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[IPk] RE: ip-uk-digest V2 #405



Pls remove my email address from your mailing list pls:
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>-- Original Message --
>Date: Thu, 15 May 2003 15:01:50 -0700
>From: email @ redacted (ip-uk-digest)
>To: email @ redacted
>Subject: ip-uk-digest V2 #405
>Reply-To: email @ redacted
>
>
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ip-uk-digest          Thursday, May 15 2003          Volume 02 : Number
405



PLEASE edit the subject line of your reply
>messages.
####################################################
This issue of the digest contains:
[IPk] Book chapter on DM type 2 - help needed
[IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS
RE: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS
Re: [IPk] 
>MPACT OF ASTHMA INHALER ON BG LEVELS
RE: [IPk] HYPERS unresponsive after several days
[IPk] hypers exercise
Re: [IPk] hypers exercise
Re: [IPk] HYPERS unresponsive after several days
Re: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS
RE: [IPk](anoth
>r BBC)Program on TV at the moment - long!
Re: [IPk](another BBC)Program on TV at the moment - long!
RE: [IPk](another BBC)Program on TV at the moment - long!

----------------------------------------------------------------------

Date: Wed, 14 M
>y 2003 22:20:00 +0100
From: "Rhoda Martin" <email @ redacted>
Subject: [IPk] Book chapter on DM type 2 - help needed

Rhoda Martin

As a rush job, I've been asked to write a chapter for the UK version of
"Type 2 Diabetes: The First Year" by
>Gretchen Becker. I was approached on
Monday and have 7 days to write it!!! Publication date is 12th September.
My draft outline yesterday has been accepted but I want to include anything
that will help a Type 2 get the best treatment available from 
>he NHS.  I
haven't mentioned NICE but have included extras like "Exercise on
Prescription" as well as the usual free eye test, prescriptions (if on orals
or insulin), VAT exemption, blood/urine/ketone testing, annual checkup,
DVLA, insurance etc.

>
Anyone with any tips would be gratefully and URGENTLY received.  I want
to
be sure I haven't omitted any of the important ones.

If you want to write to me off-list this will save cluttering up the list
for others.

Thanks in advance.

Rhoda

>
mailto:email @ redacted
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Date: Wed, 14 May 2003 23:45:58 +0100
From: "John
>Neal" <email @ redacted>
Subject: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS

Some interesting comments re stress, exercise and the effect of raising
bg's.

How about this one:DOES ANYONE KNOW WHAT THE EFFECT OF A SALBUTOMOL (ventolin)
>
INHALER WOULD BE ON THE BG'S? IS ANYONE AWARE IF THIS ASTHMA INHALER CAUSES
AN
ADRENALIN RELEASE?I AM TRYING TO DISCOVER THE EFFECT THIS INHALER HAS ON
MY
VERY YOUNG SON, DESPITE A LOT OF 'DIGGING' I HAVE NOT COME UP WITH AN ANSWER.
 ANYONE HAVE AN
> INFO. PLEASE??????????

JOHN
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Date: Thu, 15 May 2003 00:34:25 +0100
From: "J
>ckie Jacombs" <email @ redacted>
Subject: RE: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS

Hi John


 When Sasha has Ventolin it make her bg rise, it seems to be a sharp rise,
then
tapers off, it doesn't
 seem to cause a rise that car
>ies on increasing. However Beckie my non D twin
has more severe asthma
 than Sasha so I don't know what it does to a non D person. It doesn't cause
as
big a rise as the steroid
 inhalers seem to. Of course the BG may also rise a bit due to illness,
>Sasha
and Beckie only seem to
 get asthma attacks when they already have a cold. I haven't been able to
find a
great deal either about
 this. I have searched the net several times. I try to avoid giving Sasha
inhalers as much as possible,
 but th
>n her asthma is now very mild compared to Beckie's. The inhalers saved
Beckie's life on more than
 one occasion. She "goes down" very, very quickly when she gets and attack,
usually taking medical staff
 by surprise, but fortunately she hasn't had 
> bad attack for some years.
(fingers crossed!) So even
 though the inhalers aren't ideal, one has to compromise between immediate
safety of a child and possible
 other problems. So please don't be worried about having to give the inhaler
if
necess
>ry. Asthma
attacks can be very scary in young children as I am sure you know.

