Monday, 19 March 2018

The power of perspective: reflections on #DUKPC and #DUKPCInsider

Perspective is a powerful tool. One that is often undervalued or underused, but in the last few days at both the Diabetes UK Professional Conference (#DUKPC) and the Diabetes UK Professional Conference Insider (#DUKPCInsider) event it was great to see things being looked at from and by different people.

The last few days have, for me, been enlightening. Not just because I learnt so much from the lectures I attended, but also because I got a brief 'glimpse' of the drive and effort of so many of the Healthcare Professionals working within the field of diabetes. As a bonus - I also got to meet many of these wonderfully determined clinicians, nurses and diabetes professionals who are trying to push care and standards forward for not just their own patients, but for the patients of the NHS as a whole.

From the first day of the DUKPC, where Chris Askew set the scene for the next few days - making the great decision to mention the DUKPCInsider event that was running on the Saturday and how it would be bringing the highlights of the conference to those living with diabetes. On the same day Simon Stevens the CEO of the NHS announced that £40 million pounds was being allocated to continue the work of 2017/2018 - a significant moment for all who were there! Then came the opportunity for the audience to ask Simon Stevens, Jonathan Valabhji and Partha Kar questions...a chance for the Healthcare Professionals in the room to clarify, question and ask the Panel for further detail which they grabbed with both hands. For an 'outsider' (in terms of not being a Healthcare Professional myself) watching numbers of the audience stepping up to the microphone, it showed me the passion and drive of the Healthcare Professionals to want to deliver the best care they possibly can. Seeing this format where speakers gave opportunities to be questions was echoed throughout every session I was a part of – a really good approach for engagement and to help those in the sessions cement their ideas on how to drive through changes where needed.

Following on from the strong start to the day, I tried to cover as many sessions as I could. Keen to find out as much as possible about the work going on around the UK. This was an approach I took for the whole 3 days of the first conference and even to the Insider event. I wanted to make the most of the access to research information by speaking to the presenters and discussing it in the breaks.

So what sessions did i go to? Well let's just say that I covered an array of topics over the whole conference including the session on the REPOSE trial, a lecture on ‘Getting the measure of diabetes’, Diabetes education (self-management) and the ABCD Type 1 Diabetes Clinical Collaborative-UK sessions just in the first day. On day two I attended other sessions including but not limited to a lecture on ‘getting the diagnosis right’, infection in the diabetic foot, Education in diabetes and closed-loop systems. The final day saw me joining the first session on sleep followed by lectures on immune pathogenesis of Type 1 diabetes, translating DiRECT into practice, TZDs, social media and patient engagement, Technology updates and ‘exercise and diabetes’.

This is by no means an exhaustive list...with so many other sessions attended, with some run by the diabetes technology companies.

To try and cover everything I learnt, heard and discussed over the 3 days of the DUKPC would be nigh on impossible, but what I can share are the feelings, key themes and ‘take-home’ messages from both the speakers and the whole conference. So here it goes...

1. The research is happening...and not just in a lab! 
Throughout the whole conference, there was an extraordinary focus on the developments and roll-out of research from the laboratories to trials with patients. This is not to say that there isn't some wonderful and extensive research going on in the universities and laboratories in the UK and around the world, but more to say that 'real-life data' was a buzzword of many sessions with patient's being a huge focus in rolling the trials of various approaches out into the lives of others living with diabetes.

2. Technology is here to stay
There were many sessions on CGMs, insulin pumps and closed-loop systems throughout the conference which was great to hear and be a part of, as well as the launch of the Diabetes Technology Network who also shared good practice guides at the event. However, it was recognised that it has to the right technology for the right person.
This is where technology being looked at in the wider sense of the word became a big focus of a few presentations with Apps, Social Media and digital approaches being mentioned as the future approach for Healthcare Professionals to engage with patients and for our own self-management. It was also uplifting to hear charities such as Diabetes UK being recognised as one of the driving forces in helping patients access appropriate technology as well as #gbdoc amongst other hashtags and communities being mentioned during the 3 days too!

