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DESANG diabetes magazine


The bio-inspired artificial pancreas



• New Products • Groovy giveaways • News (for T1 and T2)

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A smarter tool to help you live your life The NEW Contour®Next Link meter wirelessly sends blood glucose results directly to your MiniMed device’s Bolus Wizard™ calculator to help save you time and effort • Accurate readings can help you adjust your insulin bolus dose more confidently • Multipulse accuracy technology from Bayer ensures accurate glucose measurements, even when blood glucose levels are low. Accuracy is not affected by many common interfering substances** • No Coding™ technology removes the need to manually code the meter before testing, eliminating errors due to miscoding

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* In this offer, Contour® Next LINk meters are free to customers using the following Medtronic devices: the MiniMed Veo™ insulin pump, the MiniMed Paradigm® REAL-Time insulin pump and CGM system, and the Guardian® REAL-Time CGM system. Only 1 Contour® Next Link meter can be supplied to an individual for each Medtronic pump. ** Full details available in test strip pack insert. Bayer (reg’d), the Bayer Cross (reg’d), Contour®, No Coding, and Second-Chance are trademarks of Bayer. CareLink and Paradigm are registered trademarks and Veo and Bolus Wizard are trademarks of Medtronic MiniMed, Inc. © 2013 Bayer plc. All rights reserved. Diabetes Care, Bayer House, Strawberry Hill, Newbury, Berkshire. RG14 1JA


For any queries please call our Bayer Diabetes Care Support team on 0845 600 6030 (Mon-Fri 8:30am - 5:30pm)

Editor’s comment...


ach news item or research report brings with it some hope of an improved future, but when something’s actually been produced it’s possible to breathe a sigh of relief that it actually exists (it’s not still on the drawing board, or going through rounds of corporate funding before there’s even a prototype). So I’m pleased our feature is on a new format of insulin pump, the BiAP. Not widely available yet, but trials have been undertaken and we hear from a happy human ‘guinea pig’ about her experience. Then, in Making Carbs Count (page 12), we get inside eggs to see what they have to offer. Turns out, it’s rather a lot (though no carbs!), and so neatly packaged too....

Sue Marshall ISSUE


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CGM SPECIAL OFFER! See advert page 5.




Meet the Neo, the new addition to the FreeStyle range of blood glucose systems, and say hello to the New Generation of CGM sensors from Medtronic, p.4.

Yorkshire grown rapeseed oils feature along with a new app that gives guidance on food swaps, so you can choose healthier options p.6.

Getting inside eggs p.12.

Published by Desang Ltd the aim of this newsletter is to bring news and information to people living with diabetes. Please check all matters concerning how you handle your health with your healthcare team. We welcome any feedback on the magazine or ideas for future articles. EDITOR: Sue Marshall For details of our editorial policy see The Small Print.


BLOOD SIMPLE The FreeStyle Optium Neo Blood Glucose and Ketone Monitoring System simplifies blood testing while including features that can improve overall diabetes management, such as blood glucose trend indicators and an insulin dosing guide. It uses Abbott’s TrueMeasure technology, designed to minimise errors from insufficient blood samples and interfering substances, allowing easy sample application – you can apply your blood sample from the top (drop it on) or from the side (also known as ‘end fill’). The system takes 5 seconds per test and requires a small sample (0.6 μL minimum), and supports alternate site testing. It starts automatically when the blood is detected and allows the re-application of a blood sample (if the test does not start after the first application of blood, a second sample can be applied to the same test strip within 5 seconds). Each FreeStyle Optium test strip is individually wrapped in easy to open foil, to protect it against air, moisture and other contaminants. There is no requirement for coding or calibration.