 Have you recently talked about this to your diabetes consultant, or your
child's asthma specialist? What
have they said to you about your worries?


Jackie



>
>-----Original Message-----
> From: email @ redacted [mailto:email @ redacted]On
> Behalf Of John Neal
> Sent: 14 May 2003 11:46
> To: email @ redacted
> Subject: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS


 Some int
>resting comments re stress, exercise and the effect of raising bg's.

 > How about this one:DOES ANYONE KNOW WHAT THE EFFECT OF A SALBUTOMOL
(ventolin)
 > INHALER WOULD BE ON THE BG'S? IS ANYONE AWARE IF THIS ASTHMA INHALER
CAUSES
AN
> ADRENALIN 
>ELEASE?I AM TRYING TO DISCOVER THE EFFECT THIS INHALER HAS ON MY
> VERY YOUNG SON, DESPITE A LOT OF 'DIGGING' I HAVE NOT COME UP WITH AN
ANSWER.
>  ANYONE HAVE ANY INFO. PLEASE??????????
>
> JOHN
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------------------------------

Date: Thu, 15 May 2003 09:48:36 +1000
From: Tori <email @ redacted>
Subject: Re: [IPk] IMPACT OF ASTHMA INHALER ON BG LE
>ELS

"In common with other b-adrenoceptor agonists, salbutamol can induce reversible
metabolic changes such as increased blood glucose levels. Diabetic patients

may be
unable to compensate for the increase in blood glucose and the development
of

>ketoacidosis has been reported. Concurrent administration of 
corticosteroids can
exaggerate this effect." From 
http://uk.gsk.com/products/assets/uk_ventolin_syrup.pdf

" Diabetes: Care should be taken by people with diabetes. Salbutamol can

in
>uce reversible high blood glucose during nebulized administration. 
Monitor blood glucose carefully under such conditions. " From 
http://www.mediresource.com/zellers/health/DrugInfo.asp?BrandNameID=1027

"Because these drugs are based on adrenalin
>, a substance produced in times 
of stress, it opens up the airways and makes the heart beat faster." From

http://www.buteyko.co.nz/asthma/reliever/shortact.cfm

"The basic structure of norepiniphrine can be altered to produce a variety

of drugs
>which act on the nervous system to either slow down or speed up 
certain bodily systems, or to make selected muscles contract or relax. This

is particularly true for drugs used to control the heart rate (e.g. 
isoprenaline) or constriction of bronc
>i in the lungs (e.g. salbutamol)." 
 From http://www.ch.ic.ac.uk/rzepa/mim/drugs/html/adrenaline_text.htm


HTH

Tori

At 08:45 AM 15/05/2003, you wrote:

>Some interesting comments re stress, exercise and the effect of raising
bg's.
>
>How
>about this one:DOES ANYONE KNOW WHAT THE EFFECT OF A SALBUTOMOL (ventolin)
>INHALER WOULD BE ON THE BG'S? IS ANYONE AWARE IF THIS ASTHMA INHALER CAUSES
AN
>ADRENALIN RELEASE?I AM TRYING TO DISCOVER THE EFFECT THIS INHALER HAS ON
MY
>VERY YOUNG SON, 
>ESPITE A LOT OF 'DIGGING' I HAVE NOT COME UP WITH AN ANSWER.
>  ANYONE HAVE ANY INFO. PLEASE??????????
>
>JOHN

http://www.hypostasis.info
Peer support for Type 1 diabetics, friends, family and others
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------------------------------

Date: Thu, 15 May 2003 06:58:10 +0100
From: "Rhoda Martin" <email @ redacted>
Subject: RE: [IPk] HYPERS unresponsive a
>ter several days

Well there you go.  I shouldn't have said problem was solved.

I changed site, new insulin, the whole shootin' caboodle and this morning
my
fbg was 15.7 mmol/l.

Could this be an absorption problem?

Seems weird that when mov
>ng sites around I successively hit scar tissue
(unseen and not able to be felt) on 5 occasions!  The probability of this
must be minuscule.

So I've changed again to a totally new area where no injections or pump
site
has ever been placed.

Watc
> this space!

