With over 200,000 people with type 2 diabetes in Ireland, a non-invasive neurostimulation device to control long-term blood sugar levels has the potential to make a difference in thousands of lives. 

Type 2 diabetes is a condition that causes the level of glucose in the blood to become too high, caused by problems with insulin. As it is a chronic condition, patients are generally required to gradually increase their medications, adding additional drugs or upping doses every three to four years.

The risk of progression

Dr Jason McKeown, Chief Executive Officer of Neurovalens, explains: “Very quickly, people with type 2 diabetes end up in expensive scenarios with ever-increasing medication. Side effects can be messy and, really, they are just watching their diabetes get worse — managing it, not fixing it.”

Meanwhile, overall health deteriorates as type 2 diabetes can increase the risk of serious problems with the eyes, heart and nerves. “As diabetes gets worse, there is an increased risk of heart attacks, strokes, obesity and a whole host of conditions,” McKeown says.

It could allow patients more choice and potentially restore function to maintain low-level diabetes for longer.

Innovative device

In response, Neurovalens has developed a non-invasive neurostimulation device aiming to control long-term blood sugar levels in people with type 2 diabetes. “Our interest was in improving the part of the brain that detects glucose and doesn’t function very well in type 2 diabetics,” explains McKeown. “We want to restore function or improve the performance of that area.”

The device, which is worn on the head like a small set of headphones for 60 minutes a day, transmits a small electrical impulse into the brain and nervous system to help stimulate glucose detection. Final stage trials are currently underway, and we are actively recruiting through University College Dublin to make the device available on prescription and potentially treat type 2 diabetes earlier — possibly even in the preventative stage for those with prediabetes.

Reversing the effects

“It could allow patients more choice and potentially restore function to maintain low-level diabetes for longer,” McKeown says. “This could keep people with type 2 diabetes from having to move up the treatment ladder and take on additional drugs, side effects and costs.”

He concludes: “We hope it won’t just be about stopping progression but reversing type 2 diabetes at that early treatment stage to revert patients to prediabetes or normal levels. That won’t be the case for everyone, but if we can help 30% of patients off of that chronic disease pathway — that is a huge benefit.”

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New medicines and technology can help people with diabetes live healthier lives, but there’s no substitute for weight loss, a good diet and exercise.

The impact that diabetes can have on the eyes and bodily extremities, such as feet are well known, but the heart and kidneys can also be affected. This means it is important for people living with diabetes to have their heart and kidney functions checked when they visit the GP once or twice a year. 

The various consequences of diabetes – which result from high blood sugar levels can be impaired vision, amputation of toes, feet or even legs and can also lead to heart failure, heart attack, or kidney failure resulting in dialysis. However most people with diabetes will die as a result of heart disease or stroke.

Link between obesity and type 2 diabetes 

Obesity and type 2 diabetes go hand-in-hand, with obesity being a leading cause of diabetes. There is a big risk for diabetes among sedentary, overweight middle-aged people, who need to exercise and eat well. 

It is important that people diagnosed with diabetes understand that complications do not inevitably come with the disease. Some live healthy lives, for many years with diabetes. The better a person’s diet is, and the more exercise they do, the better the chances of avoiding complications. 

It is important that people diagnosed with diabetes understand that complications do not inevitably come with the disease.

Rise of diabetes technology 

High blood pressure is a risk with diabetes, this can be treated with ACE inhibitors which act to relax the blood vessels and reduce blood pressure. The STLG2 inhibitors, meanwhile, work by lowering blood sugar and themselves reduce blood pressure in the kidney and thus can protect the kidneys. There are also new technologies which can also help. 

For example, the FreeStyle Libre System is a device that measures blood sugars every 15 minutes. It resembles a two-euro coin and is worn on the arm and linked to a smartphone. At the end of a given day, it can produce graphs of how a person’s sugar levels behaved during the day. These devices and medicines are effective and provide good information but not a substitute for a healthy lifestyle. 

Speaking to your GP 

It is important people tell their GP when they are experiencing signs of chest pain or shortness of breath. This is because GPs may test a person with diabetes for cholesterol and blood pressure, but not heart problems themselves. People with diabetes are at risk of heart problems and they may not present with typical symptoms. The simple things are important, such as attending GP appointments, exercising, eating well and not to be over reliant on drugs alone to mitigate the effects of the disease. It is important to watch closely for signs of complications and seek help when needed.

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More than half a billion people are living with diabetes worldwide and one in three families is affected by diabetes in Ireland.

