Research amongst patients with Type 2 Diabetes on insulin reveals how emotional and psychological factors are negatively impacting their condition
A quarter suffer from anxiety over getting hypos (low blood glucose levels) with more than 40% preferring to have high blood glucose levels instead of risking another hypo. This can lead to serious long term health risks
A new campaign launches today called ‘Diabetes Highs & Lows: Better Balance for a Better Future’ which highlights how emotional and psychological factors can have an impact on effective T2 diabetes management
The campaign includes the launch of a patient support website, DiabetesHighsAndLows.co.uk which is dedicated to helping patients with T2 diabetes better manage their blood glucose levels. The website is developed and funded by Sanofi.
A quarter of people with T2 diabetes feel anxious or fearful about ‘hypos’ (low blood glucose levels), with 42% preferring to have high blood glucose levels instead, despite the risk of life threatening conditions in the future.[i]
The findings also revealed that a significant proportion of patients with T2 diabetes believe that other people think they are to blame (15%), and some patients believe that other people think they are just greedy (14%) 1 . Likewise, 25% of patients with T2 diabetes only tell close friends, family or their healthcare professional about their diabetes, and 58% feel self-conscious or avoid injecting in front of other people, negative emotions are stopping people managing their condition properly.[i]
Another Sanofi-funded study conducted in adults with Type 1 and Type 2 diabetes in the UK, and published in the journal Diabetic Medicine, showed even modest improvement in blood glucose control could help prevent almost a million serious medical complications such as eye disease, kidney disease, foot ulcer and amputations, and potentially blindness, which could avoid billions in future NHS costs.[ii]
With the UK having the worst control of T2 diabetes blood glucose levels in Europe[iii], Sanofi, who conducted the report, is launching a new patient support website to help the 52% of T2 diabetes patients who find it hard to balance their blood glucose levels.[i]
The Sanofi ‘Diabetes Highs and Lows: Better Balance for a Better future’ campaign aims to help people with Type 2 diabetes feel in control and positive about how they can balance their blood glucose levels. A new website, developed and funded by Sanofi has been launched, diabeteshighsandlows.co.uk, which includes key information on recognising and managing blood glucose highs and lows.
[i] Sanofi Data on File 2016. “Highs and lows: better balance for a better future” market research
[ii] Baxter et al, Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the
number of clinical complications and the associated financial benefit. Diabetic Medicine (2016). DOI: 10.1111/dme.13062
[iii] Khunti K et al. Study of Once Daily Levemir (SOLVETM) insights into the timing of insulin initiation in people with poorly
controlled Type 2 diabetes in routine clinical practice. Diabetes, Obesity and Metabolism (2012)
One of the big confusions, for a lot of people, is what are the different types of diabetes. In fact a lot of people have never heard of type 1.5 and type 3 diabetes. So we though we would ask Dr Max Pemberton who is an expert in this field!
He told us “I think this causes people a lot of confusion. There’s three main ones – Type 1, Type 2 and gestational diabetes and they’re all quite different. Type 1 diabetes is caused by an immune response whereby the body creates antibodies to the cells that make insulin in the pancreas, and it destroys those cells. So people with Type 1 diabetes no longer have the cells that make insulin, and so therefore they have low or no insulin in their blood.
Type 2 is quite different and that’s where the cells in the body have become resistant to the effects of insulin, so their body still makes insulin but the cells aren’t responding to it in the way that they should.
Now, gestational diabetes, that refers to a condition where women who are pregnant can sometimes develop diabetes and it’s just for the time that they are carrying a baby. So when they then give birth the majority of them, the diabetes then sort of passes. It’s really a response to being pregnant and the physical and hormonal changes that take place. People with gestational diabetes are at risk in the future of possibility developing diabetes but it is one of those things at the time, it then does go.
Now there’s these other terms that you mention, 1.5 and Type 3 and to be honest these complicate matters a bit. So all that 1.5 means really, it used to be thought that Type 1 diabetes affected people when they were very, very young and that’s when they first got diagnosed with it, and Type 2 was a result of lifestyle like being obese and so on, and that tended to happen when people were much older. Actually what they realised, that there is a group of people who despite might be relatively normal weight, they don’t have high cholesterol and so on and so on, so relatively physically healthy and yet still it’s often in their 40s or so they develop diabetes. So it’s not clear if it’s because of lifestyle changes, and it’s got a component probably of auto immune to it but it’s just presented much later, so it sits in-between Type 1 and Type 2 so they call it Type 1.2. To be honest I don’t think it is particularly helpful, I think it just confuses people.