Rhoda
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Date: Thu, 15 May 2003 15:51:54 +0100
From: "fiona.stoat
>" <email @ redacted>
Subject: [IPk] hypers exercise

Hi Abi

It's interesting how sensitive the body can be to exercise, colds etc. 
I
think the analog insulins, level of circulating insulin being much more
precise means slight chang
>s in need are acutely evident.  I have found
exercise has affected my insulin requirements hugely.  I coincided starting
glargine and running perhaps daft. I noticed as I was so unfit to begin
with
that my bs would shoot up after a run.  Now I run r
>gularly and manage 30  to
45mins nearly every day.  Starting glargine had me reduce my total daily
dose
(tdd) bolus and basal from 30u to 25u. As my exercising got better I find
needs are 20  tdd but I still wake with bs2.5mmol approx. I suspect tha
> the
slightest upset or if I stop exercising and have a mega stressful time in
SCBU
things could go haywire very quickly.  I am awaiting news from PCT and hope
to
start pumping in July.  Headlines in local paper today are that PCT overspent
by a mi
>lion pounds that they hadn't accounted for, (somehow lost!) plus
another  1 1/2 million they knew about, chaos but it may well affect how
they
look at my application which seems small fry indeed with those figures.
Can't
believe what bad timing the 
>pplication is.

Hope things settle quickly for you and you're fit and active again soon.

Fiona
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-------------
>----------------

Date: Thu, 15 May 2003 17:51:19 +0100
From: "Abigail King" <email @ redacted>
Subject: Re: [IPk] hypers exercise

- ----- Original Message -----
From: fiona.stoate <email @ redacted>
To: <email @ redacted
>org>
Sent: Thursday, May 15, 2003 3:51 PM
Subject: [IPk] hypers exercise


> Hi Abi
>
> It's interesting how sensitive the body can be to exercise, colds etc.
 I
> think the analog insulins, level of circulating insulin being much more
> preci
>e means slight changes in need are acutely evident.  I have found
> exercise has affected my insulin requirements hugely.

thank you
cold better today ( also went for run yesterday): woke up 4 .9 and was 3.6
before lunch ( back on normal basal). I
>suspect the cold had alot to do with
things as well



 I coincided starting
> glargine and running perhaps daft. I noticed as I was so unfit to begin
with
> that my bs would shoot up after a run.  Now I run regularly and manage
30
to
> 45min
> nearly every day.  Starting glargine had me reduce my total daily
dose
> (tdd) bolus and basal from 30u to 25u. As my exercising got better I find
> needs are 20  tdd but I still wake with bs2.5mmol approx.

You do seem to be unusually senstive t
> insulin ( my TDD is usually about 32
to 34 units)
As far as I am aware low requirements are supposed to be good although this
is probably related to not being overweight and insulin resistant rather
than the actual insulin level itself. The low wa
>ing BS is a problem isin't
it? and a definite argument for the pump





I suspect that the
> slightest upset or if I stop exercising and have a mega stressful time
in
SCBU
> things could go haywire very quickly.


Yes, I find stress can b
> really variable, Sometimes I can just hypo and
need far less insulin/ othertimes go sky high ( I suspect it's interacction
between other factors: whether " rushing aound" time of month etc)

 I am awaiting news from PCT and hope to
> start pumpin
> in July.  Headlines in local paper today are that PCT
overspent
> by a million pounds that they hadn't accounted for, (somehow lost!) plus
> another  1 1/2 million they knew about, chaos but it may well affect how
they
> look at my application wh
>ch seems small fry indeed with those figures.
Can't
> believe what bad timing the application is.

I undertand there has been major confusion and chaos with the abolition
of
the old health authorites and PCTs have in many cases"inherited" debts.
I
>m
sure with the old system  overall less money must have been swallowed up
in
admin costs etc, also less centralised control surely means more scope for
"
postcode" prescribing
Last month HAs in Wales were replaced by local health boards, and I am 
>ure
absolute chaos must be the order but I am still told that the LHB has no
objection " in principal" to funding my consumables: have just written to
consultant detailing what I use and costs. Just hope they aren't so totally
uninformed that they 
>xpected it to be far less costly
Best of luck in your application for funding anyway!
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--------------------------
>---

Date: Thu, 15 May 2003 14:51:39 EDT
From: email @ redacted
Subject: Re: [IPk] HYPERS unresponsive after several days

In a message dated 5/14/2003 10:23:29 PM GMT Daylight Time, 
email @ redacted writes:


> When any of you ha
>e had this experience have you just binned the bottle of
> insulin or have any of you returned it to the pharmacy?
> 
Hi Rhoda,

Having just caught your later e-mail I hope that things are improving once

more.  

