How many of you heard in the news that Home Secretary Theresa May has been diagnosed with type 1 diabetes? It sounds like she had the classic weight loss, which often comes with uncontrolled diabetes.
I was intrigued to hear that for someone who quite obviously has a very erratic lifestyle and quite irregular meal times as Home Secretary, she is on a twice-daily insulin regime. I would presume that she is taking a mixed insulin, but would challenge her statement that it will not interfere with her work as Home Secretary.
Of course there is no reason why in the long run she would not be able to manage her diabetes well, and live a normal life; however being a senior politician is incredibly demanding, and there must be significant dangers of hypoglycaemic attacks when she has been unable to eat sufficiently at the right time.
We will have to stand back and watch with interest. It seems there are a number of MPs with diabetes, but more seem to develop type 2 diabetes such as Keith Vaz and Adrian Hamilton, who is chairperson of the All-Party Committee on Diabetes.
How many of you have been advised by your clinical commissioning group (CCG) that you need to be more selective in the blood glucose monitors you supply to your patients? This is a cost-saving exercise, as we are being encouraged to use meters for which strips cost up to £10 for a box of 50.
Unknown to me, my practice manager got my colleague to order in some of these meters, and also accepted some other meters with cheaper test strips, so I am now awash in meters about which I know very little, and certainly nowhere near enough to be able to teach patients how to use them effectively. In such a small practice, I should think I now have a year’s worth of meters or more.
We are now coming to the end of Ramadan, and I think my Muslim patients have got through this okay. Although an exemption from fasting between sunrise and sunset is permissible, most patients don’t see diabetes as a reason not to fast.
And it is not just food - water cannot be consumed in daylight hours either. With the weather we have just experienced, can you imagine how you might cope with no food or drink for up to 20 hours.
We need to advise our patients of the risks and teach them why it is so important to regulate their fasting, to avoid hypoglycaemia or hyperglycaemia. The latter may also lead to hypotension and the associated danger of falls.
It is important for patients to check their blood sugars, and where very low (< 3.9mmol/l) or very high (16.7mmol/l) they must eat.
Also it is helpful for them to be aware that eating slow-release carbohydrates before and after fasting will sustain them much more effectively. However, it is interesting to note that relatively few patients with diabetes who fast end up with any significant problems.
One last thought: is diabetes ever “resolved” in any patient? Some clinics are using this term to describe people who are very well controlled or possibly in remission.
Let’s think carefully before we tell our patients this could happen.
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