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

 

So way back in April (wow time flies) I blogged about launching my low carb experiment. I was trying for ultra low carb because I’ve always been a bit all or nothing. I recognise for a lot of people it seems to work well, although I note that it seems to be men who really thrive on this regime. For me, despite perservering for some weeks, and despite the advice that this too will pass from low carb advocates I don’t like living with: Continue reading