Diabetes in a Technology age

Dean Minnock - Monday, October 10, 2016

What I seem to be finding more and more in recent times is the involvement and incorporation of technology in all aspects of diabetes. The addition of technology in the treatment of many health issues has only naturally become more popular as technological advances in medicine strive. I have seen the incorporation of a variety of technology in both clinical practice, academic research and patient treatment of diabetes and it is finally getting great traction from physicians, researchers and patients after a number of years. Accessibility and convenience of new devices, therapies, protocols and compliance aids are among the strongest reasons for this recent surge in the incorporation of technology in diabetes care.

Following many discussions with my colleagues and peers we seem to be asking the same question ‘Why have the government not gotten behind this technology as treatment movement?’ It seems absurd that relatively low cost technology that can improve treatment and quality of life is taking so long to get the attention of government officials and people responsible for making healthcare policy decisions. Some of my peers suggested that there is currently just not enough research conducted and therefore evidence to support the use of technology as conjunctive treatment of diabetes. For me this is simply not the case. There have been numerous studies examining the effects of various technological aids in the treatment of diabetes from glucometers, compliance devices, insulin pumps and artificial pancreas. Each and every new device, protocol and therapy is tested on some scale to insure its efficacy and effects, most of which display positive results which would be beneficial to the user.

So simply I think the questions I want to discuss from this post is why are the health services not backing these advances? Why are these technologies not being made available through public healthcare systems if they show they can improve patient health, well being, quality of life and even reductions in other medical services? Why are the patients and physicians not trying more to make their own lives easier by pushing for these amenities?

This is a topic that has been heavily discussed on my Twitter account and I hope this only makes for more debate surrounding the topic.  If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck 

Summer Camps and T1D kids

Dean Minnock - Thursday, July 21, 2016

This month’s blog is not so much an informative piece as it is an information-sharing tool I am hoping can add to my knowledge base surrounding the subject. Any of you guys who follow me on Twitter know well by now that my industry and academic life is entirely devoted to diabetes but specifically Type 1 diabetes. For somebody like me who is also not a T1D or has somebody close to me who is a T1D, it can often be difficult to understand and appreciate particular day to day challenges people with T1D face.  I mean after all unless you are positioned in a direct situation, the entire book smarts; academic information, and research and industry knowledge can only take you so far.

Back to this months topic and as with seasonal changes the type of questions I am asked change in accordance (maybe there’s a research paper in that) but that’s for another time. This month has seen the rise and rise of summer camps across Ireland. GAA, FAI, School activity, County council, Summer games and many more take a 4-6 week period to get kids active and out of the house as they set in to their school breaks. These camps mean, early mornings, excited kids, (emotional changes) varied physical activity, weather exposure, altered sleeping patterns and UNSUPERVISED TIME. In the past 4 week 60% of my Twitter feed or PM has been from parents on how they can best manage their children’s diabetes during these camps.

Hand on heart this is something I can provide very little information and insight into. I have not got kids let aloe diabetic kids. My initial response was probably blatantly obvious, but sometimes hearing it makes people pay more attention to it. 1) Your child is in a routine as their diabetes has been a huge part of their life so trust them to continue monitoring and treating it as normal, however a few annoying reminders can help. 2) Be sure to inform the camp director and all of the coaches and supervisors and be the person to physically hand over a glucose drink in case of emergency, this handing over of a drink will serve the purpose of directly reminding the coaches your child has T1D and an extra eye on the child watching for hypos. 3) Using technology to remember when to inject and monitor glucose levels can be key.  

These are not the most reassuring facts people have been looking for from me regarding how to manage their Childs’ diabetes during summer camp season. So I invite any of my followers or readers to please get active in the comments section. Your insight and information from real life scenarios may be the piece of mind tool to other parents in similar situations. So comment, interact and share any useful tips you have.

