Jenny Lind Diabetes Team

NNUH Diabetes Team Update - Spring 2017

TOP BANANA! All diabetes services in England have to take part in a national audit of diabetes care, and we’ve just had our results for 2015-16. You are doing well! Over all, more of you are getting good results for HbA1c than elsewhere in East Anglia, with over a third of you getting an HbA1c less than 58, and fewer of you getting a high HbA1c. In the whole of England, only two large centres get better results than us. Thank you for coming on our journey to improving diabetes control! We feel the improvement is because of the new glucose targets we started using last year. Another factor is that now we are using the Libre glucose monitor or for some continuous glucose monitoring, and that really helps understand getting the timing of insulin right, particularly at breakfast.

BE AFRAID! We have a new member of our specialist nursing team, Louisa Fear however, there is no need to be afraid - Louisa is an experienced diabetes and research nurse and will be a real asset to us, especially as Paul is taking time out to be a student again (when did he stop?!). In fact some of you will already know Louisa if you been in some of our diabetes research studies. Louisa was the nurse responsible for the Begin study - a research study looking at the new long-acting insulin, degludec. The study has led to degludec being approved in Europe, North America and elsewhere in the world. Insulin degludec greatly reduces the risks of developing ketones and hypoglycaemia at night, as well as being as good as insulin detemir for overall control. Cheers, Louisa!

KEEP ON PUMPING! Insulin pumps aren’t for everyone, but 56% of our patients are now on insulin pumps, compared with 26% in East Anglia as a whole. We now do 3 diabetes devices fairs a year, so if you want to know more, come to the next fair on March 14th 4.30pm - 7pm and see what’s new. Some new pumps are coming along - if you want to see them, come along to one of our diabetes devices fairs.

LIBRE UPDATE The Freestyle Libre continues to be really popular. Many of you now have your own Libre thanks to the generosity of the Norfolk Diabetes Trust and Abbott, who have supplied us with a large number of readers. Although many of you can’t afford to use the sensors all the time, we think it is still a great idea to use the Libre for difficult times – like holidays, exams or illness. If you have an up-to-date Android phone, you can also get LibreLink from the Android store, which will allow you to use your phone to scan your Libre. Using your phone lets you share the results with those who need or want to see what’s going on! It sounds like it would be great for school trips and other times away from home. Abbott have applied for the Libre to be available on the NHS, but we don’t know when – or if – it will be approved

KEYA TO SUCCESS A British company called Keya has launched a really clever new blood meter – it measures glucose and ketones at the same time on the same strip! This could be great for those who are at increased risk of getting ketones – especially patients on pumps, or people who perhaps don’t test as often as they should, as the meter will alert you to high ketones – and hopefully help you avoid diabetic ketoacidosis. The company are giving us some supplies, and the strips will be available on the NHS in the spring. Even better for the NHS, the strips cost the same as regular high-quality glucose strips, and include the ketones for free! Check it out at http://keyasmart.com/

ARTIFICIAL PANCREAS One really massive breakthrough in the diabetes world is the first commercial artificial pancreas, the Medtronic 670G. Launched in spring 2017 in the USA it is a real breakthrough. Our Artificial Pancreas study colleagues in Cambridge are looking for customers for a clinical trial of the 670G, which hopefully will lead to it becoming available in Europe. They have asked us for help recruiting patients, so if you’re interested ask us at your next appointment. Other artificial pancreas systems are in development, too, so hopefully the 670G is just the first kid on the block!

ON THE HORIZON Until now, the only treatment we’ve had for Type 1 diabetes is insulin, but it’s likely in the next few years that we will see several new treatments coming along. The most exciting is a class of drugs called SGLT inhibitors. These have been shown to reduce complications and deaths in adults with Type 2 diabetes, and are now being tested in adults with Type 1 diabetes. There are some risks in that they increase the chance of diabetic ketoacidosis, but – perhaps if combined with insulin degludec – these new drugs could be a really good addition to our arsenal – here’s hoping! There are also other studies looking at drugs targeting the immune system to try and buy some extra life from your insulin producing beta cells at diagnosis of diabetes, which could really make things better for our new customers.

FAREWELL TO DR T Nandu is leaving the Jenny Lind in April. He started in February 1996 as a senior registrar in the old hospital, and he’s been a consultant since April 2002. He’s sad to be going, and is going to miss his old customers very much. The Trust has asked him to take an extended career break, rather than resigning, so there is a chance he might come back in autumn 2018. As he puts it, “For health and sanity I need a break!” He’s not planning to leave Norfolk, though, so you might still bump into him in the supermarket! He will still be involved in diabetes, but he’s not sure exactly what he’s going to get up to. There will be a replacement for him, but it’s likely there will be a gap after he leaves before help arrives. Luckily, we have a super diabetes team, who will do our utmost to keep up the good work.