DVLA changes to driving regulations from January 1st 2018 - Insulin ...
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March 2018 Newsletter, Issue 96
DVLA changes
to driving
regulations
from January
1st 2018 IN THIS ISSUE…
• FreeStyle Libre and the NHS
• Living with diabetes and depression
C
hanges to the law concerning medical • Discontinuation of beef insulin –
fitness to drive for diabetes have taken latest dates
effect from January 1st 2018. The
• Dodgy slimming pills
amendments on diabetes reflect developments
in the diagnosing and treatment of diabetes since • Jeremy Hunt’s plans for the NHS
the 2006 Directive came into force. The changes
to regulations apply to group 1 drivers only and Three Month Period
the DVLA has not considered making a change in The current rules do not permit driving for those
these regulations for group 2 drivers. who suffer recurrent, severe hypoglycaemias
within a rolling 12 month period. This can result in
The Amendments a wait of close to 12 months for the first episode
to drop out of the 12 month period. The new
Hypoglycaemia while asleep
rules now state that this time span is no longer
Until these changes, there has been no medically justified and a 3 month period after the
distinction made between hypoglycaemia most recent of the two episodes within 12 months
experienced while awake or while asleep but the would be a more appropriate duration.
new rules now state that hypoglycaemia should
not be classified as severe when it occurs during The effect of the new regulations is that if a person
sleep because it is more difficult to recognise suffers two or more episodes of hypoglycaemia
the warning symptoms and to treat the event while awake within a 12 month period, their
appropriately. As applicants or drivers cannot licence will be refused or revoked, unless they
demonstrate an understanding of the risk and have been free of hypoglycaemia for the last
adequate control of the condition while asleep, it three months. If the licence is refused or revoked,
is considered unfair to continue with the current driving entitlement can be restored once that
rules. The new regulations will apply only to person has been free of hypoglycaemia for a 3
hypoglycaemia experienced while awake. month period.
A charity supporting and listening to people who live with diabetes
www.iddtinternational.org enquiries@iddtinternational.org 1
Glucose Monitoring Be aware!
There is an additional measure in the regulations These new regulations do not mean that
that does not stem from the EU directive. The alternatives to the ‘finger prick’ blood test are
current regulations require group 1 drivers to automatically permitted. The new regulations
undertake appropriate blood glucose monitoring. enable alternative methods to be considered,
There are now methods available commonly but decisions will be made as to which methods
described under the heading ‘Continuous Glucose are appropriate in consultation with the medical
Monitoring Systems (CGMS)’, which includes advisory panel.
flash glucose measuring using the FreeStyle
Libre. These methods measure the glucose At this point, no method other than the blood
level in interstitial fluid (a bodily fluid), but the test has been deemed appropriate, so the current
specific reference to “blood glucose” in legislation rules on glucose monitoring will not change on 1
precludes the use of these methods for driver January.
licensing purposes.
Should this change, the DVLA will
The new regulations remove this restriction
by replacing the requirement for “appropriate
amend their guidance accordingly.
blood glucose monitoring” with “appropriate DVLA provides guidance for the medical
monitoring to assess glucose levels and any risk of profession “Assessing Fitness to Drive” available at:
hypoglycaemia.” www.gov.uk/dvla/fitnesstodrive
Advice on vitamin D
Based on the recommendations sources of vitamin D. It is difficult • People who always cover their
of the Scientific Advisory for people to meet the 10 skin when outside,
Committee on Nutrition (SACN), microgram recommendation • Ethnic groups with dark skin.
in July, Public Health England from foods naturally containing
(PHE) issued new advice on the or fortified with vitamin D, so Children
intake of vitamin D. The advice people should consider taking
is that 10 micrograms daily are a daily supplement containing • Children aged 1 to 4 years
needed to help to keep bones, 10 micrograms of vitamin D in should have a daily 10
teeth and muscles healthy. autumn and winter. microgram supplement of
Vitamin D is made in the skin by vitamin D,
the action of sunlight and this Vitamin D is found naturally in a
small number of foods including • Babies should be exclusively
is the main source of vitamin D
oily fish, red meat, liver and egg breastfeed until about
for most people. However, the
yolks and in fortified food like 6 months old but as a
SACN could not say how much
breakfast cereals and fat spreads. precaution, all babies under
vitamin D is made in the skin
1 year should have 8.5 to
through exposure to sunlight,
10 micrograms of vitamin D
so it is therefore recommending Some groups of supplement.
a daily dietary intake of 10
micrograms.
people should • Children who have more than
consider taking 500ml of infant formula daily,
In spring and summer most do not need additional vitamin
people get enough vitamin D
vitamin D all
D as formula is already fortified.
from sunlight and a balanced year round
Vitamin D supplements are
diet but PHE advises that in
• People in institutions, such as available free-of-charge for low-
autumn and winter everyone
care homes, who may get little income families on the Healthy
will need to rely on dietary
exposure to sun, Start scheme.
2 March 2018, Issue 96
What can of Coca-Cola really do to the body?
Just a bit more information, • Within 20 minutes of drinking a such as bone growth.
following the article in the June 12-oz can of Coca-Cola, blood
• After an hour, the diuretic effects
Newsletter about sugar content sugar levels spike causing a burst
of caffeine kicks in causing urinary
of various drinks. As we said, of insulin to be released.
excretion of the bonded calcium,
the World Health Organisation
• Caffeine absorption is complete magnesium, and zinc, as well as
recommendations are a maximum
after 40 minutes causing blood sodium, electrolyte, and water.
of 6 teaspoons per day, yet a 12oz
pressure to rise and adenosine
can of Coca-Cola contains about • Finally, a sugar crash occurs,
receptors in the brain to be
10 teaspoons. So what happens causing irritability and drowsiness.
blocked preventing drowsiness.
with Coca-Cola and all caffeine (Consumption of sugary drinks in
carbonated drinks? • Dopamine production is increased
the US, 2005-2008, accessed 31 July
after 45 minutes which stimulates
• The high amounts of fructose corn 2015 and Harvard School of Public
the reward and pleasure centre
syrup, refined salts, and caffeine Health, Soft drinks and disease,
of the brain, similar to how heroin
found in these drinks contribute accessed 31 July 2015) While all this
works.
to high blood pressure, diabetes does not mean that these drinks
and obesity when regularly • The phosphoric acid masks the should be completely banned from
consumed. People who drink 1-2 sweetness of the drink but binds the public’s diet as small amounts
cans of sugary beverages a day are to calcium, magnesium, and zinc, will not do any major harm, who
26% more likely to develop Type 2 preventing them from being wants to consume a drink with such
diabetes. absorbed and used for processes effects?
