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Diabetes Dissertation Topic Help?!!!!

V

Vondsuk

Newbie
Messages
4
Type of diabetes
Type 1
Good evening everyone,

I am currently leading up to my dissertation module and would love to do something about diabetes.
I am a nursing 3rd Year student and so far I have done some research around diabetes but in regards to patient education on the role of insulin and how exercise plays an important role in regards to optimal blood glucose.

I have been on and off with this topic and I keep coming up with other idea topics I was hoping if any one you could help me with a dissertation question.???!!

Hope to hear from you all soon!
God bless xx
 
How about patient education on the role of carbohydrates in diet for non-insulin users?
That should be a good one!
 
How about the role of insulin, in the build up to insulin resistance and type 2! (Hyperinsulinaemia!)
 
Ah - exercise hasn't exactly played a great role in the improvements in my post prandial numbers I was 17.1 mmol/l at diagnosis and the last reading I took was (correction) 5.8 - some slight increase in movement as I feel so much better, but all I did was reduce carbs. I even stopped taking Metformin as it is so nasty to my gut.
 
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Vonds, there's a lot of politics going on at the moment about whether Libre and the others should be on the NHS.

I think a good, and topical, subject would be how useful are AGP graphs in a clinical context.

At all hospital check ups I've been to, there's been a lot of emphasis placed on hba1c results. That's fair enough, it's a valuable tool. But it's still just an average: if there's a good result, it's either because bloods have been good consistently across the entire period, or because there's wild swings between highs and lows. That's the problem with averages, the detail is missing. Docs will just say, your hba1c is low, you must be having hypos all the time.

On the other hand Libre and the others have the AGP, ambulatory glucose profile graph, which does some fancy statistical stuff to present a "modal" or typical day. I've been able to see recurring patterns in mine which have been massively useful.

Yet, one doc at consultation told me, "we don't pay much attention to these because they're not on the NHS yet", whereas another doc at the same hospital spent twenty minutes looking over the AGP and daily graphs and actually paid attention to them.

I think we're at this point where the change from meters to cgm will be as massive as the change from colour changing strips to meters, and it's just politicians standing in the way of it.

Roger Mazze is the guy who came up with the idea of the AGP, so google him. My DSN is also T1 (I see you are too) and she's convinced that cgm will be standard in the next few years. I don't think you'll do your career any harm at all by disserting on a topic which is a major step change in D management.
 
Same here - exercise has had little to do with me controlling my BG. My highest ever BG was 33.7 - now living happily in the 4s, 5s and low 6s.
 
My biggest question is why health care professionals seem reluctant to promote a low carb lifestyle when, for so many people, it obviously works.
 

VondsUK, I guess if you want to do something diabetes related one of your considerations could be whether your findings would be going against the flow of current mainstream belief, and if they did, what impact that might have on your end result; your degree.

Going back to your original question though, there is some fascinating work going on at the moment on the impact of very basic exercise on insulin resistance and blood glucose control. It follows on from this paper here: http://www2.le.ac.uk/offices/press/...ber/standing-up-helps-prevent-type-2-diabetes

I found it utterly fascinating that it appears standing up for 5 minutes every 30 can have a fairly significant impact on blood glucose and also on the accumulation of visceral fat around the mid-section.

The practical lab work for the study above was conducted in a shared Uni/NIHR lab, and from the description very simple to replicate, as well as cheap, just a controlled environment with T2 participants willing to sit and be sedentary for an 8-hour day, with a defined diet to be consumed during the same period.
 
Things I sometimes ponder include why there aren't any tests done to profile the type of T2 Diabetes an individual has. Oh, and confirm that it is T2 and not slowly creeping T1.

Broadly you can be insulin resistant but producing plenty of insulin, or your pancreas is failing and your insulin production is dropping.

I understand that this is not done because the default treatment is much the same; Metformin, progress to oral stimulation of insulin production, progress to injected insulin. However beating a failing pancreas with a big stick may be futile.