One in 10 people around the world has diabetes, a chronic condition listed by the World Health Organization in the top 10 leading causes of deaths globally. It is important to know that when diagnosed early and managed well people can live long and healthy lives. 

The surge of diabetes – any type, any age

Diabetes occurs when there is too much glucose in the blood because of a lack of insulin (type 1 diabetes) or insulin is not working properly (type 2 diabetes). The most common type of diabetes is type 2. 

Risk factors for type 2 diabetes include age, family history sedentary behaviours, obesity/overweight, stress and previously having gestational diabetes. It is usually diagnosed in adults and its incidence increases with age. Type 1 diabetes is one of the most prevalent chronic illnesses in children and adolescents but is diagnosed in people of all age-groups. It is an autoimmune condition not preventable and its causes are unknown. 

Awareness and education

Type 2 diabetes is often treated with lifestyle modifications (healthy eating, exercise and weight management) combined with medication if required. With type 1 diabetes, insulin therapy is a must – it requires daily (multiple) insulin dosing (via injections or an insulin pump) and frequent (or continuous) glucose monitoring in order to decide about the doses.

The insulin doses are calculated based on the meal content, exercise, stress levels and many other factors. In both types, diabetes education and support are instrumental in helping the individual to self-manage their condition daily and achieve recommended blood glucose values.

Early recognition of diabetes and medical intervention are necessary to live long and healthy lives, and to avoid short and long-term diabetes-related complications.

Recognise the symptoms 

Early recognition of diabetes and medical intervention are necessary to live long and healthy lives, and to avoid short and long-term diabetes-related complications. One of the most serious complications is diabetes keto-acidosis (DKA) – it results from insulin deficiency and is life-threatening. It often occurs at the time of diagnosis of type 1 diabetes. According to the Irish Childhood Diabetes National Register, in 2020, over 40% of newly diagnosed children with diabetes had DKA. It could have been avoided, if the symptoms were recognised sooner.

Know the signs 

Therefore, the TEST campaign was launched to raise awareness of the symptoms of type 1 diabetes. TEST represents the following: thirst (increased), energy (reduced), sudden (weight change) and toilet (trips increased). These symptoms are key indications that a person might have diabetes and a simple finger-prick blood glucose test is required urgently.We hope that this simple acronym will help you to more easily remember and recognise the symptoms of diabetes and take action when these are noticed. If so, contact your GP immediately, or talk to your pharmacist.

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World Diabetes Day 2021 marks 100 years of insulin discovery. After a century of this life-saving medicine, we still need better access to diabetes care.

Thanks to the outstanding developments in medicine, people with diabetes can now live long and healthy lives. However, more than half a billion people with diabetes still face challenges in accessing best standards of diabetes care. As a result, the main theme of this year’s celebrations is access to care.

Access to education

In Ireland, despite the reimbursement of medicines, over 225,000 people living with diabetes still have unequal access to the best available treatments and care.

In many places across the country, there are shortages in diabetes specialists (nurses, dietitians, endocrinologists), therefore many aspects of the service (structured diabetes education, access to diabetes technology) are unavailable. Adults with type 1 diabetes are waiting years to access education programs, whereas education is key to self-manage diabetes and should be delivered within the first year after diagnosis.

For people with type 2 diabetes, HSE offers the Integrated Care Programme for the Prevention and Management of Chronic Disease. Recently implemented, it aims to reshape the delivery of specialist diabetes care for people with uncomplicated type 2 diabetes. Investment in more than 200 posts for the Community Chronic Disease Specialist Teams will surely improve access to education for many. However, this model is ‘free of charge’ for Medical Card holders only, meaning that approximately 40% of people with diabetes may have no access to this intervention.

In Ireland, despite the reimbursement of medicines, over 225,000 people living with diabetes still have unequal access to the best available treatments and care.

Access to support

Psychological support is instrumental in helping to deal with the burden associated with living with diabetes but it is almost inaccessible. It is not formally embedded as part of diabetes management and is not in line with diabetes-related health-services delivery in Ireland. Presently, there is a 95% deficit of diabetes psychologists in adult diabetes services in acute hospitals and there is no access to dedicated diabetes psychology services in primary care. 

Highlighting the gaps 

Ireland is also one of a few countries in Western Europe that does not have a National Diabetes Registry. We don’t really know how many people have diabetes, how many suffer from complications and what their clinical outcomes and needs are. The establishment of a registry would help with tracking the prevalence of the condition, measuring outcomes and cost of care and planning for future services. Highlighting all of the above, Diabetes Ireland has prepared pre-Budget submission 2022 and proposed eight immediate actions for implementation to improve access to and the quality of diabetes care in Ireland.