Latest on beef insulin Regular
discontinuation IRN-BRU is
As our members are aware, beef insulin is being discontinued because
the raw materials, beef insulin crystals, are no longer being made and are
not available anywhere in the world.
reducing its
We have tried to reassure people that pork insulin will remain available,
so this is the nearest available option. However, we have been very
sugar content
disturbed by reports from our members that their health professionals From January
have told them that pork insulin is also being discontinued, even worse, 2018 IRN-BRU
those telling their patients this have said they were told this at a health will contain
professional conference! Who gives out such misinformation? approximately 50%
PORK INSULIN WILL CONTINUE TO BE AVAILABLE, less sugar. The sugar
content per 100ml
SO DON’T BELIEVE ANYTHING TO THE CONTRARY will reduce from
10.3g to 4.7g. For a
Latest Hypurin® time old and new
Bovine Insulin products may be on
the shelf together
predicted so remember to
depletion dates check the label.
The manufacturers
Predicted depletion dates
warn that people
are based on current stock
with diabetes
and average sales. Right
should be aware of
are the latest updates for
the carbohydrate
the withdrawals of beef
content change
insulin provided
and should seek
by Wockhardt on
medical advice.
January 23rd
3
FREESTYLE LIBRE AVAILABLE
ON THE NHS, BUT IS IT?
In the last Newsletter, we reported free reader but only one sensor including lancets. However, the
that the Freestyle Libre by Abbott and then expected to buy cost for the FreeStyle Libre is
was made available on the NHS them after using this one. worked out on the private cost
from November 1st 2017 for • More than one person has charged to buy from Abbott at
people with Type 1 and Type been told that they are ‘too £57.95 but the equivalent list price
2 diabetes. This device checks well controlled’ for the device to the NHS is £35.00! So the prices
glucose levels by scanning a to be prescribed on the NHS are not comparing like with like
sensor worn on the back of the which begs the question of and if they were, then there would
arm without having to prick the whether this is due to the only be a difference of about £200
fingers, so it is a non-invasive way number of tests they are between testing 10 times daily
of checking glucose. It actually carrying out per day! with strips and using the Libre
checks the glucose levels in the sensors and no difference at all
interstitial fluid (the fluid in the What were the reasons if people test 15 times a day, and
cells) and there is a 5 to 10 minute for refusal? some do! Is this a mistake on the
delay in this glucose response to part of the CCG and are other CCGs
changes in blood glucose. Glucose • The most common was ‘It is using the same misleading figures?
readings on the interstitial fluid not being prescribed in this
area’.
have been proven to reliably
• Cost.
No evidence of benefit
reflect glucose levels.
• Not accurate enough. It appears that some CCGs are
It has been approved for use on prescribing the FreeStyle Libre for
• No evidence of benefit. selected patients and monitoring
the NHS across the UK for people
with Type 1 and Type 2 diabetes the results and one of the four
who are treating their diabetes Cost Regional Medicines Optimisation
intensively with insulin. However, One member sent us their local Committees has put out a Position
prescribing it is subject to local CCG Position Statement on their Statement with recommendations
Clinical Commissioning Group reasons for not prescribing the of what information should be
(CCG) approval, which runs the risk FreeStyle Libre, one of which collected. So perhaps they will
of a postcode lottery of availability. was cost. Below is the table in gather the evidence of the benefits
their Statement but there is one which will enable the device to be
We asked Newsletter readers what major fault with it – they are not available on the NHS.
was happening in their areas when comparing like with like.
they asked to be prescribed the It is hard to resist saying that if the
FreeStyle Libre on the NHS and the The cost of self-monitoring test evidence is good enough for the
results did not surprise us! strips is the list price charged to Prime Minister to use the FreeStyle
the NHS (not the price we pay at Libre, surely it is good enough for
• Of all the people who the pharmacy) at about £11.00 other people with diabetes!
responded, only one
succeeded in being prescribed
the device. Recommended products for Cost per year
• All those already using the glucose monitoring per person
FreeStyle Libre by paying
privately for it were refused it Self-monitoring strips and lancets –
on the NHS. This was despite testing 4 times daily £320
their reports of improved
control, no severe hypos since Self-monitoring strips and lancets –
using it, improved quality of testing 10 times daily £790
life and comments such as, ‘it
FreeStyle LIbre sensors estimate
has transformed my life’.
with free sensors £1,511
• Some people were offered a
4 March 2018, Issue 96
Quality of life believes that everyone with Type 1 2017 (when the announcement
Are CCGs best placed to judge and Type 2 diabetes using insulin was made)?
about improvements in quality who wants to use this device, should
of life? What do they really know be allowed to do so on the NHS. • How many people have
about living with diabetes and all been successful in getting
this entails? We could make a long There have been several the FreeStyle Libre system
list but it is worth remembering Parliamentary Questions asking why prescribed since it was included
that home blood glucose testing the FreeStyle Libre is not available to on the NHS Drug Tariff in
first became available in 1981, so everyone but the answers offered no November 2017?
some people have been pricking explanations. In order to fight a case,
we need to know on what basis • What are the criteria on which
their fingers for over 30 years.
these blanket refusals are being decisions about whether people
Don’t they now deserve a painless,
made. So we are sending Freedom are prescribed the FreeStyle
non-invasive way of testing?
of Information questions to all CCGs Libre are made and who is
to ask: responsible for making these
What is IDDT doing criterion-based decisions?
about this? • How many requests have you
received from people with Hopefully, the information
Understandably, we have had diabetes to have the FreeStyle provided will enable us to fight the
some very angry calls and emails Libre glucose monitoring system decision to refuse to pay. We will
with demands to take action. IDDT prescribed since September keep you informed.
Facts you need to know!