The correct thing to do if you
>think it's the insulin that's the problem is 
to return the bottle to the pharmacy - ideally the insulin activity etc
will 
be checked, and if there's a problem batch testing and tracing should be

carried out.  I admit that I have never actually do
>e this (it's quite a 
hassle, though in the long run of course it could benefit others - must
try 
to be more altruistic :) ).  If you didn't actually use any Humalog in your

hyper haze, you can't really blame the glargine as you'd have been chasin
> an 
impossible tail with such a long-acting "basal" insulin.

Unless you know that you have really bad absorption problems, it seems 
extremely bad luck to hit that many problem sites in a row and I would look

at other possibilities first.

Ho
>e you're feeling much better,

Best wishes,

Mary
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Date: Thu, 15 May 2003 16
>06:19 EDT
From: email @ redacted
Subject: Re: [IPk] IMPACT OF ASTHMA INHALER ON BG LEVELS

In a message dated 5/15/2003 12:47:26 AM GMT Daylight Time, 
email @ redacted writes:


> "In common with other b-adrenoceptor agonists, 
>albutamol can induce 
> reversible
> metabolic changes such as increased blood glucose levels. Diabetic patients

> may be
> unable to compensate for the increase in blood glucose and the development

> of
> ketoacidosis has been reported. Concur
>ent administration of 
> corticosteroids can
> exaggerate this effect." From 
> http://uk.gsk.com/products/assets/uk_ventolin_syrup.pdf
> 
Sorry not to have caught up on this before (slowly trawling thru e-mails...).
Salbutamol does share some of
>the properties of adrenaline (now known as 
epinephrine, though this grates to many UK medics!) as they are structurally

very closely related.  There is good evidence that salbutamol can increase
bg 
level.

However, most studies looking at bgs i
> relation to salbutamol have used 
relatively high doses - oral or nebulised.  Absorption rates from inhalers
is 
low and leads to a lower dosage.

A person using maximum frequency inhaled doses together with oral steroids

(as opposed to inhaled 
>teroids, which again result in low doses) would 
probably find an effect on their control.  Those on regular treatment with

inhaled salbutamol / steroids would probably not find a significant 
difference.

HTH,

Mary

PS I didn't keep study r
>ferences, though I'll find them if you wish.  Most 
of this is from my own medical background and clinical experience supported

by the Oxford Textbook of Clinical Pharmacology and Drug Therapy.
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Date: Thu, 15 May 2003 21:06:46 +0100
From: Lesley Jordan <email @ redacted>
Subject: RE: [IPk](another BBC)Program on TV a
> the moment - long!

Hi all

If anyone does write to the Beeb, how about making them aware of INPUT,
as an
official authority on pumping and diabetes?

There's so much reality TV on, I wonder if they would consider doing a one-off
about insulin
>pumpers.  For a spin, they could focus on how much money the NHS
could save in the long term, but how reluctant they are to fund.  And how
narrow minded some docs can be.

Just my two-pence worth!

Lesley


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Date: Thu, 15 May 2003 16:27:17 EDT
From: email @ redacted
Subject: Re: [IPk](another BBC)Program on TV at the moment - long!

>
Lesley
Some time back, last year I think, there was a programme on about the 
benefits of pumping. My mum saw it but I missed it. It was on quite late
at 
night. I'm not sure which channel ran it. Does anyone know which channel?

Helen
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Date: Thu, 15 May 2003 23:01:56 +0100
From: "Andrew Dysch" <email @ redacted>
Sub
>ect: RE: [IPk](another BBC)Program on TV at the moment - long!

Helen,

I think you're referring to 2 programmes shown on Channel 4, which were
about diabetes generally.  There was a small part showing a teenager
starting on a pump.

Best wishe
>.


Andrew

- -----Original Message-----
From: email @ redacted [mailto:email @ redacted] On Behalf
Of email @ redacted
Sent: 15 May 2003 21:27
To: email @ redacted
Subject: Re: [IPk](another BBC)Program on TV at t
>e moment - long!

Lesley
Some time back, last year I think, there was a programme on about the 
benefits of pumping. My mum saw it but I missed it. It was on quite late
at 
night. I'm not sure which channel ran it. Does anyone know which channel?

>
Helen
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------------------------------

End of ip-uk-digest V2 #405
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