3. Psychological support is needed, in all its forms...
For those of you with diabetes, this will one will most probably not come as any surprise, however it was refreshing to hear from various Healthcare Professionals first-hand that they appreciated the need for additional psychological support within diabetes care. Additionally, they also recognised the huge role that peer-support, whether online or face-to-face plays in this, with ‘meet ups’ for those with diabetes being referred to on a number of occasions as a mechanism for this peer support and shared-understanding.

4. Education - the key to success
Education was mentioned as a subject on its own in a few sessions (education for professionals as well as structured and self-management education for people with diabetes). Furthermore, as I travelled through a variety of different sessions, education seemed to be mentioned time and time again. There are many strengths to the education provided currently, however there were suggestions and ideas proposed about the use of digital platforms in disseminating information, as well as the different methods that education can take - whether self-directed, led by people with diabetes or through online Apps and portals. Whatever the mode chosen, it was agreed and even voted on in one session (through a show of hands) that education is key for everyone and that through it, the best approaches/ care and use of the correct tools and technologies can be unlocked.

5. Patient involvement is important and essential
Whether it's trials of new approaches, local studies, psychological support or professional education - people with diabetes were seen as the pivotal part to this. Sharing our experiences and day-to-day tactics, the 'trial and errors' we go through, 'the good, the bad and the ugly' of our diabetes journeys as well as the great approaches and attention that we receive for different elements of our diabetes care. Our unique perspective was respected and acknowledged, with some of the talks with the most impact being those that involved both a Healthcare Professional and a person with diabetes talking side-by-side on the same topic.

As you would expect, these points above were replicated to one degree or another in the DUKPCInsider event on the Saturday.
The speakers at this event were again from a range of backgrounds with differing areas of expertise within the field of diabetes. I think that there was a great spread of topics relating to the DUKPC with sessions relating to people in all parts of their diabetes journey and interests – diabetes and pregnancy, psychological support and Type 2 diabetes, the tech revolution, diagnosis matters, DiRECT route and Social Media being just a few of the sessions.

Again, the opportunity to ask the speakers questions was a highlight of the session with a full 25 minutes of questions from the audience for the Panel at the end of the day.

Also, like to the DUKPC, there were a mix of people with diabetes and Healthcare Professionals delivering talks which proved to be a popular approach.

From a personal perspective, I again learned a lot from this conference from hearing different sessions to those I attended, by hearing the Q&A sessions and by sharing experiences with both the people with diabetes in the room and the Healthcare Professionals who sat and chatted.

DUKPCInsider was a great event and success in my personal opinion – I hope that Diabetes UK build on this and run a similar event next year to compliment and feedback from the DUKPC!

To round off my post, I would like to say that I am very grateful to Diabetes UK for allowing me to attend both of these conferences and would like to thank them for all their support, from start to finish.

I would also like to say a personal thank you to Chris Askew and to Dai Williams for their support throughout the conference. Additionally, I would like to thank the many, many Healthcare and Diabetes Professionals who gave up their time to chat to me and to have the occasional selfie, or two.
Thank you all for the amazing work you do and your enthusiasm to keep striving forward!

Once again, thank you to all the lovely people who have been messaging me and engaging with my tweets throughout my time at the conferences. I hope I did you proud… x

Sunday, 31 December 2017

2017 Reflections - a busy year

*DISCLAIMER - Please note in this article I am purely referring to Type One Diabetes and my personal views in relation to the Animas Vibe as well as my own personal experiences of NovoRapid and Fiasp. Remember Your Doses May Vary and all information found in this blog post is my opinion and is what works for me ONLY. It is not intended as medical advice. Please consult the relevant health care professionals before you make a change to your treatment plan in any way*

Well it's been a while hasn't it....

This year has certainly been one of ups and downs...and I'm not even talking my diabetes. There has undoubtedly been a lot going on with job changes, buying a house, family illness, house renovations to name but a few. Oh, and then of course there's the diabetes to throw into the mix.

Well after the HUGE transformation that the insulin pump made to my life back in July 2016, I would love to say that it's been smooth sailing ever since. In reality though - that just isn't diabetes now is it?