VAT free if buying privately FreeStyle Libre and Swimming
As the FreeStyle Libre is a medical device, it can be One of our members asked if she could wear the
obtained without having to pay VAT when you are sensor while swimming and we thought this may be a
purchasing the device or sensors yourself. The way to question other people may ask. The sensors are water-
do this may not be obvious on the website, so the best resistant and can be worn while bathing, showering,
way is to telephone Abbott to place the order and tell or swimming as long as you:
them that you want to apply for VAT exemption, their • Do not take it deeper than 3 feet (1 meter)
number is: 0800 1701177. Once registered this way, all
• Do not keep it under water for longer than 30
future orders will be VAT free.
minutes at a time.
5
NHS NEWS
Missed hospital more than 110,000 referrals to
date, so reflecting its growing
and a small number from India,
with the aim of delivering 622
appointments ‘cost popularity with the public and nurses by March 2020. By August
healthcare professionals. 2017, the scheme had cost
NHS 1bn a year’ £566,000 but only secured 12 new
In the last 18 months the roll-out has
Missed hospital appointments are covered three quarters of the country. nurses. The scheme to recruit 200
costing the NHS £1bn a year, according The aim is to achieve full national international nurses is expected to
to the Chief Nursing Officer, Jane coverage next year, with as many as cost around £10.5m over the four-
Cummings, who says the cash wasted 200,000 people referred and 80,000 on year period but the expenditure for
on missed appointments could 2016/17 was £4.2million, nearly half
programmes in 2018/19.
be used to fund 250,000 extra hip of the £10.5million total allocated for
replacements. Official figures show the whole period. So nearly half the
that 7.9m NHS appointments were The need for a budget has been spent and only an
missed last year with an average cost eighth of the target number of nurses
of £120 per slot which indicates that standardised has been achieved so far!
around £950m was wasted. qualification for nurses
The official figures also show that specialising in diabetes NHS hospitals made
between June 2016 and June 2017,
90% of hospital beds were classed as Dr Partha Kar, associate national £174 million in car park
"occupied", the highest rate since 2010. clinical director for diabetes for NHS
England, has asked Trend-UK to define
charges last year
This figure has consistently been above
the so-called "safe occupancy rate" of the role of the diabetes specialist Overall hospitals made £174m in the
85%. nurse because of concerns about last financial year from car parking
the variation in skills, competence, charges to patients, visitors and
experience, titles and problems with staff. Shadow Health Secretary, Jon
NHS diabetes recruitment. The co-chairs of Trend- Ashworth, called the charges an
"entirely unfair and unnecessary
prevention programme UK (Training, Research and Education
for Nurses in Diabetes) also want the burden" and that a lack of central
update role to have a clearer definition and government funding was forcing
for there to be a single foundation hospitals to drum up more revenue
The NHS diabetes prevention and that “Even Jeremy Hunt has
specialist qualification.
programme has succeeded in described this outrageous practice as
signing up significantly more people At the present time there is no
a ‘stealth tax’.” The Liberal Democrats
than expected. (Report in Diabetic mandatory qualification available for
described the charges as a "tax on
Medicine, December 2017). a diabetes specialist nurse so anyone
sickness".
in nursing could call themselves
Highlights from the report show: The people most affected are people
a diabetes nurse. It is hoped that
• The programme received 43,603 there will be a position statement with long-term conditions, such as
referrals between June 2016 and for 2018 but it appears that the diabetes, and disabilities who have
March 2017 – 16% higher than Nursing and Midwifery Council need to regularly attend hospitals. Let’s
expected. to be persuaded to support the also not forget the staff working in
idea of a diabetes specialist nursing hospitals, many of whom have to pay
• Nearly half of those referred to
qualification. to park their cars to go to work to care
the programme attended their
for us all.
first session – more than the 40%
originally planned for. Over £4m spent to A Department of Health spokesman
said, “Patients and families should
• Attendance rates for men, for bring 50 nurses from not have to deal with the added
people from black, Asian and
minority ethnic groups, and for Philippines stress of complex and unfair parking
charges. NHS organisations are locally
people from the most deprived An overseas nurse recruitment scheme responsible for the methods used
areas were higher than expected in Northern Ireland has secured just to charge, and we want to see them
suggesting that the programme is under 50 new staff after nearly two coming up with flexible options that
reaching those who are at greater years and has spent £4.2million to do put patients and their families first.”
risk of developing Type 2 diabetes so. There is currently a 1,500 nurse
and who access healthcare less shortage in Northern Ireland. This is yet another example of local
effectively. decision-making and no national
In May 2016 the Department policy within what is called a National
• Further analysis shows that there of Health launched an overseas Health Service over which the
has been an additional 70,000 recruitment scheme to encourage Secretary of State, Jeremy Hunt, has no
people referred since March with nurses to come from the Philippines control.
6 March 2018, Issue 96
Dodgy slimming pills
The Medicines and Healthcare The downside… drug reactions (ADR) reporting,
products Regulatory Agency there was an increase of 13% and
(MHRA) is working in partnership Almost two-in-three (63%) suffered the campaign reached over two and
with Slimming World as part of unpleasant side effects after taking half million people.
the Agency’s wider FakeMeds slimming pills bought online
including diarrhoea, bleeding that Adverse reactions to medicines,
Campaign to encourage those
wouldn’t stop, blurred vision and whether prescription medicines
wanting to lose weight to
heart problems but of concern is (including insulin), or over-the-
turn to safe, legitimate and
that 81% didn’t report these side counter medicines can occur at any
appropriate routes.
effects to anyone. time and should be reported.
