[Diabetes] General Chat and Support Thread

CramCycle

I once woke to find a nurse about to inject me with Insulin intervenously. It would have killed me, or put me in a coma. I don't think paramedics would have insulin or administer it, so I presume it is an error in the article.

Alanstrainor

feedthegoat wrote: »

Shocking article. Would put a small doubt in you mind about pumps and was it a pump failure. Irrespective of what it was a terrible tragedy for her family.

The article states that the pump was functioning correctly, and that there was a self administered 68 units of insulin. My pump is configured to only allow a max single bolus of 10 units. This was the default value, it is however possible to increase this to 75units. I would wonder if she attempted a set change while intoxicated and primed the pump while attached?

That being said, the article is clearly off when it states that paramedics gave insulin when they arrived. It also strikes me as strange that her husband didn't know how to react to this scenario, a shot of glucagon was called for, but even still it might have been too late.

I wouldn't let this article put anyone off a pump, it's obviously a tragedy, but it sounds like alcohol coupled with user error caused this.

CramCycle

When I was a student many moons ago, another student died (in a different college), without much publicity. Diabetic, night out. Found a few days later. Best guess is massive hypoglycaemia. While I was not directly involved or knowledgable (I knew a guy in his class), two scenarios played out in my head from people who knew him. He left early, rake of pints, wanted a chipper on the way home. Took a shot of insulin on the way and the chipper was closed when he got there. Walked back, fell asleep, never woke up. The other option was his bloods appeared high when drinking and he took a corrective dose that was not necessary.

It is the one benefit of a pump or those devices that let you know how much you injected recently. My pump has stopped me double dosing plenty of times when I am busy. I wouldn't have double dosed with a pen because it would not have been on me in work but having a machine that I look down at over coffee, that says, hey you, you took a few units 45 minutes ago, no need to correct that slightly elevated sugar, just ride it out, is brilliant for me.

Buford T. Justice XIX

CramCycle wrote: »

When I was a student many moons ago, another student died (in a different college), without much publicity. Diabetic, night out. Found a few days later. Best guess is massive hypoglycaemia. While I was not directly involved or knowledgable (I knew a guy in his class), two scenarios played out in my head from people who knew him. He left early, rake of pints, wanted a chipper on the way home. Took a shot of insulin on the way and the chipper was closed when he got there. Walked back, fell asleep, never woke up. The other option was his bloods appeared high when drinking and he took a corrective dose that was not necessary.

It is the one benefit of a pump or those devices that let you know how much you injected recently. My pump has stopped me double dosing plenty of times when I am busy. I wouldn't have double dosed with a pen because it would not have been on me in work but having a machine that I look down at over coffee, that says, hey you, you took a few units 45 minutes ago, no need to correct that slightly elevated sugar, just ride it out, is brilliant for me.

Yeah, the records are brilliant. I'm pretty flat out this week and next and sometimes, being tired, don't remember if I took a bolus or not. And working alone wouldn't be the best situation for getting an unexpected hypo either.

I couldn't recommend a pump enough to any one if they have the option. It really has made my life so much simpler since I got one.

Snake Plisken

Alanstrainor wrote: »

The article states that the pump was functioning correctly, and that there was a self administered 68 units of insulin. My pump is configured to only allow a max single bolus of 10 units. This was the default value, it is however possible to increase this to 75units. I would wonder if she attempted a set change while intoxicated and primed the pump while attached?

That being said, the article is clearly off when it states that paramedics gave insulin when they arrived. It also strikes me as strange that her husband didn't know how to react to this scenario, a shot of glucagon was called for, but even still it might have been too late.

I wouldn't let this article put anyone off a pump, it's obviously a tragedy, but it sounds like alcohol coupled with user error caused this.

It would kind of Putnyou off the pump, I think I will stick to administering my own insulin.
Some things don’t add up and it would be good to see a better report but did her husband not try and test her bloods?
Did the paramedics give her a shot of insulin? Did they check her blood sugars on arrival?
If drinking alcohol would you be better off removing the pump and manually administering insulin?

CramCycle

Snake Plisken wrote: »

It would kind of Putnyou off the pump, I think I will stick to administering my own insulin.