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Challenge yourself

Going after goals — big or small — while managing diabetes is extra effort and sometimes scary. But when you challenge yourself and reach a goal you start to change your mindset. You can progress your diabetes forward while believing in yourself. Also, you’ll find more confidence to set new ambitions. Create realistic goals with a timeline, like running a 5km race in January. Once you achieve it, set a new goal.

Get connected

Living with diabetes doesn’t have to be lonely, so get yourself connected with others. Sharing diabetes stories and daily struggles with other people who have diabetes is good mental therapy because they can empathise with you. In Ireland, there are local meet-up groups and Facebook groups in nearly every county. Get involved, be it at a diabetes-related event or advocacy group or be part of the online community like Diabuddies or the Diabetes app.

Allow your mind to take a break from diabetes. Finding ways to be present in a mindful practice will help reduce stress and revitalise your body.

Find your own meditation

Allow your mind to take a break from diabetes. Finding ways to be present in a mindful practice will help reduce stress and revitalise your body. Meditation can be anything – hiking, knitting, sea swimming, gardening, cooking, cycling, dancing, etc. Find an activity that you enjoy and that gives you a restful mind.

Identify imbalances

I like to call this diabetes mapping. First, take a look at your diabetes and how it relates to your lifestyle and environment. You can start to identify imbalances with your diabetes and where you need to spend more time to create a healthy balance. These areas include technology access, stress management, self-confidence, eating habits, physical activity, relationships, joy and overall health.

Explore food flexibility

People with diabetes can eat all types of food and even carbohydrates. By exploring different food and cooking, you improve your relationship with food. Combine carbohydrates and starchy foods with protein and fibre to stabilise glucose levels. Keep a food journal to better understand your glucose trends with snacks and meals. This data transparency will give you more flexibility with eating.

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Taking a holistic view of diabetes can help people with the disease live better lives, stay healthy and feel more confident about themselves.

Erin Dolan admits that when she was first diagnosed with type 1 diabetes around 30 years ago, she experienced a loss of self-identity, fear of judgement and lack of confidence. 

These days, however, she takes a holistic approach to the disease, which entails focusing on her whole self (rather than just her diabetes) to find a balance between her mind, body and spirit. This has worked so well that she is now a health coach with her own business called Crazy About Diabetes that helps those with diabetes to lead more fulfilling lives.

You don’t have to feel alone. There are so many resources available to help anyone with diabetes progress their health — and live their best life.

“Diabetes is often referred to as ‘an invisible disease’ because you can’t tell if someone has it just by looking at them,” says Dolan. “Yet it comes with many physical and emotional challenges. That’s why it’s important for anyone with diabetes to find ways to reduce their mental stress, while being aware of the effects that physical activity, food and nutrition can have on their body. Finally, by embracing their diabetes, they can increase their self-esteem and lift their spirit.”

Tapping into resources to boost physical and mental health

To help her mental health, Dolan swims in the sea, has run marathons and even cycled across Central America. But mindfulness practices don’t have to be as big and ambitious as that. “If you have diabetes, it’s constantly on your mind,” she says. “It’s exhausting. So being present in the moment with something you love to do gives your mind a much-needed break. It could be cooking, gardening, knitting or dancing. As long you enjoy it and it redirects your focus, it’s a valid mindfulness practice.”

When it comes to bodily health, Dolan has reassessed her relationship with food. “There’s no ‘one-size-fits-all’ diet,” she says. “It’s up to each individual to experiment with cooking, crowding out processed foods and bringing in healthier alternatives.” She also advocates meal planning and using technology such as carb-counting apps to help make the process easier. 

To soothe the spirit, Dolan stresses that people need to embrace their diabetes (rather than wishing they didn’t have it) and connect with others in the same position. “It can be an isolating disease,” she says. “Yet you don’t have to feel alone. There are so many resources available to help anyone with diabetes progress their health — and live their best life.”

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New data from the International Diabetes Federation highlights the alarming growth of diabetes prevalence across the globe.

The findings from the IDF Diabetes Atlas 10^th edition highlight the alarming growth in the prevalence of diabetes around the world. More than 537 million adults (one in 10) are now living with diabetes worldwide — a rise of 16% (74 million) in the past two years. Without sufficient action to address the situation, we predict 643 million people will have diabetes by 2030 (11.3% of the population).

More than 537 million adults (one in 10) are now living with diabetes worldwide — a rise of 16% (74 million) in the past two years.