Recent research shows that online
How to report an adverse
sellers of potentially dangerous
slimming pills containing Reputable groups reaction
withdrawn pharmaceutical There are reputable groups in the ADRs can be reported by health
ingredients are putting dieters’ community, such as Slimming professionals, pharmacists or
health at serious risk by attracting World and Weight Watchers, which patients. Patients can report online
them with the promises of quick- can support people to lose weight at www.yellowcard.gov.uk or on a
fix weight loss and bypassing through healthy lifestyle changes. Yellow Card which can be found in
discussions with their GP and Your GP or healthcare professional pharmacies. Alternatively, they can
pharmacist. According to a can advise you on finding the right call the Yellow Card line on 0800
FakeMeds survey involving 1805 option for you. 731 6789 (10am to 2pm Monday to
slimmers carried out by the MHRA Friday only) or write to:
However, if you’re looking to buy
and Slimming World, one in three
medicines online, check if the seller Yellow Card Scheme, Vigilance and
slimmers have tried slimming pills
is registered by using the following Risk Management of Medicines,
purchased online. Since April 2013,
online checking system, www.gov. MHRA, 4.M, Buckingham Palace
the Agency has seized nearly £4
uk/fakemeds or check if they display Road, London SW1W 9SZ
million worth of dodgy weight loss
the distance selling logo. If you
pills. The survey showed: How does reporting improve
think you’ve bought fake medical
• 77% of slimmers were enticed products, please report this via patient safety?
by promises of rapid weight www.gov.uk/fakemeds Information gathered from Yellow
loss. Card reports is continually assessed
• 57% were attracted to being Reporting adverse by experts. If a new side effect is
identified, it is carefully considered
able to order discreetly. reactions in light of the overall side effect
• 44% ordered online because Reporting suspected side-effects profile of the medicine and how it
they didn’t want to speak to a makes medicines safer and helps compares with other medicines to
GP or pharmacist. save lives. As a result of the 2016 treat the same condition. Action is
social media campaign run by the taken whenever necessary to ensure
EU to raise awareness of adverse that medicines are used to minimise
the risks to patients.
7
Living with diabetes and depression
The winter months are a time 19% had used support or in those with depressed mood,
when people are more likely to feel counselling from a trained rising to 25% greater in those
depressed – short days, miserable professional to help them manage on antidepressants,
weather and post-Christmas blues their diabetes, and at some point, • People with diabetes had a
and this is the case without adding nearly a third (32%) had used greater risk of depression rising
diabetes or other conditions into self-help materials, such as books, to 53% higher among those
the mix! There is a condition of videos and the internet. treated with insulin. (Arch
Seasonal affective disorder (SAD) in Intern Med 2010;170:1884-9)
which some people are particularly But depression is perhaps a
affected by depression in the stage further………… The risks associated with a
darker, winter months. This kind of diagnosis of depression in
In the general population, as many
depression goes away when the
as one person in three experiences Type 1 diabetes
days are longer but there are other
an episode of depression in their Middle-aged people with Type
forms of depression which are
lifetime and the presence of other 1 diabetes diagnosed with
longer lasting.
illnesses may complicate or worsen depression are at least twice
A large survey carried out depression. Research shows that as likely to experience a severe
people with chronic conditions,
by Diabetes UK of 8,500 including diabetes, are three times
hypoglycaemic or hyperglycaemic
people of different ages, event requiring an A& E visit or
more likely to have depression than hospitalisation, compared with
ethnicities and backgrounds the general population. those without depression. The
from across the UK showed greatest risk was seen in the first
Research has shown that
that 3 in 5 people living 6 months after a diagnosis of
depression may occur in:
with diabetes experience depression.
emotional or mental health • Up to 60% of stroke patients, An analysis of medical records also
problems as a result of their • Up to 40% of people with showed that people with Type
Parkinson’s disease, 1 diabetes who experienced a
condition. hypo- or hyperglycaemic episode
• Up to 42% of cancer patients,
The research showed: were at least twice as likely to later
• Up to 21% of people with
• Emotional wellbeing stood be diagnosed with depression
irritable bowel syndrome,
out as a major issue for compared with those who did not
• Up to 14-18% of people with experience severe hypoglycaemia
respondents, with 3 in 5 (64%)
diabetes. or hyperglycaemia.
saying that they often or
sometimes feel down because Studies also suggest that people Interestingly, the majority of
of their diabetes. with lower HbA1cs tend to have research on depression and severe
lower levels of depression than hypoglycaemic or hyperglycaemic
• One in three (33%) said that
those with higher HbA1cs. While events has been in people with
diabetes got in the way of them
it appears there is an association Type 2 diabetes, despite these
or a family member doing
between high blood sugars and events being much more common
things they wanted to do.
depression, it remains unclear in those with Type 1 diabetes.
• Only 3 in 10 (30%) said they whether high blood sugars cause
definitely felt in control of their People with Type 1 diabetes
the depression or depression are about 4 times more likely to
diabetes. causes high blood sugars. experience severe hypoglycaemia
Research published in 2010 found and 3 times more likely to
that: experience hyperglycaemia (DKA)
• people with depression were than those with Type 2 diabetes.
17% more likely to develop The study involved 3,742 people
Type 2 diabetes, aged at least 50 years old with Type
• people with diabetes were 29% 1 diabetes between 1996 and 2015
more likely to have depression and showed:
compared with people without • Depression was associated with
diabetes, more than a twofold risk for
• the risk of diabetes was greater severe hyperglycaemia and a
8 March 2018, Issue 96
• Feeling tired or lacking energy. diabetes receive their treatment.
• Being agitated or lethargic.
How does depression affect
• Feeling sad or low much of the
time. people with diabetes?
• Weight gain or weight loss. Research using questionnaires
• Sleeping too little or too much. has shown that depression in
near doubling of risk for severe people with both Type 1 and Type
• Difficulty paying attention or 2 diabetes may have the following
hypoglycaemia and this risk
making decisions. effects:
was markedly stronger during
the first 6 and 12 months after a • Thinking about death or • They are less likely to eat the
depression diagnosis. suicide. types and amounts of food
• People with diagnosed If you have some or all of these recommended.
depression were 5 times more symptoms over two weeks or more, • Less likely to take all their
likely to experience a severe then you should see your doctor. medications.
hyperglycaemic event and 4 • Less likely to function well, both
times more likely to experience
The need for diagnosis
physically and mentally.
a severe hypoglycaemic event It is estimated that in up to three
• Greater absenteeism from work.