You are still administering your own insulin, the pump in no way takes over from that, you still have to pick it up and decide to bolus for anything.

Some things don’t add up and it would be good to see a better report but did her husband not try and test her bloods?

I am sure he did, it would be weird not to have done but the mind acts weirdly in stressful circumstances. There are alot of things that do not add up about the story as reported, but down that rabbit hole are a world of possibilities.

Did the paramedics give her a shot of insulin? Did they check her blood sugars on arrival?

If they were alerted to her being a diabetic, having worked on training courses with paramedics, the chances of them administering insulin is so unlikely, I just could not believe it. Her husband was their as well, presumably well versed, he would have told them not too if they did. The only logical explanation is that the paper reported it wrong and they administered Glucagon. The cause of death was the 68 units in two hours, how that happened is a case to ponder but probably not one to ponder here.

If drinking alcohol would you be better off removing the pump and manually administering insulin?

If drinking, specifically above the recommended/norm/getting off your face, you should not be administering insulin, manually or by pump. If on Long term injections, unless having a meal early in the night, let your long term carry you through and deal with the hyperglycaemia in the morning. If on the pump, just don't bolus, and deal with the hyperglycaemia in the morning.

Alanstrainor

Snake Plisken wrote: »

It would kind of Putnyou off the pump, I think I will stick to administering my own insulin.
Some things don’t add up and it would be good to see a better report but did her husband not try and test her bloods?
Did the paramedics give her a shot of insulin? Did they check her blood sugars on arrival?
If drinking alcohol would you be better off removing the pump and manually administering insulin?

It's already been said but you are still administering your own insulin on a pump. Just as there is a chance of you administering the wrong done with a pen, there is a chance you could with a pump. But the pump has plenty of safe guards to prevent stacking dosages. It tells you how much insulin is active, it saves a history of all boluses given.

I am a pump fan. And obviously it is fine for others to not want or like pumps. I just don't want the reasoning behind that to be based on misinformation.

CathyMoran

Alanstrainor I saw your posts on the pump, your latest pump sounds amazing and exactly what I would love to have - my reasons for nor wanting it in the past were being scared about never getting away from diabetes but that was just an excuse looking back, I have used the libre for over a year so far and it has been a life changer. I do have one concern in that I am worried that I would have to stay in a hospital overnight to do a course to get it and that is when I get most of my severe hypos (my husband is a light sleeper so he is my hero and has saved my life several times), I would also miss my kids. Do you know if you I have to do an overnight course to get the pump still? Thanks. I will be with my consultant again in April so may want to bring it up. I have found splitting my background insulin has made huge differences so far.

CramCycle

I certainly didn't have too. The way James worked they sent you home with a pump attached after talking through it but it only had a saline cartridge. Mainly to make sure you were actually happy with it, I think I had it for a few days before they switched me over.

CathyMoran

CramCycle thank you so much for your reply - it is the only thing that I am worried about. I have never done a course on carbs but I have gastroperisis from getting my esophagus removed over 11 years ago but I do know what works for me. I attend St. Vincent's.

Buford T. Justice XIX

CramCycle wrote: »

I certainly didn't have too. The way James worked they sent you home with a pump attached after talking through it but it only had a saline cartridge. Mainly to make sure you were actually happy with it, I think I had it for a few days before they switched me over.

Same here, was on the saline for 4 days after doing the course in hospital during the day and left off with the pump that evening and rang the consultant twice a day for a few days after with readings at different times to adjust the basals and the ratios of glucose to carbohydrate until it was settled.

CathyMoran

Buford T. Justice V thank you as well for your reply - I do not mind doing a course during the day as I work in any case but night time would be tough.

imfml

Hi all,

I am with my consultant mid March and he wants me to have blood tests on a long list of items. My GP usually does this for 40 euro, the Mater Private charge over 150 euro.

My consultant has brought the appointment forward and now my GP can't give me an appointment for the blood test in time. I am in Dublin, northside.

Can anyone recommend somewhere to have a blood test please.

CramCycle

Is it possible to get it done in the Mater Public?

