I was one of the many pwd who was stunned back in 2015 when the UK’s National Institute for Clinical Excellence (NICE) issued its Guidelines for Type 1 Diabetes in Adults. These guidelines recommended a “target” HBA1c of less than 6.5%. The previous target was 7.5%
What I found stunning was that so few people managed to achieve an a1c of 7.5% or less and yet here they were setting an even lower target. For the record -the UK National Diabetes Audit showed that 29% of adults with type 1 recorded an a1c <7.5% (or 58mmol in the new measure) in 2015/16 AND fewer than one in fifteen (i.e. less than 10% of pwd) recorded an a1c of less than 6.5%.
It makes you wonder what exactly is the point of setting this number, what does it mean and is it sensible to set a target that appears cannot be achieved by 90% of people.
Despite a lot of words to the contrary there is no one-size fits all solution for diabetes management. With choices about technology, different versions of similar technology, different insulins and different diets it is actually quite a complex business to decide what you’re going to do. Sadly, I think healthcare doesn’t really understand the notion of patient choice-they do in theory but practically they can’t stop themselves from knowing what’s best. (See for example this, that refers to patient preferences not to use CGM or a pump as “barriers” and assumes tech is universally beneficial!)
So this is the sort of stuff I consider before adopting a new piece of tech, I’d be interested in hearing if you have other ideas or experiences in deciding upon tech. Continue reading →
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 →
It’s Day 2 of Diabetes Blog week and we’ve been asked to talk about the other half of diabetes, the psychological side of diabetes. There’s already been some great posts from a personal perspective about this, for example, Georgie’s blog at Lazy Pancreas or Tim’s blog. For the full list click here.
I’d like to talk about the psychological harm some diabetes organisations are imposing on the very people they’re supposed to be helping-those with diabetes.
We’ve all seen those ads based on fear, the horror stories of complications and the frightening statistics telling us to avoid or “manage” diabetes. Frank blogged about this last week, Type 1 Writes.
So what’s the problem, shouldn’t people avoid diabetes and/or avoid complications? Well yes, and if doing either of those things was as simple as giving up smoking then the campaigns might be justifiable BUT it’s not that simple and that’s where the problems start. You see, if you get a terrifying message and yet you have little power to change the situation that gives rise to the terrifying consequences then you are likely to act in a negative way.
So if you have type 1 diabetes there’s nothing that can be done to reverse it and despite even the most diligent efforts and best technology it isn’t possible to entirely normalise blood sugars. In these circumstances the research supports that these fear-based messages cause people to engage in negative or health-defeating behavior. See for example, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678850/ , and Goldenberg J.L., Arndt J. The implications of death for health: A terror management health model for behavioral health promotion. Psychological Review. 2008;115(4):1032–1053.
So these fear messages have a negative effect on people with diabetes. It appears that diabetes organisations such as DiabetesNSW who have recently been unapologetically tweeting mortality statistics without any context or background either ignore this or they are quite happy to cause harm to the people they’re supposed to represent in hopes that they are having a positive impact on those who are at risk of diabetes.
Is this ethical? Are you happy to be a member of, or have your tax dollars support such behaviour? I always thought the first principle of intervening in health was “do no harm”. Guess they’ve abandoned that notion. Shame.
I’ve just spent the last 24 hours with people who also happen to have diabetes, specifically people who blog and/or are active in the diabetes social media space. We met because Abbott invited us to trial their Freestyle Libre, which has just been approved for use in Australia. Yes this was a marketing event, no I have not been paid to write about it. My travel and accommodation expenses were covered by Abbott and I was given a reader and 2 sensors but I am under no obligation to blog or otherwise write about or comment on their product.
I offer some information and my very limited experience of it in hopes they may be of interest to readers interested in new technology. Continue reading →
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 →
Diabetes Australia has launched a Diabetes Week Campaign. So be aware of this-the week is 12-18 July. To quote their website
“Diabetes Australia has developed campaign material to launch in National Diabetes Week (12 – 18 July) to raise awareness of the seriousness of diabetes and the growing number of people who have it. The national television advertisement features 280 images of people with diabetes – representing the 280 people who develop diabetes every day in Australia. It will feature 10 “hero” images that will be on screen for approx 2 seconds – some with people managing their diabetes and some with the serious complications of diabetes including heart disease, stroke, amputation and blindness. The campaign call to action will be “What do you need to know about diabetes?” (my bold)Continue reading →
There have been some interesting things happening in the world of diabetes of late, particularly in relation to funding and advocacy, so I’ve decided to put my twittering and facebooking to good use and bring our blog readers a round-up of interesting and concerning “stuff”.
Government guidelines require type 2s on tablets to test before they drive. Subsequent Government publications say most type 2s on tablets don’t need to test.
What the?? Is self blood glucose monitoring for type 2s on tablets necessary to protect your own and public safety OR is it something that provides no benefit to health or well-being? The contradiction might be a bit of a yawn but not when you realise it could result in a jail sentence.Continue reading →