in the first 12 months vs. those quarters of people with diabetes,
without a depression diagnosis. depression may go undiagnosed. Treatment
• People with Type 1 diabetes This may be because of poor
detection rates but it could also be Treatment for depression in people
who did not have depression
that some people with diabetes with diabetes has been shown to
at the beginning of the study
don’t report their symptoms of be effective and has the additional
but subsequently experienced
depression because they see them benefits of improving blood sugar
severe hyperglycaemia, were
as ‘just part of having diabetes’. control. The evidence suggests that
more than twice as likely to
In the UK, the Department of cognitive behaviour therapy and
be diagnosed with depression
Health recommends that all GPs anti-depressant medicines are as
during follow-up as those who
use two simple questions to screen effective in people with diabetes
did not experience severe
for symptoms of depression, in as in those without diabetes. One
hyperglycaemia.
their patients, including those with study found that not only did
• Patients without depression at treatment improve blood sugar
the start of the study but who diabetes. These questions are:
control but during treatment there
experienced a severe hypo, • During the last month, have was an improvement in mood
were 75% more likely to be you been bothered by feeling and weight. As the treatment of
diagnosed with depression down, depressed or hopeless? depression can improve blood
compared to those who • During the last month, have sugar control, it is also likely to
did not experience severe you often been bothered by reduce the risk of complications
hypoglycaemia. having little interest or pleasure but importantly, it can also improve
The researchers concluded that in doing things? quality of life.
as the risk for severe hypo- and If people answer ‘yes’ to either of It is also well recognised that
hyperglycaemic events was these questions, they are given a exercise helps to reduce depression,
especially high during the first questionnaire to answer to measure so although it may be the last thing
year after depression diagnosis, the extent and nature of the that people feel like doing, it is
it is important for clinical staff to symptoms. So if you answer ‘yes’ worth increasing the amount of
be vigilant during this vulnerable to the two questions above or you exercise being taken.
period. (Diabetes Care, December have more mild symptoms, you are Note: IDDT has two booklets
2017) not alone and the clear message that may be helpful: ‘Diabetes,
from research is to seek help from Anxiety and Depression’ and
The practical aspects… your doctor because there is a good ‘Diabetes and Exercise’. If you
Signs of depression include chance that your life will improve. would like copies, please call
the following: It is important that similar methods IDDT on 01604 622837 or email
are used in diabetes hospital clinics enquiries@iddtinternational.org
• No longer enjoying or being
where many people with Type 1
interested in most activities.
9
Laughter is
good for you THE IDDT’S LOTTERY DRAW
We published this article in a 2007
Newsletter but it is worth revisiting.
We all know that laughter makes us feel better
and this is because even for a few minutes, we are
WINNERS
forgetting our troubles. So it appears that laughter We are delighted to announce the winners
improves our quality of life or does it? The research of the draw of our monthly lottery for
on laughter and its effects is mixed and there is not November 2017. They are as follows:
that much of it. Some ‘humour experts’ believe that
laughter actually stimulates the immune system 1st prize of £455.28
to help to ward off infections and illness. There is goes to Dorothy from Doncaster
research that shows: 2nd prize of £341.46
goes to Susan from Milton Keynes
• People who survive one heart attack are less likely to 3rd prize of £227.60
have a second if they have 30 minutes humour a day. goes to Anon. from Newcastle upon Tyne
• Laughter has been shown to stimulate the 4th prize of £113.80
levels of steroid chemicals in the blood that are goes to Ruth from Alton
associated with stress.
Winners of the December 2017 draw are:
• It has also been shown to improve the tolerance
levels of pain. 1st prize of £462.40
However, the psychological aspects of humour goes to Jane from Farnborough
are its best use. Often we use humour as a coping 2nd prize of £347.04
mechanism – it can defuse stress, humiliation, goes to Avice from Cheltenham
embarrassment and it can also help us to cope with 3rd prize of £231.36
pain. At the right time humour can be helpful, even in goes to John from Dryslwyn
awful situations but if used inappropriately it can be 4th prize of £115.68
destructive. goes to Anon. from London
The research into humour is not conclusive. For Winners of the January 2018 draw are:
instance 40% of people with heart disease are
less likely to laugh in funny situations than people 1st prize of £469.92
without heart disease, so does this mean that to John from Farnborough
humour prevents heart disease or that people with 2nd prize of £352.20
heart disease lose their sense of humour? goes to Barbara from Kirkheaton
Research evidence or not, perhaps we should all 3rd prize of £234.96
carry on believing what we have been told from goes to Anon. from Chorley
the cradle, that laughter is 4th prize of £117.48
good for us and it certainly goes to Anon from Middlesbrough
helps to make the world
seem to be a happier place. Note: the winners of the draws for February, March
and April will be announced in our June 2018
Newsletter and will be available on our website.
In 2017, the Lottery raised over £7800.00
to help to fund IDDT!
A huge ‘Thank You’ to everyone who has
supported IDDT through the lottery.
If you would like to join in for just £2.00 per month,
then give us a call on 01604 622837 or email
jo@iddtinternational.org
10 March 2018, Issue 96From our own correspondents
More on toenail cutting Received on New Year’s Eve!
Dear Jenny, Dear Jenny,
Further to the letter in the December Newsletter about All the best for the New Year and to all at the IDDT. After
toenail cutting and this being carried out by Age over 50 years on beef insulin, sitting here comfortably
Concern, your readers may not be aware that if you are with my pork insulin !!!!!!!
taking blood thinners, such as heparin or warfarin, then By email
Age Concern cannot cut toenails.
As a result of this, my husband is still left with no
podiatry service on the NHS and we are now appealing
to the local CCG. Diabetes – Everyday Eating
Mrs M.H. - Kent Dear Jenny,
At the beginning of December 2018, I was advised I was
pre-diabetic and the nurse suggested that I joined a
diabetes prevention programme and she also gave me
Benefit cuts and Type 1 a copy of your booklet, Diabetes – Everyday Eating. I
found the 4 week menu plan extremely helpful, so much
diabetes so that by the first meeting a month later, I had lost 2
Hi Jenny, kgs. Please could the other members of the group have
copies too!
Like others, I have had my benefits cut through
government policy and I know others who are awaiting Miss M.E. - North East
payments. In these situations, there is no allowance Note: this is by far our most popular booklet and we are
made for people with Type 1 diabetes. While insulin is happy to supply it free of charge.
free on the NHS, we need sufficient food in conjunction
with it – one is no good without the other!