Type 3 again I find it a slightly confusing term. It’s used by researchers just to talk about the evidence that shows that in some types of Alzheimer’s, the brain has become resistant to the effects of insulin. It’s just purely one of those scientific anomalies no one really quite understands quite what this means or the implications for either Alzheimer’s or indeed diabetes, but it’s one of these things you hear very occasional, sort of banded around usually within academic circles. It’s not something to worry about. Personally I definitely don’t think about Type 3 diabetes. The main three don’t forget are Type 1, Type 2 and gestational diabetes. ”
We also asked for a definition of pre-diabetes. Max told up “Although there are three main types of diabetes, there’s also a stage before diabetes and that’s called pre-diabetes. It’s noticed impaired glucose tolerance and it’s a condition where your blood “
As many of you know by now this week is Diabetes Week. To help promote understanding and awareness of diabetes we have conducted this fascinating interview with TV’s Dr Rob Hicks.
PATIENTTALK.ORG: Ok so just to start, can you please tell me what diabetes is?
DR ROB HICKS: Well diabetes is a condition where basically there is too much glucose in the blood and the consequence of that is that the glucose damages the blood vessels in the circulation and it damages the nerves and if somebody has diabetes and it’s not properly treated or managed then there is a risk of damage to the circulation or the nervous system resulting in complications like heart attacks, stroke, kidney disease and damage to the skin around the feet and indeed blindness which is why we make a big effort in healthcare to encourage people to watch out for the warning signs and indeed to get themselves checked to see if they have got diabetes.
PATIENTTALK.ORG: And can you explain the differences between the various types: type 1, type 2, and type 3, 1.5 and gestational diabetes
DR ROB HICKS: Yeah there are different types of diabetes, type 1 diabetes is where the body for some unknown reason turns on itself, it damages the pancreas which is the organ in the body which makes insulin such that a person really doesn’t have any insulin or at least they have a very tiny amount and that’s why people with type 1 diabetes need to have insulin usually by injections in order for them to remain fit and healthy. Type 2 diabetes which is the more common form of diabetes, it affects around 90% of people who have got diabetes, it happens when either there isn’t enough insulin or the insulin that is there doesn’t work properly so the body becomes resistant to the insulin and you also mentioned gestational diabetes and that diabetes that essentially develops for a woman when she is pregnant and that makes up about 5% of women who are pregnant will develop gestational diabetes.
PATIENTTALK.ORG: And what that just be in the period of the pregnancy or would that then turn into a different type of diabetes?
DR ROB HICKS: For the most part women who develop gestational diabetes once they have had their baby the diabetes disappears however saying that they are at a greater risk at developing type 2 diabetes later on in life so it would again be important to keep an eye on.
PATIENTTALK.ORG: What are the warning signs of diabetes?
DR ROB HICKS: Well there are symptoms for many people that act as warning signs I mean particularly for type 1 diabetes, they are passing urine more often particularly at night, feeling very thirsty despite drinking lots of liquid, feeling very tired or indeed losing weight when you are not trying too and one of the places I work is a sexual health clinic and we often see that people are get recurrent bouts of thrush infection despite the right treatment it comes back and get treated then comes back again , they often have underlying diabetes, another possible symptom is the slow healing of wounds or blurred vision. Now for someone with type 1 diabetes these symptoms become quite obvious and can happen over a couple of weeks. The challenge is that with type 2 diabetes which tends to affect more mature adults so traditionally over the age of 40 although it is possible to get type 2 diabetes earlier in life often the symptoms are not so obvious so somebody might get diabetes but may not get any symptoms which is why we encourage people to get tested, in face the current figures suggest that just short of 600,000 people in the UK have diabetes but are not yet aware of it because they haven’t been diagnosed so again this is why it’s important to get this checked , particularly if you have got diabetes in the family , if your over weight and if you are in an specific ethnic group so if you from south east Asia , Chinese , African Caribbean or black African origin then the risk of diabetes is greater in these groups so again it should prompt you to have a chat with your doctor about whether you should be tested.
PATIENTTALK.ORG: And what are the complications of diabetes in particular foot ulcers and sight problems?