Kurtosis

A number of public hospitals provide GP-ordered blood tests via their phlebotomy department, so this might be an option e.g. http://www.stjames.ie/GPsHealthcareProfessionals/GPBloodTesting/

imfml

Thanks, I made an appointment in Mater public using swiftqueue.ie
I’ve never used it before and it doesn’t state the cost but I’ll call up tomorrow to check. Hopefully it’s reasonable and works ok, looks like a handy service if it isn’t expensive.

Buford T. Justice XIX

Adult onset diabetes can be divided into 5 distinct categories.

https://www.theguardian.com/society/2018/mar/01/five-categories-for-adult-diabetes-not-just-type-1-and-type-2-study-shows

And they also show a different response to different treatments and complications.

banie01

Buford T. Justice V wrote: »

Adult onset diabetes can be divided into 5 distinct categories.

https://www.theguardian.com/society/2018/mar/01/five-categories-for-adult-diabetes-not-just-type-1-and-type-2-study-shows

And they also show a different response to different treatments and complications.

I'm very tempted to pay for full access to thelancet to read this as the info available is very superficial.

My Endo has been talking along these category lines for quite a while.
I was a fairly atypical Type 2 diagnosis.
Diagnosed at 26 by fluke, Fit and healthy BMI with no symptoms.
Was treated as normal type 2 for the 1st 9yrs and then changed Endo(Due to previous 1 retiring) and he was of the opinion that I was a type 1.5 or a LADA.

The antigen test ruled out LADA but my treatment regime did switch to a basal insulin regime with oral treatment too.

Whats of particular interest to me regarding the new study is the determination that "Cluster 2" patients were more prone to Retinopathy!
My diabetes control has been good apart from @6/7 months since I have been diagnosed and BP has been in a normal range every time the 24hr monitor was used.
Yet, at my last Retinopathy screening background retinopathy was detected in both eyes and I'm waiting on an ophthalmology appointment now.
Wouldlove to able to streamline my treatment regime to alleviate any future issues as much as possible.

Kurtosis

From what I've seen, there have been some mixed responses to this Lancet paper. A number of health researchers I follow on Twitter have criticised this as using a purely data-driven approach to identify the clusters/categories, and that there's no evidence yet that these categories are a valid way to determine different treatment approaches or varying prognoses.

Kurtosis

Also banie, to save you forking out, it's always worth searching for a paper's title on scholar.google.com, it squirrels around to see of there is an open access version of a paper somewhere on the net. It seems the authors of this one have an earlier version of the manuscript posted as a preprint: https://www.biorxiv.org/content/early/2017/09/08/186387

banie01

@Kurtosis many thanks for the link.
I look foward to giving ot a read and reviewing the methodology.
Whilst I'm not medically qualified, breaking out statistics and methodology are a big part of my day job and I always enjoy seeing how a causation is inferred and proven.

Regarding the mixed responses to the paper, I've at thos stage only gotten the abstract and the associated hype.
The data driven approach to the "clustering" is of interest, with a large enough dataset, clustering of particular pathology is surely only to be expected?
And whilst diabetes may be a common factor, causation is more likely to be related to other common factors amonsgt the cluster such as age, sex, other pathologies or even down to income range and patient location.

Kurtosis

banie01 wrote: »

@Kurtosis many thanks for the link.
I look foward to giving ot a read and reviewing the methodology.
Whilst I'm not medically qualified, breaking out statistics and methodology are a big part of my day job and I always enjoy seeing how a causation is inferred and proven.

Regarding the mixed responses to the paper, I've at thos stage only gotten the abstract and the associated hype.
The data driven approach to the "clustering" is of interest, with a large enough dataset, clustering of particular pathology is surely only to be expected?
And whilst diabetes may be a common factor, causation is more likely to be related to other common factors amonsgt the cluster such as age, sex, other pathologies or even down to income range and patient location.

I'm also a fan/nerd when it comes to statistics and analysis methods! I think the expectation to find clustering is part of the criticism, but also that pigeon-holing patients into one of five categories and using that to explain prognosis/outcomes is a lot less informative than using the characteristics that feed into the clusters/categories (i.e. you end up throwing out a lot of valuable information on a person's characteristics).

Also, people who are in the same cluster may actually be more similar to some individuals in another cluster - there's a good explanation of this available in this blogpost: http://www.fharrell.com/post/errmed/#cluster

Start by envisioning the clusters as non-overlapping regions such as rectangles, ellipses, or circles.