I highlight the case of David Clapson, who had Type 1
diabetes and sadly died within 18 days of his benefits
If you have a smart phone…
being stopped. He had worked for 30 years, served 5 Dear Jenny,
years in the army and gave up work to look after his I noticed the product Solesee in the December
mother with dementia. After her death, he was applying Newsletter and I think this is excellent for patients who
for jobs but he missed attending the Job Centre and his cannot bend down or raise their legs. I fall into that
benefits were stopped. He died of diabetic- ketoacidosis, category but have come up with another solution that
no food in his stomach and only £3.44 in his pocket. may benefit your members. If you have a smart phone
and a selfie stick try doing a selfie of the sole of your
Are health conditions not taken into account when foot. This can then be retained for future reference to
these decisions are made? show your health professional if there are any problems.
By email By email
C-peptide test after 47 years
Dear Jenny,
Recently I went to my diabetic clinic and I was given a new Note: C-peptide is produced in the pancreas at the same time
blood test, called the C-peptide test, which apparently as insulin, so the test is used to check whether or not people
gives the doctors an indication of the amount of insulin my are producing their own insulin. In grey areas where it is not
pancreas is able to make itself. clear whether people have Type 1 or Type 2 diabetes, the
I have had Type 1 diabetes for about 47 years, so there can C-peptide test is used. For example, Type 1 diabetes is usually
surely be little doubt that the insulin capabilities of my diagnosed at a younger age but it can occur in older people
pancreas ceased a very long time ago. I cannot see what and the C-peptide test helps to ensure the diagnosis is correct.
benefit such a blood test would have for me, or indeed, for So if the test shows C-peptide is not present, then the person
anyone with longstanding Type 1 diabetes. Surely this is a is not producing insulin and therefore is likely to have Type 1
waste of very valuable NHS funds? diabetes.
Mr E.J. - Scotland
11The late Colin Johnson
Colin lived through 67 years among other things, for the acclaim.
of diabetes before his death in legendary Ford Cortina gearshift
Colin continued writing books
August 2017 and has supported which set a new standard for car
and articles (sometimes
IDDT for many years. He never gearboxes. He designed buildings
jointly with Arabella), mainly
really came to terms with his using radical new techniques
about health, politics, and the
diabetes and always resented the and the then-novel material of
environment, for the next fifteen
effects it had on his life but he GRP (fibreglass), but left this
years, after which he decided it
learnt to stay well by living well, career when he became involved
was time to get an education.
getting to know his body so that in the Alternative Press in the
Despite having no qualifications
he could respond appropriately late 60’s, setting up a wholesale
whatever, he was offered a
to its signals - when he chose to and distribution business which
place by Hull University to study
do so. He was always as active became the main outlet for
philosophy and was awarded
as he could be, both mentally radical publishing.
an MA in 1998. His last book,
and physically, working in the Deliberately bankrupted by the Creating Health, was based on his
woodland burial ground he co- mainstream press in 1977 (who Master's dissertation.
founded with his partner Arabella saw his libertarian attitudes as
after the loss of one foot and He responded characteristically
a threat to their business), Colin
other disabilities resulting from to his brush with death in 2000
moved with his partner Arabella
MRSA contracted in 2000. by setting up The Eternal Forest
Melville to South Wales, from
Trust, a charity dedicated to
He was an exceptional man in where he started industrial
natural woodland and offering
many ways. Despite leaving co-operatives before becoming
woodland burials. The wood at
school at the age of 14 to join the a writer. Cured to Death: the
Boduan in North Wales opened to
local fairground, Colin became Effects of Prescription Drugs was
the public in 2007 and Colin was
a design engineer, responsible, published in 1982 to considerable
buried there ten years later.
PREGNANT WOMEN WITH DIABETES NOT
GETTING THE SUPPORT THEY NEED
In a press release, the Royal College of general population, and the neonatal
Midwives expressed their concerns about death rate is more than four times as
the findings of the National Pregnancy in high.
Diabetes Audit 2016 which showed that
many women with diabetes are not getting • Nearly half of the babies born to women
with Type 1 diabetes, and nearly a quarter
the support they need before and during
pregnancy. The report, published in October born to women with Type 2 diabetes
2017 by NHS Digital, measured the quality were larger than gestational age.
of care and outcomes for women with pre-
gestational diabetes who were pregnant in
• Few women living with diabetes are well
prepared for pregnancy, with only one in
2016. 12 women (8%) achieving all three key
The audit which covered England, Wales recommended pre-pregnancy health
and the Isle of Man, looked at 3356 measures.
pregnancies in 3297 women across 172
Note: IDDT has a booklet, ‘Pregnancy
antenatal diabetes services. Of these
and Gestational Diabetes’ which we
women, 1608 had Type 2 diabetes.
are happy to supply free of charge,
It showed: just contact IDDT on 01604 622837,
• The stillbirth rate for women with
diabetes is twice as high as that of the
email enquiries@iddtinternational.
org or write to IDDT, PO Box 294,
Northampton NN1 4XS.
12 March 2018, Issue 96Jeremy Hunt Watch
Cabinet reshuffle - Responsibility for patients in
Jeremy Hunt to remain these areas would then be held by
new bodies, called Accountable
In the Cabinet reshuffle in early Care Organisations (ACOs). This
January, Jeremy Hunt refused to could lead to newly merged NHS
take another job and so not only super-organisations or a non-NHS
remains as Secretary of State body being awarded contracts
for Health but now also takes to manage and provide entire
responsibility for Social Care. So packages of care as the ACOs
his official title is Secretary of could choose to subcontract the
State for Health and Social Care service or provide it themselves.