DR ROB HICKS: Yeah I mean diabetes that is not treated or managed properly the damage to the heart and circulation is likely to increase the risk of someone having a heart attack or a stroke, the damage to the kidneys a form of kidney disease can happen, in men diabetes can also be the cause of erectile dysfunction, you also mentioned foot ulcers and because they are harder to treat and harder to heal or sometimes can be ignored for a while by an individual may result in amputation being needed off a foot or a lower limb. You mentioned the issues with sight, if diabetes isn’t treated properly it can damage the back of the eyes can damage the retina and indeed if that’s not treated properly then that can result in blindness.
PATIENTTALK.ORG: What treatments are available and how effective are they?
DR ROB HICKS: Well nowadays we have a host of treatments available, so everyone will be offered for type 1 insulin because they need it as they are not making any or are making very tiny amounts. For type 2 diabetes they will be advised to follow a healthy lifestyle such as losing some weight and being more active and there are different ways of achieving that so somebody might choose to use a health app for example. Who did a health report make health apps to help try and encourage people to adapt their lifestyle to healthy one and then there’s medications for people with type 2 diabetes and indeed some people with type 2 diabetes also need insulin to keep the condition under control.
PATIENTTALK.ORG: And what are the best ways of preventing diabetes/
DR ROB HICKS: With type 1 diabetes you can’t prevent it but thankfully with type 2 diabetes many people can prevent it and the best way really is to maintain a healthy weight, so lose weight that you need too to achieve a healthy weight and particularly try to get rid of the fat around your middle around your tummy as that alone increases the risk significantly of somebody being diagnosed with type 2 diabetes.
PATIENTTALK.ORG: And what advice would you give to somebody who has just been diagnosed with diabetes?
DR ROB HICKS: I think the advice I would give to somebody who has just been diagnosed with diabetes is to take it seriously, make sure that you seek the advice of your doctor / diabetes nurse, know that you can be in control of it I think I important and the control of it is extremely important to avoid the potential complications and if it means losing weight as it often does then choose a way that works for you , choose a way that suits you so that may be going for a brisk walk a day or a bike ride, it might be using a health app to motivate you and help you in a fun way monitor how well you are doing. I think that the bottom line increasingly we are seeing many people who are not following a healthy lifestyle I mean the Noom Report showed that around 1 in 3 people said that they never exercise and almost 2 in 5 said that they would wait till they have a health scare or a warning from their G.P before they did anything healthy or adopt a healthy lifestyle, I always say to people don’t wait get onto it and do it now whether you have got diabetes or not.
PATIENTTALK.ORG: That’s fantastic, Rob is there anything you would like to add at all?
DR ROB HICKS: I mean if people want to find out more about diabetes or whether they should be tested then obviously they can have a chat with their G.P or if they want to find out about Noom Then they can log onto noom.com/diabetes.
PATIENTTALK.ORG: Wonderful thanks so much for your time and for answering all of those questions.
Recent research has suggested that too little sleeps increases the risk of developing type 2 Diabetes. Indeed 9 in 10 are consistently plagued with disturbed or sleepless nights and almost half say that it was worrying about something that keeps them awake at night – with money being the obvious concern. In fact is sleep is disturbed a person is quite likely to only sleep for four hours.
PatientTalk.Org conducted this interview about sleep and diabetes with TV’s Dr Rob Hicks just before Easter!
We kicked off with asking Rob to tell us a bit about the connection between sleep and diabetes. He replied “The connection is that if you’re suffering with a problem with sleep and so for example you’re not getting enough sleep that there is a link with an increased risk of developing type two diabetes and that’s two fold, one is because people who do not get enough sleep tend to gain weight and that’s often because actually when we are tired we eat more comfort food and we are less active and there’s also been some research recently suggesting for people who are not getting enough sleep on a regular basis this effects just how effective insulin is , it increases something called insulin resistance which is felt to be the most main reason for type two diabetes so this is one of the many reason why we should take a good night’s sleep very seriously indeed. ”
Turning to the prevention of diabetes he shared “Well the important thing about a good night sleep is obviously the following day if you haven’t had a good night’s sleep you feel really tired , not only loss concentration pool but also productivity is likely to be bad but also you switch to move too eating more comfort food which tend to be high in calories and high in saturated fat, your less likely to be active you’re more likely to drink alcohol, that piles on the pounds in weight and the major risk factor for type two Diabetes is gaining weight. ”
Of course a good nights sleep is important for those who have already been diagnosed with diabetes. “A good night’s sleep is good for everybody whether they have got diabetes or not because one of the problems is with not getting a good night’s sleep and certainly the Dunelm sleep survey has highlighted this is that people who are left tired the following day they are more likely to be irritable, they are more likely to adopt unhealthy lifestyles habits that increase blood pressure that increase cholesterol , we know that those factors increase the risk of not just diabetes but also of heart attacks and strokes but also it increases the risk of stress and anxiety and when we are felling stressed again we don’t follow healthy practises so if we want to get the best out of the day look after our emotional and physical well being then it’s very very important to have a good night’s sleep. ”
It’s one of the most exciting fields of scientific research today, yet more than a third of the country say they don’t really know anything about it.