THE NEW GENERATION There is now a New Generation of Medtronic’s Enlite sensor and now you can get them as a single unit, instead of a pack of five. This generation now features increased comfort with improved adhesive to reduce the likelihood of skin irritation. Also, the tubing around the sensor electrode has been removed, reducing the implanted volume by 80% (there’s just less of it in your body). This has reduced the possibilities of the sensor kinking or bending. The sensor electrode design has been modified, the aim being a more consistent performance throughout the life of the sensor and the connection between the sensor and transmitter has been improved to help reduce the likelihood of data gaps. Single unit sensors are being made available so that more people have the chance to access to CGM and, with qualifying Medtronic pumps, the Low Glucose Suspend feature. The product codes to order the New Generation Enlite sensor remain exactly the same as the existing Enlite sensors. Single unit pack: MMT-7008B; 5 pack: MMT-7008A; 10 pack: BNENSENS10PK1001. See special CGM offer on page opposite.

Our free online magazine for people with diabetes sent to your inbox each month. News, views, reviews, features, free samples and giveaways. Sign up with your email address! email address

Special offer, save 48% on CGM This introductory offer from Medtronic features the Enlite CGM sensor. You need to be on a Medtronic MiniMed Veo pump to access this offer. SPECIAL OFFER Box 1 is £275 with free kit worth £490 (includes MiniLink reader) Box 2 is £275 Box 3 is £275 Box 4 is free. There are five sensors per box, each works six days which gives one month of coverage per box. This offer should give four months coverage. Available from /patientstories/hypo-protection


OIL ABOARD! Despite on going campaigns about the dangers of overeating, Brits still eat too much saturated fat which can lead to obesity, high cholesterol, diabetes and heart disease. Rapeseed oil has been shown to help reduce the chance of developing these conditions when it is used as part of a balanced diet. Wharfe Valley Farms is run by the Kilby family, third generation farmers who added oil seed rape to it’s traditional crop rotation in the early 1980s. Rapeseed oil is a healthy alternative to other cooking oils, boasting a range of excellent health benefits, having higher Omega 3 and more Vitamin E than olive oil and is a versatile oil for all cooking needs. Products can be used to dip, drizzle and dress, and are brilliant for bakes, roasts, stir fries and marinades.


Launched earlier this month, FoodSwitch is the first smartphone app to enable consumers to make healthier and smarter food and drink choices. Putting you in control when you’re out shopping, FoodSwitch can help you make more informed decisions. You to scan the barcode of over 80,000 packaged food and drinks sold across major UK supermarkets using a smartphone camera in order to receive immediate, easy to understand ‘traffic light’ nutritional information along with suggested similar, healthier products. Using the app you can reduce high levels of fat, salt and sugar in your (and your families’) diet. The app compares the overall nutritional value

of the product to existing Department of Health criteria. FoodSwitch was developed by leading UK nutrition research experts Consensus Action on Salt and Health (CASH), the Medical Research Council Human Nutrition Research, The British Heart Foundation Health Promotion Research Group, and the Nuffield Department of Population Health and Nuffield Department of Primary Care, University of Oxford, and led by The George Institute for Global Health (TGI). It can be argued that many manufacturers have been hiding behind their labels for years. FoodSwitch gives customers the perfect opportunity to get to grips with what the labels mean by colour coding each product by the content of four important nutrients: total fat, saturated fat (saturates), sugars and salt). For products that are not listed in the database, shoppers are invited to ‘crowd source’ the information by using the app to take photos of missing products, they will be validated before being added to

the database. Bruce Neal, inventor of FoodSwitch, says: “The app is all about putting power back into the hands of the community. At the same time as recommending healthier alternatives to shoppers, the photographs of missing products sent in by users give us a complete picture of what’s in the food supply. Such information can be used to hold big businesses directly accountable for what they are putting on the shelves.” Dr Peter Scarborough comments, “With all the messages about health in the public eye, it is hard for consumers to know what is ‘healthy’. The established nutrition criteria used in the app shows customers products that are healthier overall, not just whether they are higher in just salt, fat or sugar.” Download for free from iTunes or Google Play.



