Latest guidelines

[MickyFinn]

Last night I attended a refresher session for the carb counting course I went on last year in December, during which we were all made aware of the latest national guidelines on insulin use, bg targets etc.

I don't know if anyone else has been made aware of these latest guidelines, but bg target range has now been revised to between 4.5 and 6.9. This apparently as a result of research collected from use of CGM's, specifically the freestyle libre. The new advice also means we would be injecting 6 or 7 times a day. For example, if you go to a restaurant, you would inject for the main course, and take another separate injection for the desert. I need not say that all this went down like a lead balloon.

They were suggesting that it's no longer acceptable to have a bg of 8 or 9. I know there's going to be plenty who will ignore this and resist it, but this is apparently where we are.

Another interesting piece of info was regarding the needles and that the majority of people were switched to glucoRX needles. That should never have happened as it only applied to certain type 2 diabetics, but GP surgeries seized on it to cut costs. That's misleading too, because the actual cost of each needle, irrespective of brand is 1p to the NHS. It actually costs no more for them to prescribe us BD microfine needles than the terrible glucoRX ones.

I have made an appointment with the diabetes nurse and dietitian in order to go over a lot of this, and apparently there will be changes made to my prescription such as an expert meter etc.

It will be interesting to know how many GP practices ignore this and just carry on as before.

 

[tim2000s]

Interesting! Was it a DAFNE refresher?

 

[MickyFinn]

Interesting! Was it a DAFNE refresher?

They call it after the hospital/area but it's essentially the same thing as a dafne course.

 

[CarlyB]

Wow very interesting. I've been happy to be in single figures following meals. Better be more strict then!

 

[iHs]

I would need to permanently use cgm to achieve such tight control and eat a very low carb diet to avoid multi injections.

 

[MickyFinn]

Wow very interesting. I've been happy to be in single figures following meals. Better be more strict then!

That's now the general idea. I think I am going to aim to be between 5 and 7 from now on. My practice DN wants me to maintain bg levels of 7 and over, but clearly that now goes out the window.

 

[catapillar]

I would need to permanently use cgm to achieve such tight control and eat a very low carb diet to avoid multi injections.

One can but hope that if they use these targets in the guidelines, they will discover that CGM + pump are invaluable to achieving them and therefore provide the tools and training needed to use the tools to achieve the targets.

And also, I would like world peace (well, I thought as I'm being wildly optimistic I'd throw it out there).

 

[CathP]

What was the bg target range before then? We've had 4-7 mmol as the target for our 5 year old since dx a year ago...

 

[iHs]

I would like to know where the money is going to come from to fund cgm and insulin pumps if not from a rise in income tax and an increase in other taxes.

 

[catapillar]

What was the bg target range before then? We've had 4-7 mmol as the target for our 5 year old since dx a year ago...

Nice targets are currently 4-7 pre meal and <9 90 minutes after eating, for adults with type 1, and a hba1c <48

 

[iHs]

That's now the general idea. I think I am going to aim to be between 5 and 7 from now on. My practice DN wants me to maintain bg levels of 7 and over, but clearly that now goes out the window.

As as I know, loads of insulin dependant diabetics have been experiencing hypos due to trying to keep bg levels too low and have been admitted to hospital in back of ambulances with iv glucose drip going in so that's why the new bg targets have been changed.

 

[catapillar]

I would like to know where the money is going to come from to fund cgm and insulin pumps if not from a rise in income tax and an increase in other taxes.

I don't know. I'm kind of happy with the option you propose. Also, if they fund my CGM and that stops me hypoing overnight and waking up with a significant brain injury that requires 24 hour care I can carry on working full time and paying taxes etc, also the CGM will be significantly cheaper than 24 HR lifetime care.

I didn't pretend it was realisic or viable - just an optimistic hope with no actuall plan of how to actually implement it. But then maybe if there is "buy in" that that technology is required to achieve targets, then there might be an incentive for people to actually do a long term cost benefit analysis of the technology. You know, something along the lines of: without CGM out of 100 diabetics not on CGM in 30 year 30 of them will not be working and payin NI, of those 30, 10 will have had laser treatment for retinopathy, 2 will have had dialysis, 8 will require frequent visits from the distric nurse for wound dressing, 10 will have had hospital admissions by ambulance for hypos. But with CGM numbers and cost of diabetic complications/ emergency diabetic treatment is greatly reduced to the extent that it pays for itself. I don't know, I've just pulled numbers out the air, but it's that kind of research that is required, I think, to make an informed funding decision on diabetic technology.

Sorry, so off topic!

 

[CathP]

Nice targets are currently 4-7 pre meal and <9 90 minutes after eating, for adults with type 1, and a hba1c <48

Ah thanks, so they're suggesting people stay below 6.9 post meal as well then? We do try, but nightscout data says we only achieve 4-7 mmol 70% of the time. So still work to do.

 

[MickyFinn]

What was the bg target range before then? We've had 4-7 mmol as the target for our 5 year old since dx a year ago...

I was told the target range was to aim for between 5 and 8.

 

[MickyFinn]

I would like to know where the money is going to come from to fund cgm and insulin pumps if not from a rise in income tax and an increase in other taxes.

They're not going to fund CGM's and pumps. These latest guidelines have come about as a result of research based on trials of specifically the freestyle libre.

 

[MickyFinn]

As as I know, loads of insulin dependant diabetics have been experiencing hypos due to trying to keep bg levels too low and have been admitted to hospital in back of ambulances with iv glucose drip going in so that's why the new bg targets have been changed.

The other part of it is to apparently get the background insulin dose exact. That is supposed to be done by eating a carb free meal for lunch and testing bg two hours after. If the dose is correct, bg would be within 2 m/mol of what it was pre meal. Same is carried out on a separate day for the evening meal/night time dose.

 

[himtoo]

this is really interesting ..so overnight I have become a "bad diabetic" with my post meal spikes hitting 8.6 ( tonights meal )

with changing the targets the money to fund achieving those targets require adjusting ...........

 

[CathP]

I was told the target range was to aim for between 5 and 8.

Perhaps they advise different for children? We correct anything over 7.

 

[MickyFinn]

As as I know, loads of insulin dependant diabetics have been experiencing hypos due to trying to keep bg levels too low and have been admitted to hospital in back of ambulances with iv glucose drip going in so that's why the new bg targets have been changed.

And this is also something that was raised last night. I have had one mild hypo in 7 months. We were all told last night that we should expect to have three mild hypos per week. This is partly why I have suggested that I expect most people will ignore this. I see nothing wrong in aiming for a bg of around 6. The suggestion is that doses of both background and fast acting need to be tighter with no guessing.

 

[iHs]

I cannot see many hospital clinics following these guidelines just because of a research trial using technology that only a small number of diabetics can afford to buy due to the high expense. As it is, loads of diabetics are not getting sufficient bg teststrips thanks to CCGS