DiabEasy as 123

25/04/2026

If you’re free at lunchtime on 29th June feel free to join me online for a short session. See link:

Join us for our Lunchtime Health News Sessions, where we invite experts to share insight and perspective through an informal interview and live Q&A. Managing Diabetes in Primary Care: Q&A 📅 Date: Monday 29th June 2026 ⏰ Time: 12:30pm – 13:15pm (BST) 📍 Where: Online – grab your lunch an.....

24/04/2026

Diabetes UK press release 23.4.26 - 'MajorFreeDM2 trial shows continuous glucose monitoring improves blood sugar management in people with type 2 diabetes'. Have you seen the digital CRAFT cards from Issues & Answers in Primary Care for all the info you need on implementing ? They are free to download onto your mobile device. Take a look now https://www.issuesandanswers.org/resources/digital-craft-cards-continuous-glucose-monitoring-cgm-and-freestyle-libre-2/

23/04/2026

23/04/2026

In the news today we are being reminded that Levemir is being discontinued and we need to ensure patients are switched as soon as possible. Supplies will be gone by the end of 2026. This AI generated infographic isn't perfect but it the best I could do.
Here's my way of explaining it.

WHAT’S HAPPENING?
1. Levemir is being discontinued
2. Stock expected to run out by end of 2026
3. Do NOT start new patients on Levemir
ALL EXISTING PATIENTS WILL NEED A PLANNED SWITCH TO ALTERNATIVE BASAL INSULIN

HOW TO SWITCH SAFELY
1. Clinical review is essential before switching
2. Choice depends on: once-daily vs twice-daily Levemir
3. Dose reduction is usually needed to avoid hypoglycaemia:
E.g. Once daily → consider long-acting insulin (e.g. glargine) → reduce dose by 20%
E.g. Twice daily → consider intermediate insulin (e.g. NPH) → reduce dose by 10%

REMEMBER: Switching is NOT 1:1 due to different absorption rates and time / action profiles

MONITOR, SUPPORT, REVIEW
1. Expect glucose instability during the switch.
2. Use: Capillary glucose ≥4 times/day, CGM if available, NOT HbA1c alone
3. Follow up at 1–3 weeks (earlier if high risk)

PROVIDE:
1. Education (including sick day rules)
2. Clear safety-netting
3. Written information

CHECK:
1. Understanding of changes
2. Injection technique
3. Lipohypertrophy (Lumps and bumps at injection sites) if control is erratic.

BASICALLY THIS:
1: Review
2: Replace & Reduce dose
3: Review again

REMEMBER TO TELL YOUR PATIENTS:
"Your insulin isn’t unsafe – it’s just being discontinued. Nothing is wrong with it – we just need to move you to a newer option that works just as well (if not better) and keep you safe whilst we make the change."
Please comment if helpful.


https://mot.southyorkshire.icb.nhs.uk/rotherham/files/Rotherham%20Guideline%20Insulin%20Levemir%20discontinuation.pdf

23/04/2026

This was a really popular post - as it is an easy way to remember blood glucose targets. I have changed it a bit to be more in-line with my colours so it looks less busy. 7 is heaven - as it is ideal not to go too much above this number for too long - (Not because that is where you go. It's just a good rhyme). Feel free to share.

22/04/2026

This is one of my Intro to diabetes courses. Please see link to PCDC if you’re interested or know anyone who is. https://www.pcdc.org.uk/

20/04/2026

Today is World LIVER Day
Why am I posting about the liver?
Well….
In Type 2 diabetes we often focus on glucose, but we know that T2D is now regarded as a Cardio Renal METABOLIC disorder.

That word “METABOLIC”
actually relates to the LIVER which is right at the centre of the diabetes story.
Why do I say that?
I will try to explain in my way.

“Metabolic” refers to how the body processes and stores energy (glucose, fat, etc.)
The liver is central to metabolism, especially relating to:
1: Glucose production (hepatic glucose output).
2: Glycogen storage.
3: Fat metabolism (lipogenesis & export).

In Type 2 diabetes:
1: The liver becomes insulin resistant.
2: It continues to release glucose even when it shouldn’t.
3: It also accumulates fat (leading to MASLD) [previously known as NAFLD - non-alcoholic fatty liver disease].

MASLD is short for “Metabolic dysfunction–associated steatotic liver disease” and is now one of the most common comorbidities in T2D.
Here’s how I explain this in my way.

1: Up to 70% of people with T2D have MASLD.
2: Many don’t know they have it!
3: It increases risk of fibrosis, cirrhosis & cardiovascular disease.

In danger of repeating myself, my way to think about this is:

1: Insulin resistance means fat builds up in the liver.
2: The liver then overproduces glucose and releases it into the bloodstream.
3: This causes blood glucose to rise further…(I call it leaky liver).
And so a vicious cycle develops!