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MP Mark Field (left) and Dr.Nick Oliver.




team of researchers has been undertaking pioneering work into the development of an artificial pancreas for the treatment Type 1 diabetes. Diabetologist Dr Nick Oliver has been leading the work of the Diabetes Technology Research Group at Imperial College London at St Mary’s Hospital. The researchers are part of a global effort to develop artificial pancreas technology. At present the are the only group in the world using a ‘bio-inspired’ approach – mimicking the physiology of the human body. The Bio-Inspired Artificial Pancreas (BiAP) is worn externally and combines a continuous glucose monitor that reads the user’s interstitial fluid sugar level. It also has an insulin pump that infuses the insulin into the body. The most innovative element is the biologically-inspired microchip which uses an algorithm to combine the CGM data with the pump’s capacity to infuse insulin. This has enabled the research team to replicate the activity of the beta cells of the pancreas using integrated circuits on a silicon microchip. With this they have been able to “deliver insulin profiles expected in a healthy pancreas”.

Human trials The technology has been validated using a patient simulator and now twenty people with Type 1 diabetes aged between 18 and 75 are taking part in the first human clinical trials. These are underway at Imperial College London at St Mary’s Hospital, where the artificial pancreas has now been used for over 500 hours of diabetes control.

If the patient trials are successful, the team hopes that the technology will become available to the 400,000-or-so people in the UK with Type 1 diabetes. The Cities of London and Westminster MP Mark Field visited Imperial College London and St Mary’s Hospital in late January. He commented, “This technology has the potential to bring huge benefits to thousands of patients by preventing their glucose levels from fluctuating above and below normal levels, eliminating the need for constant counting and guesswork, and helping them lead a normal life. It also offers enormous potential to save the National Health Service money and improve efficiency. I very much enjoyed witnessing this exciting development first hand and look forward to hearing more as the trials progress.”

Field trials Mr Field has given his backing to a pledge to improve patient access to medical technology. The pledge is being organised by the Medical Technology Group (MTG), a coalition of patient groups, research charities and medical device manufacturers, which is committed to increasing patient access to high quality, life-improving technologies to all who need it. Barbara Harpham, Chair of the MTG, said, “The NHS currently spends around £1bn on treating the complications of Type 1 diabetes. It is estimated that the use of artificial pancreas technology could save around 80% of that cost, while transforming the lives of people living with the condition. It’s another example of the

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Lesley Jordan of INPUT (left) and Dr.Nick Oliver. potential value that medical technology can deliver, and while this technology may not yet be available, I would urge health commissioners to re-examine their approach to existing technology in other areas.” Dr Oliver added: “Our research is at a very exciting stage for patients and health care professionals. Using the patient simulator we were able to regulate the patient’s blood glucose within target levels 93% of the time. Should these current patient trials, which are the culmination of years of work, prove successful then the next step will be to develop this into a larger scale study that will take this from the clinic to the home.” One participant in the trial, 32-yearold Melissa Holloway from Pimlico, said of her experience, “‘My 25-hour BiAP trial session was my first day off from having to think about my blood glucose level every waking hour since I was diagnosed 20 years ago. This research gives me hope

for the future for myself and others living with type 1 diabetes.”

Group action The Medical Technology Group (MTG) is a coalition of patient groups, research charities and medical device manufacturers working to make medical technologies available to everyone who needs them. Uptake of medical technology in the UK is not as good as it should be, given its great potential to provide value for money to the NHS, patients and taxpayers. The MTG believes that patients and clinicians need better information about medical technologies so that they can make informed choices about their medical care. Find out more here It is estimated that 5% of the UK population has a form of diabetes, of which 10% have Type 1 (diabetes mellitus), the autoimmune disease in which the beta cells in the pancreas (the cells responsible for

sensing your blood glucose and releasing the insulin) get destroyed. Traditional insulin injections solve the problem in the short term, but patients still end up having large glycaemic variability, meaning their blood sugar still fluctuates throughout the day – a leading cause of secondary complications like heart disease and nerve damage. The bio-inspired artificial pancreas replicates the work of the damaged cells taking the job of controlling blood sugar away from the individual. The Diabetes Technology Research Group is a multidisciplinary group of biomedical engineers and clinical researchers. Funding for the artificial pancreas is being provided by The Wellcome Trust. Funding for the novel continuous glucose sensor is from the National Institute for Health Research (NIHR). INPUT helps get people on pumps. Find out more HERE.