Spiralling out of control

I wish I could report that the past two decades have witnessed decisive action to tackle diabetes. I wish I could share the news that all people living with diabetes worldwide can access and afford the care they need. I wish I could declare that 100 years after its discovery, therapeutic insulin is now within reach of all those who need it to survive. Unfortunately, I cannot. Instead, I must repeat the message that diabetes is a pandemic of unprecedented magnitude spiralling out of control.

Diabetes is one of the top 10 global causes of death. So why is not enough being done to prevent diabetes and its complications and provide the best available care to people with the condition?

Much can be done to reduce the impact of diabetes. Evidence suggests that type 2 diabetes can often be prevented, in some cases reversed. Meanwhile early diagnosis and access to appropriate care for all types of diabetes can avoid or delay complications for people living with the condition.

Rays of hope

There are some rays of hope. The centenary of the discovery of insulin has attracted greater attention to the diabetes cause. In April, the World Health Organization launched its Global Diabetes Compact, marking an increased focus on diabetes. Soon after, a landmark Resolution was agreed by the World Health Assembly, highlighting the importance of prevention, diagnosis and control of diabetes. These are important steps towards addressing the continued and rapid rise of diabetes prevalence, particularly in countries that do not have a national diabetes plan. 

Support our call

Words must now be turned into action. If not now, when? The theme chosen by the International Diabetes Federation for diabetes awareness month and World Diabetes Day is access to diabetes care.

The IDF is calling on national governments to provide the best possible care for people living with diabetes and to develop policies to improve diabetes screening and type 2 diabetes prevention, especially among young people. 

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A sugar-free diet is not necessary for people managing diabetes. In fact, dietary recommendations for sugar for people with diabetes are the same as those for the rest of the population.

A healthy eating plan, as is recommended for the majority of the population, is also recommended for people with diabetes. This eating plan is for example high in fibre and vegetables, low in saturated fat, and low in free sugars.

Carbohydrates – our fuel source

Starchy carbohydrate foods, such as whole grain breads and cereals, potatoes, pasta, rice and noodles, are broken down into glucose (sugar) during digestion, and used by the body for energy. These foods also provide us with essential vitamins, minerals and fibre. In conclusion, eating moderate amounts of starchy carbohydrates at mealtimes helps regulate blood glucose levels.

Foods containing natural sugars, such as fruit, milk and yoghurts, also provide us with fibre, vitamins and calcium, and are a healthy addition to our eating plan.

Less healthy sugars

Free sugars, such as those found in table sugar, honey, syrups, biscuits, cakes and sugar-sweetened drinks, are not essential, and these foods are low in nutrients. Whether we have diabetes or not, it is important to remember that we all, limit our intake of free sugars to a maximum of 5% of total energy per day [1]. In other words this works out at 25g of free sugars for an average adult eating 2,000 kcals per day.

Sugar content of some common foods:

For those who like the sweet taste, but wish to reduce their sugar intake, artificial sweeteners are safe and can be used instead.

When free sugars are needed

Low blood glucose levels (hypoglycaemia or blood glucose less than 4mmol/l) may occur for people on certain diabetes medications. In fact, the fastest way to raise low blood glucose is to drink a liquid containing sugar. Fifteen grams of sugar is surely enough for an adult/teen of average build: younger children may need smaller quantities. 200ml of fruit juice or 150 – 200mls full-sugar fizzy drink, will in fact provide approximately 15g of sugar.

Individual dietetic advice

With this in mind, Dietary advice from a CORU-registered dietitian is recommended for people with diabetes. This can be provided on an individual basis or through structured group education programmes in either primary care or the hospital setting.

[1] Diabetes UK Evidence Based Nutritional Guidelines for the Prevention and Management of Diabetes, March 2018

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Abby Langtry

Director of Patient Advocacy and Community Engagement, Genomics Medicine Ireland

Genomics research could offer a significant healthcare breakthrough — that is to say, more targeted, personalised treatments for patients with Type 1, Type 2, rare… all forms of diabetes.

One-size-fits-all treatments are generally not the best way to treat all forms of diabetes. However, if you have diabetes, this is likely what is on offer.

However, genomic research offers the possibility of more targeted, personalised, precision treatments that promise better patient outcomes.

This can’t come too soon. Especially with rates soaring, there’s an urgent need to find new therapeutics that can treat all forms of diabetes more effectively.

Michael Higgins is Clinical Programme Manager at research company, Genomics Medicine Ireland (GMI), which was established in 2015 with the aim of building a world-class disease specific genomic database.