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

PhD Candidate at UCD & Physiologist at InsulCheck  

Diet is not the only influencing factor in diabetes

Dean Minnock - Thursday, May 26, 2016

People who do not have diabetes, work in the medical or research side of diabetes or simply those uneducated or inexperienced with diabetes may more often than not underestimate the seriousness of the illness and how it can both be influenced by and influence people who are diabetic. When I discuss my research with some of colleagues not familiar with the diabetes in detail, or with anybody unfamiliar with diabetes for that matter, I tend to get a the same response such as “well isn’t it just poor sugary diets?”, “If you control your eating and medication your fine” and “can there be so much research involved in diabetes? I mean what are the benefits of your research when it is just a sugar imbalance”. This for me is terribly frustrating and for people who live 24 hours a day, 7 days a week, 365 days a year with diabetes this must become much more than frustrating.  Some things that are important factors worth considering that will impact on diabetes are as follows.

1) Emotional Situation and Stress: Stress and emotions change for many different reasons. Work pressure, home life, romance, children and a host of other daily activities can create situations of stress that can severely alter your diabetes state.   

2) Hormones: A physiological aspect that people always undermine is the role of hormones in diabetes. Exercise, sleep, diet, workload, stress all contribute to changing a variety of hormones on the body. These hormones can increase blood glucose, reduce blood glucose, inhibit the effectiveness of insulin etc. and can be very influential in diabetes. Things to note here are hormonal adaptions with aging and the ever changes physiological processes from puberty to menopause.   

3) Medications:  Using other medications, supplements, vitamin additives are among some of the most dangerous factors influencing diabetes and the impact of insulin. Ensure you speak with your endocrinologist or diabetes nurse before starting new medication or supplements to confirm they will not impact on your diabetes or diabetes medication.

4) Miscalculation:  Undercounting for what you are eating can also cause you to have a high or low blood sugar depending on which way you miscalculated.  So as you can tell, it isn’t because you were out with some friends shopping and saw that very special treat that you just had to have.  Everything affects our numbers.

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck  

Insulin losing its potency?

Dean Minnock - Tuesday, May 10, 2016

In this blog I hope to continue a recent discussion I started on Twitter recently rather than report on a current topic or provide opinion on a new diabetes topic. For those of you who don’t follow my Twitter discussions, a recent discussion that really opened my eyes to peoples challenges, struggles and sometimes. In actuality people make mistakes, they forget certain things with their insulin or on occasion have no choice financially but to use what they have regardless if they feel the insulin has been degraded due to any reason.

Insulin is very sensitive to sunlight, indoor lights, and to extremely hot or cold temperature.

Insulin is not OK to use if exposed to very hot or cold weather. The three drug manufacturers of insulin in the United States say UNOPENED insulin is best stored inside the fridge (2° to 8°Celcius) UNOPENED insulin stored in the refrigerator is good until the expiration date printed on the insulin box. The expiration date will usually be 1 year from the date of purchase but you have to check the box to find out.

Storage of OPENED insulin:

Once open there are different storage needs for insulin. What does OPEN mean? This does NOT mean removed from the box. OPEN means the insulin cap is removed and the rubber stopper was punctured.

Vials and pens have different needs for storage. These differences can lead to confusion. Therefore, it is very important for you to become familiar with the recommendations for the insulin product that you use.

What is an OPEN vial?

Vial: Once the vial is punctured, it is OPEN. Once you stick a needle in the vial, it is OPEN. OPEN vials can be stored in the fridge or at CONTROLLED room temperature. Regardless of where it is stored, OPEN insulin will only last 28 days before it must be thrown in the trash. Insulin kept in the fridge should be removed and allowed to reach room temperature before injection.

PEN: Once used for the first time, insulin pens should not be stored in the fridge. Instead, they should be stored at CONTROLLED room temperature. The number of days you can use the pen will depend on which pen you use. Talk to your doctor or pharmacist. Pens last 7-28 days if stored at CONTROLLED room temperature. The number of days depends on which pen you use.