MOTIVATED TO IMPROVE Susannah Elliott was diagnosed with Type 1 diabetes in 2007. During her regular visits to the Diabetics Centre at Hammersmith Hospital she was invited by her consultant, Dr Nick Oliver, to take participate in clinical trials with his team – the Diabetes Technical Research Group – and their development of the first bioinspired artificial pancreas. The Bio-Inspired Artificial Pancreas (BiAP) is worn externally and combines a continuous glucose monitor (CGM) that reads the user’s interstitial fluid sugar level with an insulin pump that infuses the insulin into the body. The most innovative element is the biologically-inspired microchip which uses an algorithm to combine the CGM results and the pump’s infusion capability in terms of its delivery of insulin doses. As a result, the research team at Imperial College and St Mary’s Hospital is able to replicate the activity of the beta cells of the pancreas using integrated circuits on a silicon microchip. With this they have been able to deliver insulin profiles in a manner similar to that of a healthy pancreas. Susannah, now six months into the trials, has had her blood sugar monitored and the algorithm used to calculate what her insulin basal level should be. At different points in the research time was spent testing results under certain conditions, such a night time tests or fasting. Armed with this information, even though she finds her diabetes as difficult to manage as any other diabetic, she has been able to tweak her lifestyle even while

working full time. As a side benefit to the research, she has found that her motivation to improve her blood glucose control has also increased. Continuing with the trials until the end of March, she says: “In this economic climate, it’s very inspiring and

uplifting to see such a dynamic team working in the NHS. I’m excited about how this technology can improve the lives of other people with diabetes. I am more than happy to take part in future tests with the Diabetes Technical Research Group.”

Susannah Elliott and her BiAP insulin pump





CK IN FAVOUR As sure as eggs is eggs, there is always going to be controversy over foodstuffs. Eggs had their day in the doldrums but are now claiming back the high ground as research is proving their nutritional worth and their helpful role as part of a weight-loss diet. The following is extracted from an article first printed in NHD, the Dietician’s Magazine, written by freelance dietician Dr Carrie Ruxton PhD.


ccording to labelling regulations in the EU, eggs qualify as a source of Vitamin A, folate, choline, phosphorus and selenium, and are rich in Vitamin D, riboflavin, Vitamin B12, biotin and iodine. The high Vitamin D content of eggs is noteworthy given the current interest in Vitamin D insufficiency in the UK. An average egg (58g) contains just 66 calories but their protein content is high at 4.5g per medium egg. That means that one egg represents about 10% of an adult’s daily protein requirement. Eggs have long been acknowledged as a healthy food but studies now point towards benefits for weight management, most recently from a trial presented in 2012 European Congress of Obesity. Eggs are related to weight management because certain nutrients such as protein, fibre, novel oils and nondigestible carbohydrates are believed to be useful for weight management due to their affect on satiety (defined as ‘a feeling of fullness after eating’). An enhanced and prolonged satiety may limit food intake at later meals, thus contributing to a reduction in overall daily energy intake.

As a high protein food, eggs may exert an effect on satiety and thus support weight management. One long-term study reported a significant greater weight loss and reduction in waist circumference when an egg breakfast was consumed in preference to a cereal breakfast.

