Mayank Patel

Mayank Patel

I am a Doctor who works as a Diabetes Specialist. I have an interest in education and am always keen to broaden my horizons!

Location Southampton, United Kingdom

Activity

  • hi, it comes back to the individual, their circumstances and what we are trying to achieve. Ideally, particularly in type 2 in the UK at least, national guidelines recommend starting once daily long acting first, assessing response and intensifying to more injections etc if needed, but the other factors need to be in place, eg, who is doing the injections?...

  • welcome!

  • hi for a 24 hour basal profile insulin, the traditional time to administer is bedtime. that said, as long as daily timing is consistent, that should provide appropriate basal cover, but will not of course cover additional glucose load from food for example. choice of basal will depend on local formularly. some patients do require twice daily basal doses, or a...

  • hi the decision as to when to use either intermediate or long acting once daily insulin will depend on a few factors: local insulin formularies, clinical need, eg, if someone is prone to low sugars overnight, use of an intermediate acting insulin during the day may allow them to run a little higher at night, or give the option of giving a second smaller...

  • agreed..

  • absolutely!

  • hi, yes, your thoughts on CF diabetes are correct. This natural insulin secretion can vary, but missing insulin doses would not usually cause hypos, more likely high sugar levels. Hence monitoring is key and a low threshold to adjust doses and ensuring person has appropriate support and guidance on dose adjustment

  • Hi Sarah, use of glucose testing early in diagnosis can either cause anxiety but in others can help inform the impact 'visually' and directly of certain food choices for example. Hence for the majority, in the UK at least, start with education and advice and a 3 month HbA1c as a minimum
    kr

  • Different GPs have different levels of expertise, so not one rule for all. best to seek advice locally and see what support is needed.

  • not all patients benefit from self testing glucose levels in type 2 diabetes if not on insulin. Diabetes UK website does have some guidance in this area.

  • Someone should seek advice on what exercises are most appropriate when living with diabetic foot disease. Armchair exercises can be considered. If someone has active diabetic foot disease, ie receiving treatment acutely, they need to reduce mobility as more movement can put more stress through a damaged foot and markedly delay healing time. Mobilising for 10...

  • yes, agreed, pts I am aware of locally receive insulin literature that is relevant but I cannot vouch for all places..

  • hi. interesting. I am aware that many patients have had unusual reactions to certain insulin preparations under different circumstances - exercise, warm weather etc. I will be honest, I have not encountered or read about what you are describing. I hope that you have now found an insulin regimen that works better for you. regards.

  • hi, re: sport/exercise and insulin, absolutely, some dose changes are likely to be needed, also can vary depending on nature of exercise or sport. Worth talking to a team who know about exercise and diabetes. A couple of UK based resources that might help: excarbs.com and runsweet.com

  • hi, a 24 hour long acting insulin should cover for 24 hours, whatever time it is administered. The dose should be adjusted if there is a persistent hyperglycaemia effect during the whole 24 hours. Sometimes, the basal dose can be split 50/50, if a higher dose is needed to cover half a day for example (eg overnight) If someone is also on rapid acting insulin, ...

  • Hi, yes patients can react to some of the components within certain insulin preparations and be described as having 'an insulin allergy' to certain types, but best to get detailed assessment on this where possible. Brand names can vary in different countries, but carrying the insulin paperwork that comes with the packaging etc is likely to have the generic...

  • hi, when there was only type of insulin, ie no choice, people just had to try it I guess. Insulin has been used by patients for almost 100 years, with the main progress in different insulin types etc only really happening over the last 30-40years.

  • for a rapid insulin, usual advice is approx. 10-15 mins just before or after a meal to get most benefit. however, there can be individual variation and meal content can also affect rate of glucose absorption, so some trial and error needed.

  • Hi there are some devices, with associated software for online support, that can be used to share data online about glucose levels, between patient and clinical team, using the cloud. information about insulin doses given can be seen if person using an insulin pump. Examples include the Libre reader, where information can be shared using Libreview, with...

  • hi. Broadly, most rapid acting insulins, for meals, should ideally be given within 10 minutes before or after meal. Insulin performance profiles can sometimes vary between people. Mixed insulins should ideally be given 15-20 mins before meals..

  • in my opinion, a basal insulin with a flat profile could be administered morning or evening, as long as consistent. Some times work better for some than others. the aim of the basal is to provide a constant flat insulin stream as background, but not necessary impact on the glucose rise linked to meals for example.

