Homefield: Diabetes

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Sick Day Rules

Diabetic keto-acidosis

Sandwell Diabetic Care Guidelines

Particularly for children and parents of children with Diabetes

United Kingdom Pre-Diabetic Study (UKPDS)

Targets in Control of Diabetes

Toward a Cure for Diabetes

Impotence and Diabetes

Reproduction

United Kingdom Pre-Diabetic Study (UKPDS)

Entry to the Study
• Sugar 5.5 to 7.8
• Fat or a family history of Diabetes
• Fasting Hyperglycaemia

Early Diabetes Intervention Trial (EDIT)

20/09/1998 The results of the most recent trials of tighter Diabetic control are very persuasive that this reduces the chances of blindness and kidney failure considerably compared to looser control.

Diabetic Retinopathy Screening (Camera) Service

• Chris Brown Diabetic Support nurse
• David Taylor is the screener
• Liz Gadston is the administrator

Can be done at surgery or in Diabetic Centre

There is a check of visual acuity and the nurse puts in Tropicamide drops to dilate the pupil.

Prefers to do whole days and get everyone in.

10 minute intervals

The District Diabetic Register is being constructed only by entering details of patients as they have their retinas screened.

Second session due in June 1997.

Acarbose

Blocks Glucosidase enzyme in the brush border slowing absorption of glucose from complex carbohydrates. May be useful for diabetics poorly controlled on other tablets

• The first priority is to get it below 10.1% which is the threshold for risk of micro-albuminuria
• HbA1c should be aimed for below 7.1%
• HbA1c > 8.1% very poor control, concentrate on these
• HbA1c 7.1 - 8.0% poor control

Immunisations and other Measurements

We aim to measure and record the Cholesterol (and other circulating fat) levels in all Diabetics, and advise all Diabetics to have an Influenza vaccination each year, and a Pneumococcal vaccination (Pneumovax) every 10 years.

Blood Pressure

Diabetes and high blood pressure add up in their bad effects on the kidneys and other organs.
We suggest that Diabetics should have their blood pressure treated if it is persistently abov 140/90 whereas other people would begin treatment at a level more like 160/100

Three approaches seem promising to me, for an eventual cure

Biological Replacement

Research into replacing the Islet cells found in the Pancreas where they clump together to form the Islets of Langerhans, by transplanting Islet cells grown outside the body, and in some way protecting them from rejection by the recipient's immune system, is promising.

Dr Martin Press MA MSc FRCP Consultant Endocrinologist at the Royal Free Hospital in London is one British worker on this approach.

Insulin Pumps

Dr Press and others have experimented with pumps set to deliver Insulin at a rate controlled in various ways.

The obvious way would be to have a sensor to detect the level of Glucose in the body, and the output from this adjust the pump automatically. There are problems with keeping the sensors functioning within the body, and with storing sufficient Insulin in the pump which for convenience should be implanted within the patient's body.

Nanotechnology

Sensors for Glucose can be made out of a few atoms, after all the sensors present in each cell of our bodies are made on this scale, and these sensors may in principle be used to control the rate at which Insulin is pumped out of a Bucky Ball. The complete assemblies could be injected perhaps weekly, and replace the function of the Pancreas in a more sensitive fashion than the gross scale machanical solution above. This is likely to be a few more years coming.

Impotence

To be continued...

Very often fixable nowadays.