- not an enviable task in today’s Those campaigning for the
climate! judicial review say that this
would allow ACOs to control
Jeremy Hunt taken to allocation of NHS money but the
judicial review accountability for spending it and
their obligations to the public
Professor Stephen Hawking and would be under commercial
leading healthcare professionals contracts and not parliament.
have won permission to take
Even as mere patients, we have
Jeremy Hunt and NHS England
to say that the last changes by
to court over proposals to
this government were only made ever increase of the NHS medical
restructure the NHS. Mr Hunt has
in 2012/13 and how successful workforce. It is part of a drive to
put forward a plan which could
have these been? Yet here we are increase the number of UK trained
allow commercial companies to
again, with more changes which doctors to reduce the reliance on
run health and social services
appear to be getting rid of some foreign doctors after Brexit.
across a whole region in what
of those made only a few years
some would call back-door Part of the plan is a ‘return to
ago! With billions of pounds of tax
privatisation. They have argued service’ scheme whereby doctors
payers’ money being spent, we
that an act of parliament is would repay some of their
need to know that the changes
required to change the law before training costs if they refuse to
are firstly, legal and secondly,
this could be implemented and remain working in the NHS. A
will benefit everyone using the
regulations changed. public consultation will consider
NHS. Finally, depending on your
Not unexpectedly, lawyers from political persuasion, moves to the length of service required
the Department of Health and privatise the NHS, albeit by the between two and five years, while
NHS England have rejected these back door, mean that somewhere officials will set a proportion of
claims but a court has now ruled a slice is being taken off the top repayment.
that a full judicial review will be for commercial company profit. Taxpayers pay around £230,000
granted to find out how lawful Mr Time will tell…. to train each doctor in addition
Hunt’s proposals are. to the fees paid by the students
In the proposals, the boundaries
Plans to boost the themselves and Mr Hunt said, “By
between different parts of the number of ‘home- expanding our supply of home-
NHS that pay for and provide care, grown doctors and proposing that
such as hospitals, GPs and clinical
grown’ doctors they serve patients in the NHS for
commissioning groups, would be a minimum term, we will ensure
Jeremy Hunt plans to train an taxpayer investment in the NHS is
dissolved. extra 1,500 doctors a year from returned”.
2018/19, which is the largest
13PHARMACEUTICAL NEWS
Animas stopped certain level. This would allow
insulin to more closely mimic
Roche has acquired
selling insulin pumps how the molecule is controlled distribution rights
in people without diabetes. The
in the UK and Ireland response of this drug is rapid and to an implantable
Animas, a leading manufacturer of proportionate to glucose levels and
has the potential to do away with
long-term continuous
insulin pumps has stopped making
and selling insulin pumps in the UK the need for insulin injections and glucose monitoring
and Ireland. The company, owned by glucose monitoring. It could also
Johnson and Johnson, announced in protect people from hypoglycaemia system.
October 2017 that they were leaving by lowering insulin levels as blood Roche will sell the Senseonics’
the insulin pump business in the US. glucose levels decrease. There is still Eversense CGM system implant in
a long way to go…… Germany, Italy and the Netherlands
They will continue to offer pump
and has options to expand to other
support, providing pump supplies
and upholding its warranty support Oral insulin countries. The Eversense combines a
small sensor that works for up to 90
for the Anima Vibe for a transition Biopharmaceutical firm Biocon has days, a wearable, removable smart
period. Pump supplies will be received funding from the Juvenile transmitter and mobile application.
available until the end of the pump’s Diabetes Research Foundation It is inserted below the patient’s skin
3-year warranty. (JDRF) in the US to test its oral and communicates with the smart
The transition period gives people insulin, Tregopil, on people with transmitter, which then wirelessly
time to change to a different pump Type 1 diabetes. The JDRF will fund sends blood glucose results to the
and Animas are recommending that Biocon’s global multiple ascending mobile app.
people change to the Medtronic dose study of oral insulin to evaluate
pump, although they do not have to the safety and tolerability in people
change to this brand. with Type 1 diabetes. A new mobile app for
Animas encourages users of the Another insulin manufacturer, Novo people with Type 2
Nordisk, withdrew from producing
Animas Vibe with any questions
to contact the Animas Customer oral insulin in 2016 but Biocon diabetes using insulin
Support team on 0800 0288039 announced positive clinical data in from Sanofi
(UK users) or 1800 812715 (Ireland 2016 for insulin Tregopil following a
users). set of Phase I studies carried out in This new tool, described by Sanofi as
the US. One of the studies showed a ‘digital insulin titration solution’, will
Note: Animas has stated that the be a mobile app that assists people
that the fast action of Tregopil
closing of their UK insulin pump with Type 2 diabetes on basal insulin
showed distinctive properties
business will not affect LifeScan (long-acting) with decision-making
compared to other mealtime
(makers of the OneTouch blood and self-management. The app will
insulins, so Biocon has decided to
glucose monitoring products), allow remote monitoring by the
carry out further clinical trials in
Dexcom (continuous glucose person’s health care team and is due
larger numbers of patients.
monitors) or Diasend (data sharing to be piloted in North America and
software) products. several European countries. Last year
Another insulin copy the new app received regulatory
Smart insulin Admelog made by Sanofi has approval in the US and the European
CE mark.
been approved by FDA in the US
In September it was announced that
as follow-on biologic of Lilly’s
Eli Lilly and Company are acquiring
Glycostasis, Inc., a new company
Humalog. Admelog is an insulin A new technology
lispro injection and a treatment
aiming to create “smart insulin.”
Lilly’s intention is to develop the
for adults with Type 1 and Type 2 that stops the need
diabetes and children with Type
technology further.
1. It is the first biologic version of for insulin injections
“Smart insulin” consists of a Humalog, the fast-acting insulin by A new way of administering insulin
molecule that attaches to insulin Lilly. (11th December 2017) could eliminate the need for
and only releases insulin when injections. A capsule of genetically
blood glucose levels rise past a engineered cells implanted under the
14 March 2018, Issue 96skin to release insulin as required, has
been tested in mice.
risk of them developing tumours
and growing uncontrollably. The
Soft contact lens to
As we know, scientists have
type of cells being used are human measure glucose levels
pluripotent stem cells and the
attempted to artificially cultivate This is not the first contact lens to
researchers have found that the
pancreatic cells from patients’ stem be developed to measure glucose
cell surface protein glycoprotein
cells but they have struggled to levels, the South Korean researchers
2 allowed them to isolate the
manufacture the cells at the scale say this device addresses a lot of the
pancreatic endoderm cells. From
necessary for clinical use and the problems encountered with the first
these purer cells, the researchers
cells naturally tend to die off once lenses. They believe the first lenses
were able to obtain a purer sample
introduced into the body. However, were too rigid and the electronics
of cells which could increase their
in this research human kidney too brittle so the new device is more
effectiveness and safety when
cells, known as HEK cells, were re- stable, comfortable and less prone
implanted into humans. (Cell Reports
engineered to perform the function to breaking. Previous attempts also
Journal, August 1st 2017)
normally carried out by the pancreas. hindered vision and could damage
Two genes were introduced into the the eye.