Despite my control being vastly improved from the 49 hypos a month.... (that’s right...49 a month!!) that I was having prior to starting Insulin Pump Therapy (IPT), I had still been having a few night hypos and some before meals. As a result, I trialled the Dexcom G4 sensor in the hope that the CGM link-up to my Animas Vibe pump would help with the night time hypos. Unfortunately, despite a number of attempts to use the Dexcom, for some reason I cannot get on it with. After seeing some amazing results from other people using it, I was sadly disappointed to have many false alarms and very inaccurate readings on every sensor, despite trying different sites. 

As a consequence, I intermittently used the Abbott Freestyle Libre to gain an insight into the patterns of my diabetes during those 2-week periods.
Although, as many will point out, it doesn't have the full features of CGM's such as the alarm functions or insulin suspension option, the accuracy that I get from using the Libre made it a much more reliable method of gaining continual, uninterrupted data.

I didn’t just look at the CGM/ Flash Glucose Monitoring options in isolation though. I also looked at the effects of how my recently developed (past 2 years) insulin-sensitivity affected my control. One major issue I kept facing was the difficulty of pre-bolusing at the correct time before a meal. This was particularly problematic when eating out at a restaurant or when eating at other people's houses. I would find that I would often hypo before the meal arrived, meaning a lot of explanation as to why I was eating just before we were about to eat. Step up FIASP!!!

Fiasp (a form of faster acting insulin) despite eliminating the vast majority of pre-meal hypos in a short space of time, it did take a couple of weeks to adjust to. One of the major adjustments I had to make was lowering the amount of insulin I needed for meals. It seemed, that with the differing profile of Fiasp and also not needing to pre-bolus before eating food meant that I didn't need quite as much insulin as I previously did. Conversely, I had to increase my basal rate slightly to keep my levels within the desired range. These adjustments were aided by the use of the Libre in the first few weeks of transitioning to Fiasp. Again, I am aware that a number of people have had difficulty adjusting/ using to Fiasp, however I have personally found it really beneficial.

And this was only half way through 2017...

Although some of hypos previously mentioned were still happening and my diabetes levels were erratic at times, progress was being made bit by bit. Pre-meal hypos had now been addressed!

Despite all the above, there was still another big step forward towards better diabetes management to come thanks to some hard work of a group within the NHS.

On 1st November 2017, the Abbott Freestyle Libre sensors became available on the NHS to those who meet the criteria. Despite some inevitable teething issues, as is often the case with new drugs and change, almost 2 months in there are a number of people around the UK who are benefiting from this prescription introduction. I am very grateful to be one of these people who has been massively helped by 6 weeks’ worth of data, patterns and invaluable information that I’ve seen already. What a way to end the year!

Therefore, although progress can be slow at times and it can often feel like things don't progress much from the research stage in some areas of diabetes, I would say that 2017 has been a year of fruition. This year has given us more choice in terms of the diabetes technology available on the NHS, a new insulin coming to market, trials of new CGM'S such as the Roche Eversense taking place as well as lots of pipeline developments (the DVLA changes for example) that I'm sure we will see in 2018.
Despite there also being some potentially negative changes with Animas pumps no longer being offered to new patients, I personally view 2017 as a year of advancement, with the progress still continuing into the year ahead. Additionally, and definitely on a personal level, 2017 has also provided me with the amazing opportunities to be part of formal/national diabetes events/ meetings, social meet-ups across the country and getting to know more local people with diabetes. All of these events, combined with new technology and differing approaches has certainly enriched my knowledge when looking at my diabetes management choices and decisions.

So, let me wrap up this post by saying that despite being optimistic, I am also not blinkered to the challenges that the NHS, people with diabetes and Health Care Professionals will face in the coming years as new technologies and approaches are introduced. I am yet to master the art of perfect diabetes blood glucose/ sugar levels as you can see from my Ayres Rock impression that happened before Christmas due to illness and festive eating (ooops!). However, I was able to see this thanks to the progressions of 2017 and to monitor my corrections and adjustments in addition to regular finger-prick tests.

Yet despite the challenges that diabetes throws our way...I am excited to see where we will be in a year’s time when we reflect on all that's happened in the world of diabetes in 2018! Bring it on...

Thank you to everyone who has read my posts and I have met in 2017. I wish you all a wonderful and safe New Years Eve and I look forward to sharing my 2018 adventures with you very soon.

Until next time, keep injecting 💉 or pumping 📟 insulin!

Ros x