  • hi, don't think the insulin passport took off in the way that was hoped, not aware of a replacement as yet. local solutions and suggestions welcome!

  • the profile of different insulins means that they will work best at certain times based on the rate at which they are absorbed and able to take action on glucose. rapid acting usually best just before or after meals, with mixed insulins ideally 15-30mins before meals. By giving the basal insulin at a similar daily will help to maintain a steady state in the...

  • Hi, re: Gestational diabetes, likely to be an interaction between genetics and environment, but absolute reason for increased risk of developing type 2 not clear. Hence no value in monitoring/measuring oestragen/progesterone etc routinely during or post pregnancy to help inform risk. Diabetes in pregnancy suggests insulin resistance, which suggests the...

  • hi
    yes, people can decline if not prepared to use animal derived insulin, other types do exist as you will find out..

  • hi, it is becoming increasingly apparent that not all people with diabetes need to have a very 'tight' HbA1c, as they may put them at risk of hypoglycaemia, esp if they are hypo unaware, have multiple medical problems or are frail or elderly. Hence there is information being presented on suggested HbA1c thresholds based on someones general health status,...

  • Hi Ivan, I guess insulin could be considered to be a storage hormone, though that's not a descriptive term I have heard very often. makes sense though, given its key role in promoting glucose uptake, as well as muscle and fat building..

  • hi Isaac, we are not suggesting that cortisol be used to raise glucose levels, sorry if I have misunderstood! we are just showing that cortisol has a role physiologically in helping to raise glucose levels

  • hope you continue to enjoy

  • thanks, enjoy

  • sounds like a plan! good luck

  • certainly a large variety of factors that can cause hyperglycaemia. really important to consider if blood glucose is high, try to work out why and ensure not feeling dry from osmotic effect of high glucose causing increased passing of urine (Glucose HIGH= WHY and is person DRY')

  • hi, yes hyperglycaemia does mean high blood sugar, interestingly not everyone gets symptoms with hyperglycaemia.

  • the first thing to consider is persons choice of regimen and then to adjust doses and types based on their response, broadly speaking.

  • there are some guiding principles, different ideas in different parts of the world.

  • @AndrewWalker technology certainly doing much to help make insulin use safer...

  • great idea!

  • absolutely, always interesting for me as a diabetes specialist to see how different people respond to the same insulin!

  • inhaled insulin use is not widespread, varying degrees of success. not used here in the UK for example.

  • @AndrewWalker hi Andrew. yes, ketoAcids are toxic and accumulate in the face of marked insulin deficiency, as is typically seen in type 1 diabetes with an acute event (eg sepsis, missed insulin, or a new diagnosis of type 1 diabetes) resulting in excess glucose that existing insulin levels cannot promote uptake of. so yes, once a toxic threshold is reached in...

  • hi, i think ketogenic is beyond scope of this insulin course. sorry.

  • @JamaluddinAziz sometimes. if you have severe DKA, you may be vomiting from acidosis and excess ketpne production, so apetite could be reduced.

  • yes, that classic peardrop smell from ketones, but not everyone can smell it

  • thankyou!

  • yup. was an amazing story in 1922, how far we have come...

  • hi, you are right, one size does not fit all. guidelines are there for guidance and are not an absolute roadmap. Different people need different levels of insulin dose adjustment.
    Clinical staff should be prepared to adjust their approach depending on each case, but in the context of confirmed Diabetic KetoAcidosis, the diagnostic criteria and treatment...

  • apologies for delay. different places do classify diabetes differently. we have taken points on board and will be sure to adjust the way in which we have presented this information.

  • hi appreciate that the terminology of classification of diabetes can vary. we will adjust our text to reflect that.

  • its true. not everyone gets the classic symptoms suggestive of hyperglycaemia. often, type 2 diabetes is diagnosed from a routine medical or if the urine was dipped for ? water infection and glucose was noticed also.

  • uncontrolled high glucose contributes along with cholesterol to the depositing of atheroma in key blood vessels, which can reduce blood flow. this is also worsened in BP too high and blood vessels under more pressure.

  • Short term sugar spikes may mean that there are times when glucose is not fully or efficiently taken up as fuel. In addition, short term hyperglycaemia can increase osmotic symptoms (thirst, peeing more etc). The associated dehydration can also contribute to tiredness and headaches. Also care with caffeine based drink consumption - coffee can increase peeing...

  • Hi Graham, not as far as I am aware