cells – one to make them sensitive A wearable patch to The lens works by measuring glucose
to glucose levels and a second to
instruct the cell to pump out insulin control Type 2 diabetes in tears and transmitting the results
wirelessly to a handheld device. An
when glucose levels exceeded a Researchers at the US NIH’s National LED display has been embedded in
threshold. Institute of Biomedical Imaging and the lens, which emits a non-intrusive
If this proves as safe and effective Bioengineering are working on an light if glucose levels become too
in human beings, then people with alternative therapeutic approach high. The LED display can be emitted
diabetes could be given an implant to regulating blood sugar levels for into the eye of the user or into the
that would only need to be replaced people with Type 2 diabetes using a opposite direction.
three times a year. painless wearable skin patch that can
last up to several days. Up to now it has only been tested on
Diabetic mice have been treated with animals but no signs of discomfort
the cells and found to have normal A proof of concept study was have been observed. It has yet to be
blood glucose levels for several performed in mice to test the ability tried in humans and is unlikely to be
weeks. The researchers hope to have of the patch to respond to blood available commercially for at least
a licence to test the cells in humans chemistry and manage glucose 5 years. (Science Advances, January
within 2 years. (Science, December automatically. It uses the fact that 2018)
2016) people with Type 2 diabetes can still
produce some insulin.
The importance of
Researchers To make the experimental patch
an alginate is used. This is a sticky oral hygiene in Type 2
developing ways natural substance that is extracted
from brown algae mixed with a diabetes
to make lab-grown formula of biochemical particles A study has shown that people with
insulin-producing cells that stimulates the body’s insulin
production when it’s needed and
Type 2 diabetes who received oral
health instructions and underwent
safer shuts off when normal blood sugar deep cleaning of their teeth and
It is thought that the future concentration is obtained. This is gums had significant improvements
treatment of Type 1 diabetes is all poured into a microneedle form in HbA1c levels and fasting plasma
likely to come from living cells that to create the patch. The dissolvable glucose after 3 and 6 months
can produce and release insulin microneedles make the patch a compared with no improvements
inside the body and scientists responsive delivery system for the in the control group that received
have been using new techniques therapeutics to be absorbed by the regular cleanings. The research took
to allow human stem cells to grow body over a period of time and not place in Spain and involved 90 adults
an unlimited number of insulin- all at once. and found that the improvements
producing beta cells. The advantage The study showed that just a half correlated with oral bacteria
of this is that living cells have the inch square of the patch on mice levels, and that the non-surgical
potential to directly respond to could control blood sugar levels for treatment of periodontitis led to
changing blood glucose levels and a week. Researchers said the patch improved blood glucose control and
release insulin as needed to keep needs to be modified for use with HbA1c levels. (Journal of Clinical
glucose levels stable. human skin including increasing the Periodontology, February 2018)
Researchers from the Copenhagen size and extending the microneedle.
University are developing a way (Nature Communications, November
to purify the cells to eliminate the 2017)
15Parents Part
Chronic illness in children Type 1 diabetes (1755) are more
likely to require a higher insulin
The study also found that the
prevalence of asthma in children
linked to mental health dose, are shorter in height as with Type 1 diabetes was lower
issues later adults and have a higher BMI than compared with the general
A study at the University of Sussex those with Type 1 diabetes that population, 3.4% versus 4.7%.
found that childhood chronic do not have asthma. Those with However, this was not the case
illnesses can cause emotional both conditions were more likely in studies carried out in the
and mental health problems in to be boys (61% versus 52%), were United States where there was
adulthood. Thirty seven studies older and had a longer diabetes a higher prevalence of asthma
involving 45,000 people were duration and were more often in adolescents with Type 1
analysed and a link was found using insulin pump therapy than a diabetes compared to the general
between 8 chronic conditions and conventional insulin regimen. population, 10.8% versus 8.7%. It
emotional problems later in life. has been suggested that as being
There were no between-group
The chronic conditions included overweight is a risk factor for
differences for HbA1, but those
asthma, cancer, chronic renal developing asthma, this could be
with Type 1 diabetes and asthma
failure, congenital heart diseases, an influencing factor for the higher
experienced more severe
cystic fibrosis, Type 1 diabetes, prevalence of asthma in young
hypoglycaemia compared to those
epilepsy and arthritis. people with Type 1 diabetes in the
without asthma.
United States. (Pediaric Diabetes,
All of those reviewed who There was a difference in December 2017)
experienced chronic conditions medication to treat asthma with
in childhood were at an increased 62% on specific medications:
risk of developing depression or
The Adverse Childhood
anxiety and emotional problems
that continued through adulthood.
• 28% were prescribed inhaled
corticosteroids,
Experiences (ACE) Study
Cancer was particularly associated
with depression but when this was
• 24% were prescribed
sympathomimetic drugs,
Nearly 20 years ago the above
study broke new ground by
showing a strong relationship
removed from the analysis, the
link was still there. So it is not just
• 6% were prescribed leukotriene
receptor antagonists,
between adverse childhood
experiences (ACEs) and health-
cancer that is associated with adult
emotional problems. (University of
• 4% used unspecified drugs. risk behaviour and disease in
Researchers found that patients adulthood. In November 2016,
Sussex, May 12, 2017) Public Health Wales published
prescribed sympathomimetic
drugs had a higher average a report that focused on the
Children with Type 1 HbA1c (8.42%) compared to those relationship between ACEs
diabetes and asthma need prescribed inhaled corticosteroids and chronic disease based on
questions answered by more
more insulin (8.18%) and leukotriene receptor
than 2000 adults about their
antagonists (7.97%).
Results from an observational experiences of maltreatment and
study involving 51,926 children in household dysfunction as children.
Germany and Austria found that
Almost half of those surveyed had
those with asthma and
experienced one ACE and 14%
16 March 2018, Issue 96You can also read