• There is no clinical reason why the clusters should not overlap.
• If the clusters do not overlap, imagine two non-overlapping large regions sharing a border. Consider a patient at the outer part of one cluster region and a patient in the other cluster who is close to the first patient. Though these patients are assigned to different clusters, they may very well be more like each other in every way than they are like patients at the center of their own clusters.
• Patients within a cluster are far from homogeneous.

Another good blog on the topic available here: https://darrendahly.github.io/post/cluster/. Basically it seems the number of clusters identified may have more to do with the data analysis methods used rather than the actual patient characteristics: https://twitter.com/MaartenvSmeden/status/970237614413570048

Wanton

Just for anyone using the Libre.

The phone app is now available.

Irish Wolf

Hello again!

Weird week - many hypos (in the middle of one now).

Irish Wolf

Irish Wolf wrote: »

Hello again!

Weird week - many hypos (in the middle of one now).

2.3 now and hopefully rising.

Faith

Hi all, I hope it's okay to ask a quick naïve question here . I'm currently doing my doctoral thesis on factors that may affect insulin adherence for people with type 1 diabetes. I'm recruiting through the UK only, partly because I'm based here and partly because insulin is available on the NHS so cost isn't a confounding factor. It made me wonder what the situation in Ireland is, and who better to ask that those on the inside! If you have type 1 diabetes, do you have to pay for insulin or is it covered somehow? Thanks for the insight!

CramCycle

Faith wrote: »

Hi all, I hope it's okay to ask a quick na question here . I'm currently doing my doctoral thesis on factors that may affect insulin adherence for people with type 1 diabetes. I'm recruiting through the UK only, partly because I'm based here and partly because insulin is available on the NHS so cost isn't a confounding factor. It made me wonder what the situation in Ireland is, and who better to ask that those on the inside! If you have type 1 diabetes, do you have to pay for insulin or is it covered somehow? Thanks for the insight!

Covered on the LTI scheme here. Having been on the NHS and the HSE system, I have found the HSE far easier to deal with. The NHS are quite inhibitive and time consuming. You also have discretion over here to get from a pharmacy in an emergency just by giving in your details, i don't know if it as easy as that in the UK.

I remember as well the NHS being big into reusing needles and getting the best bang for buck, actively promoted by staff in hospitals whereas over here, the policy was whatever best practice was first (in my experience)

Faith

CramCycle wrote: »

Covered on the LTI scheme here. Having been on the NHS and the HSE system, I have found the HSE far easier to deal with. The NHS are quite inhibitive and time consuming. You also have discretion over here to get from a pharmacy in an emergency just by giving in your details, i don't know if it as easy as that in the UK.

I remember as well the NHS being big into reusing needles and getting the best bang for buck, actively promoted by staff in hospitals whereas over here, the policy was whatever best practice was first (in my experience)

Excellent, thanks! That's really useful to know because I could possibly include Irish people in my study so - ethics permitting!

Buford T. Justice XIX

CramCycle wrote: »

Covered on the LTI scheme here. Having been on the NHS and the HSE system, I have found the HSE far easier to deal with. The NHS are quite inhibitive and time consuming. You also have discretion over here to get from a pharmacy in an emergency just by giving in your details, i don't know if it as easy as that in the UK.

I remember as well the NHS being big into reusing needles and getting the best bang for buck, actively promoted by staff in hospitals whereas over here, the policy was whatever best practice was first (in my experience)

I'd like to echo the praise of the HSE and their management of Diabetes medication. I have forgotten my insulin twice in my 25 years as a diabetic and both times it was easy to just supply my LTI number and phone number of my chemist and I was supplied with my supplies in the nearest chemist to me. Also the choice of test meters to suit the users needs to be acknowledged as well.

Credit where it's due.

banjobongo

Im a Type One, diagnosed about 2 yrs ago. I sometimes have lows/hypos, I think the lowest I have gone was 1.9 (today), was in a meeting at work and I know I was going low but didnt realise how low I was. Luckily I had glucose and got it up again to 6 quickly. How low can you go and still be OK enough to realise you are and sort it out? I woudl this 1.9 is about as low as possible?