PUMP: Once

7 IMPORTANT Storage tips for all insulin:

  1. Do not keep in hot places. Do not leave insulin in a hot closed car. Heat makes insulin break down and will not work well to lower your blood sugar.
  2. Do not keep in freezing places. Never store in a freezer. If insulin is frozen, do not use. You will not be able to inject the insulin if it is frozen. Do not use even after thawing. Freezing temperature will break down the insulin and then it will not work well to lower your blood sugar. Throw frozen insulin in the garbage.
  3. Do not leave in sunlight. Light can make insulin break down and then it will not work well to lower your blood sugar.
  4. Never use insulin if expired. The expiration date will be stamped on the vial or pen. Remember if not in the fridge, the date on the vial or pen does not apply. You must throw away after 28 days since outside the fridge.
  5. Write the date on the insulin vial on the day you open it or start keeping it outside the fridge. This will help you remember when to stop using it. Throw the insulin away 28 days after opened or since kept out of the fridge.
  6. Inspect your insulin before each use. Look for changes in color or clarity. Look for clumps, solid white particles or crystals in the bottle or pen. Insulin that is clear should always be clear and never look cloudy.
  7. Be aware of unusual or weird smells. Insulin should not have an odor or bad smell. If you can smell an odor do not use the insulin.

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock.

By - Dean Minnock.

Physiologist at InsulCheck  

Exercise and T1D

Dean Minnock - Tuesday, April 05, 2016

Exercise and T1D

Exercise and physical activity is essential for each and every human being towards remaining fit, healthy and full of vitality. People I work with through my various exercise outlets, be it academic research or sports training, often forget that we are a species who are highly dependent on movement and activity. Genetically speaking we have not changed a whole pile over the past 100,000 years, except for natural selection development, which is mostly governed by the landscape and nutrition of different areas in the world. Why am I pointing this out? Well, people have seemed to forget over the past 100 years that we are, by all means, a physically active race. We once climbed trees all day everyday, that itself is a demanding physical activity, we are the first species to rely on standing on two legs which are (amongst all mammals) the longest leg to body ratio. This is purely because we ran places. Before cars, trains, buses, planes, trams, bicycles even hover boards we walked and ran. We have developed the most efficient maintenance system with our ability to sweat to maintain a core body temperature, and we are the best endurance movement species on the face of the earth.

            So still, why am I telling you this? Because we need physical activity to ensure our bodies, from cells to systems remain in top functional condition. Unfortunately different diseases can be a huge factor and complicate things but it is essential to know that exercise is still necessary, on any level and can be a huge asset in treating and managing diabetes.

So some key information to remember

Preventing Lows

Your blood glucose response to exercise will vary depending on:

  • your blood glucose level before starting activity,
  • the intensity of the activity,
  • the length of time you are active,
  • and changes you’ve made to insulin doses.

Sometimes people experience a drop in blood glucose during or after exercise, so it is very important to monitor your blood glucose, take proper precautions, and be prepared to treat hypoglycemia (low blood glucose).

Learn how different types of activity affect you, you should frequently check your blood glucose before, during, and after exercise

Put a trial and error system into place. For example, increased activity may mean that you need to lower your insulin dose or eat some extra carbohydrates before exercising to keep your blood glucose in a safe range. Some activities may cause your blood glucose to drop quickly while others do not. 

If your blood glucose levels are trending down before a workout, have a pre-exercise snack. Always carry a carbohydrate food or drink (like juice or glucose tabs) that will quickly raise your blood glucose. It may take a while to figure out what works best for you. 

If your blood glucose level is less than 100 mg/dl before you start your activity, try having a small carbohydrate snack (about 15 grams) to increase your blood glucose and reduce your risk for hypoglycemia. This is especially important if you anticipate that your body’s circulating insulin levels will be higher during the time you exercise and if you will be exercising for longer than 30 minutes.  

If you use an insulin pump, you may be able to avoid adding an extra snack by lowering your basal insulin rate during the activity.

If you have repeated problems with your blood glucose dropping during or after exercise, consult your doctor.   

When Your Blood Glucose is High…

Blood glucose can also run high during or after exercise, particularly when you do a high-intensity exercise that increases your stress hormone levels.

If your blood glucose is high before starting exercise, check your blood or urine for ketones. If you test positive for ketones, avoid vigorous activity.

