The Diabetes UK Professional Conference kicks off today

[tim2000s]

If the conference doesn't begin until tomorrow, is this from a pre-meeting going on?

Yes, and being Young Endocrinologists and Diabetologists, I expect drinking this evening

 

[Dark Horse]

Wasn't talking about Micro and Macrovascular complications. Looking at nervous system, retinal and kidneys. Slightly different spin. I've asked for the data - will hopefully get a copy of the slides @phoenix. Vascular seems to be ignored. Doesn't look like particularly new data though.

Just for clarity: Neuropathy, retinopathy and nephropathy are the microvascular complications of diabetes.

 

[tim2000s]

Thanks for that @Dark Horse. I clearly need to do more reading to pass my diabetology exams Always good to be reminded of the extent of our knowledge. Original post has been updated to reflect your comments.

On further reading it seems as though there is some controversy as to whether Neuropathy is a truly microvascular complication or whether there are other factors? Would you be able to comment on those theories?

 

[phoenix]

Example given shows high as ranging 4-20 and low as ranging 7-10. Also stated that higher average with lower variability better than lower average with higher variability.

That's important. Vast difference between 4-20 and 7-10 !

 

[Bluetit1802]

That's important. Vast difference between 4-20 and 7-10 !

Is this a T1 thing, or am I being thick, because I still don't know what it means. Please can someone explain?

 

[Dark Horse]

Thanks for that @Dark Horse. I clearly need to do more reading to pass my diabetology exams Always good to be reminded of the extent of our knowledge. Original post has been updated to reflect your comments.

On further reading it seems as though there is some controversy as to whether Neuropathy is a truly microvascular complication or whether there are other factors? Would you be able to comment on those theories?

I'm sure we are all learning from these forums. I don't know about a controversy but according to the WHO (World Health Organisation):-
"Diabetes causes nerve damage through different mechanisms, including direct damage by the hyperglycemia and decreased blood flow to nerves by damaging small blood vessels. This nerve damage can lead to sensory loss, damage to limbs, and impotence in diabetic men. It is the most common complication of diabetes."

So although neuropathy is usually described as a microvascular complication, it is thought that there is also a direct effect on the nerves.

 

[tim2000s]

From what I could find, it appears that Neuropathy is considered to be the one of the complications whereby cells are directly affected by the polyol pathway opening up under hyperglycaemia and causing increased oxidative stress. From what I've read, there's some belief that this also affects aspects of the eye as well as the blood vessels.

 

[tim2000s]

Is this a T1 thing, or am I being thick, because I still don't know what it means. Please can someone explain?

One of the drivers of the micro-vascular and polyol pathway driven complications seems to be variation in BG levels.

This is described as glycaemic variability and there is increasing research into this area. It tends to be more of an issue in T1s than T2s, as T1s tend to suffer from peaks and troughs when insulin doses don't match or aren't timed well with carbs eaten (!) and is one of the key factors in the Bernstein approach.

The upshot of the presentation that Nick Oliver gave was that high bloods are bad, high variation around a mid level is also bad and it gets progressively better from there. Ideally you'd be lower bg with minimal variation to reduce the risks of Neuropathy, Retinopathy and Nephropathy, but we know how much of a challenge that can be. As a result of what seems to be a link here Retinopathy is seen as the indicator for the other two risks, although there is some controversy as to whether the effects of a high level of variation also act directly on the cells involved as well as the capillary blood vessels that feed them.

 

[tim2000s]

Interesting news from the Conference this morning:

First sight of the REPOSE study in the wild, and it shows that with DAFNE, both Pumps and MDI generate similar Hba1C levels. The key being that without structured education neither is as good. At the same time, DAFNE/Structured Ed budgets are being cut around the UK.

Recent studies seem to show that T1Ds who exercise soon after diagnosis retain beta cells more effectively than those how don't. There is also a supposition that continuing to exercise helps to retain. Issues with T1Ds wanting to exercise on medical grounds as they don't know how to deal with it. I have observations here that I will hold off from in this topic.

Further updates as I get them...