Perfectly packaged There are two additional benefits to including eggs in a weight loss diet. The first is portion control, since eggs by their nature come in a fixed unit helping people to recognise how much they have consumed. Second, the Vitamin D content of eggs may help to support general health in overweight people since adipose tissue (body fat) traps fat soluble vitamins leading to a lower Vitamin D levels in people with excess fat. Vitamin D insufficiency is increasingly linked with a higher risk of type 2 diabetes and cardiovascular disease, probably because of the vital role that Vitamin D plays in maintaining normal immune function. With few naturally rich sources of Vitamin D in the diet it is useful that two eggs can provide 36% of the EU recommended daily allowance (RDA) for Vitamin D (which is 5 micrograms).

Growing evidence suggests that eggs -particularly when consumed at breakfast or at lunch -- are a useful addition to weight management diets. There has been a marked increase in the Vitamin D content of eggs, by about 70% in a medium sized egg. Vitamin D is

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LIVING of particular interest because of concerns that about 20% of UK adults and 18% of older children have inadequate levels of Vitamin D. There is emerging evidence that low Vitamin D status may be linked to increased risk of heart disease and some cancers as well as poor bone health. Eggs can now be labelled as a ‘good’, ‘rich’ or ‘excellent’ natural source of Vitamin D. For the first time, the levels of choline and Omega 3 fatty acids in UK eggs have been quantified, and eggs are now known to be a significant source of both nutrients. Choline is an important component of cell membranes and is involved in fat metabolism as well as being needed for normal liver function. It is now possible to analyse that Omega 3 fatty acid composition of eggs is sufficient now to claim that eggs are also a ‘rich source’ of Omega 3, which can help maintain healthy blood pressure and prevent heart disease.

Hen pecked Some of the changes in egg composition, such as the increase in Vitamin D in both egg white and egg yolk, are due to changes in hen feeding practices. There has been a switch in feed to feed based on wheat, soya bean meal, sunflower meal and soya oil, leading to an alteration

Egg Nutrition The energy (calorie) value of an average medium sized egg (58g) is 66 calories. The total fat content of an average medium sized egg is 4.6g. The protein content of an average medium sized egg is 6.4g (7.5g for an average large egg). Nutrient data for eggs, September 2012, on behalf of the British Egg Industry Council.

in the fat composition of hens’ feed, so hens’ diet is now richer in fat and energy. Official new data shows that today’s eggs contain double the amount of selenium found than when previous analysis was carried out 30 years ago, back in the ’80s. Today’s eggs also contain around 20% less fat, more than 20% less saturated fat

and around 13% fewer calories and more than 10% less cholesterol than previous surveys suggested. All the compositional data provided by the Department of Health is represented on a per 100g basis.

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LIVING Eggs and cholesterol Previous advice to limit the number of eggs you ate because they contained certain dietary cholesterol has been reconsidered. It’s now understood that it is dietary fat, not dietary cholesterol, that is the main dietary factor in raising blood cholesterol. All major heart and health advisory groups, including the Department of Health and the British Heart Foundation, have lifted their previous limit on egg consumption. According to the British Heart Foundation, while too many fried eggs and cheesy omelettes may risk raising your cholesterol, it’s the added fat form the oil or the cheese that’s the problem, not the eggs. So poached, boiled or scrambled eggs (without butter) are all fine and should be eaten as part of a balanced diet. Without a doubt, eggs are eggstremely good for you, so crack on!

Marcus Bean’s Asparagus wrapped in smoked salmon with scrambled egg Serves 2, takes 20 mins 10 stems of asparagus 4-6 slices of good quality smoked salmon 3 free range eggs Salt & pepper Cook the asparagus place in a steamer or in a chargrill pan. Then wrap five stems of asparagus with 2-3 slices of smoked salmon, repeat with the other five stems. Break three eggs into a small non-stick pan, add a little salt and pepper then whisk together with a fork until mixed.

Then cook on a medium to high heat, continually stirring with a rubber spatula, and scraping the edges down Once it’s about half way cooked remove from the heat and continue stirring until egg is cooked (his helps sure you don’t overcook

the egg). As soon as the egg is cooked remove from the pan immediately and serve with the smoked salmon wrapped asparagus.

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