If you do not have ketones in your blood or urine and you feel well, it should be fine to exercise.

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

PhD Candidate at UCD & Physiologist at InsulCheck 


Diabetes on Cognitive performance

Dean Minnock - Tuesday, March 01, 2016

Only last week a guy who had been following my research and my posts on twitter, contacted me via my student email with some questions he was having trouble finding answers. In brief this man was wondering about how bouts of hypoglycemia and hyperglycemia, can impair cognitive performance in people living with diabetes, and if subsequently there were any long-term effects from this. Well, fortunately for this reader, some of my research at the moment is focusing on immediate (short-term) cognitive performance impairments resulting from hypos.

            Although I have not started any practical studies yet to examine the extent of how cognitive functions/performance have been impaired in relation to drop in blood glucose levels, I have done extensive background readings of similar studies and gotten a strong understanding of what to expect when it comes to practical studies. In brief, yes there is definitely a decrease/impairment to normal cognitive functions/performance when blood glucose levels decrease below the desired 6mmol/l. However, the extent to which the cognitive performance is impaired in relation to the level of decrease per mmol/l is still unclear. It has also been argued that the level of impairment of pancreatic function an insulin sensitivity, as well as the individuals genetic make-up is a major contributing factor in the level of cognitive impairment.

            The opposite end of the spectrum is cognitive impairments resulting from hyperglycemia. Studies have shown a reduction in speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hyperglycemia, with reduced energetic arousal and increased sadness and anxiety. This only increases the emphasis and value of accurate and well timed management of diabetes.

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck  

Research Of Interest

Dean Minnock - Tuesday, February 09, 2016

In this blog post I wanted to talk a little about some of the recent discussions we have been having on my Twitter feed. I recently posted a piece on Twitter, highlighting the continued works of Prof. Roy Taylor at Newcastle University. Prof. Taylor and his research group at Newcastle had published some findings from smaller scale studies in recent years that suggested Type 2 diabetes could in fact be put into remission with a new and sustained low calorie diet intervention.

            Well much to nobody’s surprise the work of Prof. Taylor had attracted huge attention and has recently been awarded a £2.4 million research grant to continue the work into low calorie diet and its ability to put T2D into remission. Prof. Mike Lean of the University of Glasgow has teamed up with Prof. Taylor in this huge 3-year project funded by Diabetes UK. The findings from the study will be available from October 2018.

            Simply put the idea behind the low-calorie diet intervention is to target fat reduction on the liver and pancreas of type 2 diabetics. The reduction of fat in these areas aims to improve insulin signaling and release by increasing the functionality of both organs. Based on the findings of earlier studies in this area, those who will benefit the most from this from of intervention are those suffering from obesity and T2D is closely linked with elevated body fat. Other studies in recent years have shown an 80% success rate of T2D remission with a reduction in fat storage as a result of gastric band or gastric bypass surgery. This particular study is looking at replacing everyday foods with shakes and pre made meals that contain all nutrients and vitamins needed for daily living, however the daily meal plan will only contain 800 calories. Never the less this is certainly exciting times for the diabetic community especially if you are living with T2D.  

If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck  

Insulin Cooling Cases

Dean Minnock - Wednesday, January 20, 2016

Something that has been capturing my attention over the past number of weeks has been the FRIO insulin cooling case. I must admit I am very impressed with it. Although it is unlikely, if any of you don’t know what insulin cooling cases are, then simply put, it is any case that keeps insulin at a recommended temperature (15-25 degrees Celsius).  I recently had a discussion on Twitter with a number of insulin users who were considering buying new cooling cases. As usual a debate ensued regarding the “best” model, as well as most efficient, reasonably priced and the most practical for daily living.

            In my opinion I feel the FRIO cooling case scores high enough to take top spot for me. In terms of practicality the FRIO cooling wallet comes in a range of shapes and sizes, which can account for entire insulin kits, to single and double pen-holders. The FRIO wallets come in rage of colours to suit any personal taste and preference, something that can become an essential component when buying for children. FRIO takes it for me also in terms of affordability, with the vast majority of their products coming in at under €30.