We have covered this area a number of times at PatientTalk.Org.
New treatments for Alzheimer’s, and Parkinson’s, or methods of repairing heart muscle, are vital in an aging society. Yet new research out today shows stem cell research, which has already made great progress in these fields and others, remains widely misunderstood and under-utilised.
Research shows that 83% of parents with children under ten feel well enough informed about the science of regenerative medicine to make decisions about their or their children’s stem cells. So is it that a safe and common source of stem cells – umbilical blood cord – is massively under-utilised? The first successful blood cord transplant was performed in 1988 and the method is now a treatment for many medical conditions.
Collecting umbilical cord blood and tissue is a fast way to build up a representative cord blood registry, but the combination of confusion amongst parents to be, and a lack of facilities and trained staff, mean that most of this potentially life-saving material will simply be destroyed. The new research shows that only 28% of parents of young children have even been informed about the option of stem cell storage.
A new partnership between the charity Precious Cells Miracle and the NHS Trust Croydon will start to address this imbalance. PCM will provide NHS hospitals with the staff, technology and specialised equipment necessary to collect cord blood units from families willing to donate them. Patients can choose to donate their cord blood stem cells to build up the Government’s public stem cell bank, effectively donating to any person in need, or they can privately store them for their own family. Increasing awareness of the potential of stem cell research and clearing up confusion around the subject is expected to lead to much higher acceptance of regenerative medicine.
PatientTalk.Org interviewed Dr. Husein K. Salem, BSc PhD, Founder and CEO of Precious Cells International and Dr. Salmaan Dalvi, PhD, Head of Implementation and Governance at Precious Cells Miracle: Community Blood Cord Registry to find out more about stem cell therapy!
PATIENTTALK.ORG What actually is stem cell therapy?
DR. HUSEIN SALEM Stem Cell therapy is the new form of medicine that were seeing coming through now it’s a medicine that’s actually been practised for over 60 years you’ve probably heard of bone marrow transplants.
DR. HUSEIN SALEM Yeah so it’s, bone marrow transplant is now called stem cell transplants and the idea of stem cell therapy is replacing cells in the body in specific organs depending on the type of disease that your treating with new cells that don’t have the problem that particular cells do have so if you take the example of Leukaemia, you’ve got specific red blood cells that have cancer, so you’ll remove the cancerous cells replace them with stem cells and then the stem cells will then become healthy functional red blood cells that don’t have the cancer.
PATIENTTALK.ORG and what kind of conditions is it suitable for?
DR. HUSEIN SALEM great question, I’m going to use the word theoretically, but theoretically stem cell therapy can be used to treat any disease, any disease that you think of because ultimately disease is a breakdown of cells in specific organs whether were talking about motor neuron disease, Alzheimer’s, Parkinson’s, Leukaemia , diabetes and if you think that within specific organs let’s take diabetes for example where within the pancreas the cells that produce insulin are no longer able to do that stem cell therapy becomes very exciting because you can replace the specific cells not the entire organ, but the specific cells within that organ that are no longer producing insulin with stem cells once those stem cells are within that organ they’ll then start to function as healthy cells and replace the ones that have been damaged and in the case of diabetes start producing insulin.
PATIENTTALK.ORG And why’s it considered an ethical mind field in some quarters?
DR. HUSEIN SALEM Again a really great question one of the reason why Precious Cells are really supporting Stem Cell Awareness Day and it’s to push the fact that a lot of people are unaware that there’s are two types of stem cell research that goes on. There’s embryonic stem cell research and that’s actually the research that is clouded in moral ethical debates, because it takes stem cells from embryonic sources. Whereas there’s another whole form of stem cell therapy which is called adult stem cell therapy its taking stem cells from adults, from umbilical cord blood one of the areas that special cells group specialise in and that is completely endorsed and back by every major religion in the world by every major government in the world by every major scientific community, medical community and the Labe public.
PATIENTTALK.ORG And what are their cost implications?