This in fact will include data from 400,000 volunteers in Ireland from both ‘healthy’ participants and patients with up to 60 different diseases (including diabetes). This is on the whole one of the largest genomics studies in the world.

Understanding all forms of diabetes and identifying new drugs

“Genomics is the large scale study of all our genes and their functions,” he explains. “Our genes contain sequences of DNA in our cells that act as the blueprint for every human being, controlling everything from our eye and hair colour to our likelihood of developing a particular disease.

Genomic research offers the possibility of more targeted, personalised, precision treatments that promise better patient outcomes.

“The hope is that this research will help us understand all forms of diabetes in more detail, and potentially identify drug targets for novel therapeutics for Type 1, Type 2 and rare forms of the disease.”

Naturally, in this case, this research wouldn’t be possible without patient participation. “We’re very grateful for the people who participate in our studies,” says Abby Langtry, GMI’s Director of Patient Advocacy and Community Engagement.

“We believe that every patient has the right to participate in research of this kind, should they so choose.”

Educating the public about the power of genomics

Participating in this research is on the whole a simple and straightforward process. Langtry says “If a person (over the age of 18) is deemed eligible for the study, they will be given a detailed information leaflet explaining how their data will be used, stored and accessed,”.

“Once they consent, volunteer participants complete a questionnaire and give research staff permission to access their medical records, in order for them to gain an understanding of contributing factors such as medical history and lifestyle. Participants also give a sample of blood — and that’s it.”

Data security is paramount. At GMI, personal identifiers are never used to label samples or clinical information, and data is stored on a platform with the highest GDPR-compliant standards of research and data protection regulations.

Langtry says that more needs to be done to inform people about the potential benefits of genomics.

“Last year, we carried out research into the understanding of genomics in the Irish general public,” she says. “The rate (of people who knew about it) was just 6%. So there’s a huge gap. That’s why we work with patient advocacy groups to explain our studies. This is helping educate people about how genomics could deliver real change to healthcare.”

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Type 1 diabetes onset is rapid (days-weeks) with aggressive deterioration once symptoms present. Prompt diagnosis prevents life-threatening illness and conveys better lifelong health outcomes; healthcare professionals must finger prick glucose check if in doubt.

What is Diabetes?

Type 1 diabetes is a lifelong condition in which the pancreas produces little or no insulin. Cells produce energy using glucose, which in-turn requires this hormone. The more common type 2 diabetes occurs when the body becomes resistant to insulin or doesn’t make enough insulin. While both type 1 and type 2 diabetes result in high blood glucose levels, the development and management are very distinct.

There is currently no cure for type 1 diabetes and insulin by injection is the only form of treatment.

What can happen if diagnosis is delayed

There is currently an alarming rise in the number of young people being admitted to hospitals with a new diagnosis of type 1 diabetes, which was not diagnosed immediately. This has resulted in a potentially life-threatening condition called diabetic ketoacidosis (DKA). This is 17% of the approximate 250 new cases annually.

Prompt diagnosis of type 1 diabetes means earlier administration of insulin and thereby better lifelong health.

These young people would have presented to a professional with symptom of high glucose levels such as thirst, weight loss, frequent urination etc, returning in subsequent days for a fasting blood test.

However, a simple finger prick glucose check, done immediately, could lead to prompt diagnosis and avoid the risk of developing DKA.

How does type 1 diabetes develop, what will show?

A combination of genetic (hereditary) and environmental (exposure) factors are thought to trigger the destruction of the pancreatic beta cells (insulin producing cells).

In fact the actual cause remains elusive, as does a cure or method of prevention. The destruction of the beta cells occurs over weeks/months when the young person usually presents with thirst and frequent urination. For this reason these symptoms can be mistaken for urinary tract infections.

If DKA is developing, the young person may complain of abdominal pain, dehydration and extreme lethargy. These symptoms are all similar to gastroenteritis. Although, unfortunately, if missed can lead to loss of consciousness and hyperventilation (i.e DKA) – requiring urgent, intensive therapy.

What can parents and guardians do?

Because parent know their children well, they can be the first to pick up minor changes such as being extra thirsty or needing the bathroom more frequently. If these signs are concern to the extent of seeking a medical explanation, don’t hesitate to ask your doctor/practice nurse or local pharmacy. They can help you do a finger prick blood glucose check (in a younger child, a urine glucose check).

Prompt action could avoid your child spending days in intensive care. Prompt diagnosis of type 1 diabetes means earlier administration of insulin and thereby better lifelong health.

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