            The marketing of the FRIO cases is also second to none. When you do a general search for any insulin travel/cooling cases FRIO seems to return the majority of the searches. So in the interest of continuing the debate from my twitter account, which case do you use if any? Why did you choose that certain case? What are your opinions on the case and would you recommend it or suggest try a different case? If you ever have any questions, or wish to just keep up to date on the latest work, then follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck 

Technology talk

Dean Minnock - Thursday, December 10, 2015

I am not sure how many of my readers are into apps, and new and innovative ways to “make life easier” when living with diabetes. However I am well aware that many new devices, such as the InsulCheck device, are becoming more and more popular amongst physicians, nurses and patients alike. Many of these new age methods for controlling, or recording various aspects of diabetes, are certainly helping for better diabetes management. These aids are increasing patient health and well being, as well as providing detailed patient information, resulting in much better treatment from doctors and nurses.

The most recent item I have been very impressed with, has been the “Diabetes Tracker” app, available for android and smartphone, and is a product of Diabetes UK. I think this is a must have for any person serious about managing their diabetes, as it is a free App. This is a huge bonus in any light because one less expense is great. Also, despite being a free app, it is not filled with annoying pop up advertisements, so it does not become frustrating or annoying to use.

Once on the main page, you have 5 clear sections on the bottom to choose what you wish get from the App. The first and second section is a display of weekly and daily graphs depicting any of the data you recorded, which shows an interactive view of your progress. The Third section offers an area to record the information, and to create these graphs, and to store information on your blood glucose. It also records when you tested basal insulin, bolus insulin, ketones, Carbs, Calories, weight management, and some general comment areas for you to note your physical/emotional feelings with suspected Hyper and Hypo events. All of this is broken into easy to use sections, that with just a few minutes filling in, stores all your information which can be later shown to your doctor or nurse at your next appointment.

The fourth section can save some important information such as doctor’s information, your medical information, and essential checks you should carry out on a regular basis. This can help you remember important people and appointments. Finally section five is a very helpful section on how to use the entire App. Its easy to use and well displayed, so it is practical for people of all ages and level of device skills. If you ever have any questions, or wish to just keep up to date on the latest work, follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck  

Educating yourself on diabetes

Dean Minnock - Tuesday, November 24, 2015

A question that was put to me a few weeks back on Twitter was from a lady who had recently been diagnosed with Type 2 diabetes. She asked me if I could offer any advice on how to better educate herself, when it comes to diabetes? Her concerns were that it wasn’t the quantity of information out there, but in fact it was the quality of information.

The lady in question, who will remain nameless out of respect, told me that when she began to Google many of the questions she was having about the disease, that she was finding an abundance of responses, but that they were often varied. She was left unsure as to what were the correct source in response to diet, exercise, insulin replacement and a whole host of questions surrounding her new and recent diagnosis.

My advice was somewhat simplistic and direct (or at least she later told me it was). Like anything in life her, being diagnosed with a new condition would require a trial and error lifestyle change. First off everybody is different! We are genetically different, our cells function at different rates, our metabolisms may vary greatly and our diet and lifestyle habits vary from person to person. What may work well for one person, may not work so well for another. With regards to getting detailed information about the condition, what exercise may be beneficial, and how diet can influence your diabetes, I recommended reading scholarly articles that have accredited researchers who carried out the studies.  Most of these can be found with a Google search of the general area you are looking into and  Google will return your search with a listing under the heading “Scholarly articles”.

The papers that have been cited the most will offer most credibility. I would ward away from YouTube videos and forum chats to answer questions, simply because they are personal opinions and will often be personalised to suit the presenter. Talking to your diabetic nurse or GP, will always be my advice as the first port of call. Secondary methods would be to consult people with a lot of experience working in the diabetes research field such as myself, although my capacity will only provide guidance. If you ever have any questions, or wish to just keep up to date on the latest work, follow me on Twitter @DeanMinnock

By - Dean Minnock.

Physiologist at InsulCheck  

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