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Ireland – ‘Far from Where it Should be’ in Diabetes Dr Colin Hawkes, Consultant Paediatric Endocrinologist, Cork University Hospital
Advances in technology, however, have largely replaced the fingerstick glucose checks with glucose monitors and insulin injections with insulin pumps. Possible signs of diabetes in children include increased thirst, frequent urination, bed wetting, reduced energy, unexplained weight loss, extreme hunger (possibly with craving for sugary foods) and vaginal thrush.
of this disease," said Dr Hawkes, a paediatric endocrinologist at CUH. “We are very far from where we should be, there is a lot more that we need to be doing to meet the needs of these children and their families. “In CUH alone, we have an exceptional team but we should have six diabetes nurses for the number of children we care for and we only have three. We have submitted a business case requesting three more. It is extremely difficult to provide the care these children deserve at such low staffing levels.
Ireland is "very far from where it should be" in the treatment of children with Type 1 diabetes, an expert in the disease has claimed. A co-ordinated national strategy is vital to confronting the chronic condition, said Consultant Dr Colin Hawkes ahead of World Diabetes Day held in November past.
He and the team at Cork University Hospital treats almost 500 children with Type 1 diabetes, but insufficient resources mean it is not possible to see children every three months, as recommended - with some waiting six-eight months between appointments. “We are also totally unequipped to address the psychological burden
“We also should be at the forefront of research in this condition and are working to generate energy and funding to build a research team and programme. This will help change the future of this condition.” In Type 1 diabetes, the immune system attacks the pancreas, destroying cells that make insulin crucial for sending glucose (sugars) to the body's cells for energy. When a child is diagnosed, they must learn to detect glucose levels and administer insulin throughout the day and night.
“We know that if it is not properly controlled, it increases the risk of heart disease, blindness and kidney failure in adulthood. It is extremely important to get it right. This is critical in childhood, where we are setting the child on a life-long journey in managing this condition. “The aspiration should be that every child should have access to the same and the best standard of care, regardless of where they live. There is not equity in Ireland in access to a full diabetes multidisciplinary team. “Cork is the largest centre in Ireland without a dedicated psychologist to support these families. “CUH is a regional centre of excellence for children with type 1 diabetes in the South/Southwest Hospital Group. In addition to our local children, we provide diabetes expertise for children in Kerry and as far as Clonmel (Tipperary). “Rather than bringing children long distances to us, appropriate staffing of the diabetes programme at Cork would allow our diabetes team to perform regional outreach clinics. In my view, that should be the model.”
Body Clock and Inflammatory Disease Link New research from RCSI has demonstrated the significant role that an irregular body clock plays in driving inflammation in the body’s immune cells, with implications for the most serious and prevalent diseases in humans. The research was led by the School of Pharmacy and Biomolecular Sciences at RCSI University of Medicine and Health Sciences. The circadian body clock generates 24-hour rhythms that keep humans healthy and in time
with the day/night cycle. This includes regulating the rhythm of the body's own (innate) immune cells called macrophages. When these cell rhythms are disrupted (due to things like erratic eating/ sleeping patterns or shift work), the cells produce molecules which drive inflammation. This can lead to chronic inflammatory diseases such as heart disease, obesity, arthritis, diabetes and cancer, and also impact our ability to fight infection. In this study, the researchers looked at these key immune
JANUARY 2022 • HPN | HOSPITALPROFESSIONALNEWS.IE
cells called macrophages with and without a body clock under laboratory conditions. They were interested to understand if macrophages without a body clock might use or 'metabolise' fuel differently, and if that might be the reason these cells produce more inflammatory products. The researchers found that macrophages without a body clock took up far more glucose and broke it down more quickly than normal cells. They also found that, in the mitochondria (the cells energy powerhouse), the pathways
by which glucose was further broken down to produce energy were very different in macrophages without a clock. This led to the production of reactive oxygen species (ROS) which further fuelled inflammation. Dr George Timmons, lead author on the study, said, “Our results add to the growing body of work showing why disruption of our body clock leads to inflammatory and infectious disease, and one of the aspects is fuel usage at the level of key immune cells such as macrophages.”