DR. HUSEIN SALEMI Another great question, obviously at the moment were talking about mostly clinical trials so there is still a lot of work to be done in terms of developing the actual treatments for a lot of these diseases, but what we do think, and what a lot of white papers are showing is that stem cell therapy will cost a fraction of what current treatments cost. Again this is one of the big reasons why major governments around the world are spending significant amounts of investment into developing this type of therapy because it’s going to be from an economic perspective a lot more cost effective for health care infrastructure.
PATIENTTALK.ORG What is provision like in the UK? Is it poor, is it good? Would you blame the structure of the NHS?
DR. HUSEIN SALEM I’m going to pass you over to my colleague Dr Dalvi who’s head of implementation and governors, he’s got a great incite having worked within the NHS quad bled infrastructure for a number of years.
Doctor Salmaan Dalvi -The NHS structure is set up in such a way that the NHS has been funded for six hospitals in and around the London area to collect 50 thousand stem cell units from cord blood and supply the whole nation. That is not feasible when you’ve got mothers all over the country and when the NHS stores its cord blood it is then processed in Bristol, collected in and around London, processed in Bristol, stored in Bristol. You expect a hymnologist to be able to use it, when you have got nationwide, you’ve got 90 hundred hospitals, or maternity hospitals of good quality with a lot of diversity, of patients of a lot of different ethnicities to be able to give you good quality stem cells. For a country like the United Kingdom, when you’ve got roughly 70,000 birds why haven’t we collected the 50,000 that were targeted by the NHS itself, so that is a question in its self.
PATIENTTALK.ORG Would you advise travelling abroad for treatment?
DR. HUSEIN SALEM No, it’s a case of various types of therapy developing the fastest and what we’ve found is countries where regulations are not as stringent as they are in places like the UK for example stem cell therapy has developed a lot faster for example in the far east, that said lack of regulation and control does mean that it also suffers from having a number of rogue treatment centres, and it’s very difficult for the public to really decipher between a credible centre and a rogue centres that may not actually be injecting stem cells from humans, could be injecting stem cells these have been reported cases of injecting animal stem cells into patients and charging £25,000-£50,000 pounds per procedure. So again it’s a case of the UK needing to invest more funding into stem cell therapies here to prevent reverse medical tourism, we’ve always been the centre of the world in terms of innovation, technology. With more investment here we wouldn’t need people to travel abroad for stem cell therapy.
Doctor Salmaan Dalvi -Can I add to that? What precious cells miracle is about is to collect Precious Cells as in cord blood stem cells from the UK for the use in the UK and abroad if we can give it to someone outside the UK that’s fine, but for now it is UK cord blood cells to be used in the United Kingdom for the United Kingdom therapies where we need it. There’s an urgent need for stem cells and we are not providing and we are not catered for that.
PATIENTTALK.ORG Could you tell us more about how these stem cell banks work?
DR. HUSEIN SALEM Yes, sure. The technology behind bio banking is again a very well established it evolved from the IVF technology which is 60 years old in itself. It takes cord blood stem cells from the umbilical cord after the babies been born again this after the cord has been cut from the baby and the placenta’s been delivered so there’s absolutely 0 harm to the mum or the baby. It’s really important, there’s a lack of awareness in that people are worried it’s going to harm the mum or the baby that there is 0 risks to either. We have a team of trained specialists, called phlebotomists. There able to collect the cord blood from the cord, the blood itself will typically get anywhere between a 100-150 mills of blood, it then goes through a very technical scientific procedure that separates the red blood cells, the plasma and the stem cells that are in the cord blood. Then going through cryogenic technology which is freezing, it’s frozen in a very controlled manner, 1 degrees per minute it drops down. It’s finally put into liquid nitrogen, which is stored at minus 196 degrees. One of the questions a lot of people ask is how long can stem cells be stored for? The research around the world shows that stem cells can be stored indefinitely, so for over a hundred years for example. Then they’re kept in a database that Haematologists and transplant centres around the world can access, and if they have a patient who needs a specific tissue type match for the Leukaemia or thalassemia for example then they’re able to access that, that sample will be taken from the cryogenic banks that we hold, and shipped immediately to the physician who will then be able to perform the transplant. Part of marking stem cell awareness day is that were looking and were establishing more and more centres around the country precious cells group is leading this through precious cells miracle alarm, and were looking for more and more trust to really get on board and to contact us they can find out more information about how both the public, so patients themselves can get involved and also healthcare professionals who need to understand more education so they can educate their parents. They can go onto our website http://www.preciouscellsmiracle.com .