I think that there could be two completely different treatment profiles; one to reduce insulin resistance and the other to reduce insulin demand. Nutritional ketosis can give good blood sugar readings with a very small insulin demand.

I also wonder why there isn't more emphasis on establishing how much visceral fat there is. I have had my ultrasound scan (not pregnant, my aorta looks pretty sexy) and I do wonder why you can't have a scan of your abdomen to estimate how much fat you have around your liver and pancreas. All the kit is there and there are trained staff. Size of your liver could also be significant. Having something measured and being given a target to change this can be very motivational.

On a completely different tack, you might like to look at the composition of a Multi Disciplinary Footcare Team (MDFT) and see how many hours each discipline allocates per week per bed and how this affects major harms. Compare to the profile of a Diabetes Inpatient Specialist Nurse (DISN) at one per 250 beds.
 
Hi. I guess I could write along list of things to cover, but here goes. Not sure whether you want to focus on injected insulin or the role of natural insulin in the body, but here goes:

1) Insulin is produced in response to glucose in the blood (bit of a simplification but good enough). Too much glucose and the liver starts converting it to fat and this gets deposited around the body hence insulin resistance. This is the 'classic' T2 situation. Metformin is the first drug of choice for that.
2) If the pancreatic insulin output is reduced thru anti-bodies or a few other factors such as viruses, pancreatitis etc then the glucose can't be metabolised. This is T1 and if it occurs in childhood then insulin is always injected. T1 can and does frequently occur in adulthood and referred to as Late onset T1, LADA or T1.5. This is effectively the same as childhood T1 but may creep up slowly. It can be treated for a while by stimulating the pancreas with a sulfonylurea tablet such as Gliclazide but insulin will eventually be needed. This late onset T1 is not well understood in the medical profession and often, wrongly, diagnosed as T2. The treatment is not the same as T2 as there is a lack of insulin and not too much. The c-peptide test will show the rough level of insulin being produced. The GAD test will check for a few common anti-bodies.
3) Long-term badly managed T2s can suffer insulin deficiency thru high-blood sugar damage and insulin is then, but only then, needed. Many overweight T2s appear to be given insulin 'as a last resort' which can be counter productive unless a C-peptide shows a deficiency. Injectables such as Victoza may be the better solution.
4) Most of us on the forum know thru experience and our meters that carbs are our enemy and NOT fats or protein. Carbs means all carbs and not just sugar. If you work with the NHS and related government bodies you will find the opposite advice based on very poor earlier research and the food industry lobby. This latter lobby is extremely strong and resulted in the recent Eatwell Guide update (check meeting attendees and who funds the University researchers). You may find very high resistance with your dissertation if you dare to challenge the 'Carbs are good' mantra.
4) Exercise is important but not as important as many in the NHS believe. This is pushed strongly in my opinion to avoid the serious diet advice debate as many know it's a rats nest. The result, sadly, can be bariatric surgery, lost limbs etc. So, the right diet is number one and then exercise and meds where relevant.
5) With regard to injected insulin, I can see from this forum that GPs vary in their advice and choice. Mixed seems to be fine for T2s who may need some extra management or Late onset T1s still in their honeymoon period. For almost any T1, however, when insulin is needed the Basal/Bolus regime seems to be by far the right choice. Some still use vials rather than pens for historical reasons but I've not come across any Pros for it over pens?
6) Carb-counting with insulin. Well I have to be honest and say that the NHS makes a real meal of it making patients wait months to go on week long training courses. It can be taught in 15 minutes in the surgery for many when starting insulin (like it was for me). Carb counting is VERY important and too important to leave for other than a few weeks after starting Bolus.

OK, I'll leave it at that for now. Not everyone will agree with my points but after reading posts on the various forums now for several years patterns emerge. I'm not an expert but merely a user!
 

http://www.diabetesforecast.org/2015/sep-oct/tests-to-determine-diabetes.html
 
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