Why this matters in clinical practice:
1: MASLD is often silent!
2: Normal LFTs do NOT necessarily exclude it.
3: Consider fibrosis risk (e.g. FIB-4) in T2D reviews.

Interestingly, it’s not all gloom and doom!
1: Weight loss (5–10%) can significantly reduce liver fat to improve things.
2: GLP-1 RAs & pioglitazone have evidence in helping with MASLD/NASH [non-alcolic steato-hepatitis].
3: As usual, cardiovascular risk is often the biggest threat!

So….In diabetes care, don’t forget to think LIVER, not just glucose.

I hope this helps? Please comment if you’d like.

18/04/2026

I teach about this on my diabetes courses. But this is my free weekend lesson.
When should you question a “Type 2 diabetes” diagnosis?
Think beyond T2DM if the picture doesn’t fit:
🚩 Red flags
• Diagnosis

17/04/2026

I’ve posted previously about this. But another challenge you face in clinics is this.
This is my response.
You asked:

“How can we help patients make and sustain lifestyle changes… in a world of stress and highly processed foods.”
AND
“How to we get them to “buy-in” for multiple medications… when they feel absolutely fine—and a bit resentful about it all.”
Let’s talk about it…

This is the reality of diabetes care in primary care right now.
We’re asking people to:
1: Change how they eat.
2: Move more 🚶‍♀️
3: Manage stress 😓
As well as take multiple medications 💊
All while they are feeling perfectly well AND often feeling fed up about their diagnosis!

The challenge isn’t knowledge…It’s capacity.
Because most people:
1: Already feel overwhelmed.
2: Are living in busy, stressful environments.
3: Are surrounded by food that works against them
So what actually helps?

1. Shift from “advice” to “support”
Not:
“You need to lose weight / eat better”
But:
“What feels realistic for you right now?”

2. Normalise the resistance
“It’s completely understandable to feel frustrated—most people do.”
This reduces guilt and opens the door to change.

3. Reframe medication overload
Instead of:
“You now need 4 medications”
Try:
“Each of these is targeting a different risk—together they protect your heart, kidneys, and future health.”

A phrase that works well:
“I know it feels like a lot… but each of these treatments has a specific job—think of them as a team working together to protect you long-term.”

The real goals are:
1: Small, sustainable changes
2: Shared decision-making.
3: Supporting—not overwhelming

What’s your experience?

How do you balance lifestyle conversations with medication discussions?

Please comment.

16/04/2026

Thank you Donna Atkin, your challenge suggests others find it challenging too!
Here’s my answer:-
“Getting across to people who feel fine, the importance of adding medication for cardiovascular protection—when lifestyle and dietary changes are no longer having an impact.”

This is one of the biggest challenges in diabetes care.

Because from the patient’s perspective:
1: “I feel fine”
2: “Why do I need more medication?”
3: “Surely lifestyle is enough?”

But from a clinical perspective, we know:
1: Cardiovascular risk is often silent.
2: Glucose, BP, and lipids may still be causing harm.
3: Medications like statins and SGLT2 inhibitors are about protection, not just treatment.

🔑 suggests is shift we need to make:
Instead of saying:
1: “You need this because your numbers are high”
Try:
2: “This is about protecting your heart and kidneys for the future”
3: These meds are like an insurance policy for your future health!

A phrase that can work well:

“Even though you feel well now, diabetes can quietly affect the heart and blood vessels over time. These medications help protect you from problems in the future—not just treat what’s happening today.”

Keep it person-centred:
1: Acknowledge how they feel.
2: Link to what matters to them.
3: Focus on prevention to avoid future complications.

What’s your experience?
How do you approach these conversations in practice?
Please comment if you find this helpful.

16/04/2026

Question for you from me.
What do you believe to be the biggest challenges in diabetes primary care?

15/04/2026

Another Question - this time about Type 1 diabetes and risk of cognitive decline
🧠 What’s the story? This is my way of explaining it.
What the range of evidence, including meta-analyses shows is that:
1: People with T1D can have subtle cognitive changes over time; this may include:
2: Slower information processing
3: Reduced attention or executive function.

The risk of dementia is increased, but it is less strongly established than in Type 2 diabetes and the evidence base is smaller and more mixed opinions.

The key drivers in Type1: (different to Type 2) are:

Recurrent hypoglycaemia - Especially severe hypos which can affect:
1: Memory
2: Learning
3: Brain resilience over time
This is a big differentiator from Type 2 diabetes

Chronic Hyperglycaemia over time which we know leads to
1: Microvascular damage in the brain, in a similar pathway to
2: Retinopathy and
3: Nephropathy

Recurrent DKA episodes - Particularly in childhood.
This has been shown in studies to be associated with long-term cognitive impact, especially if severe.
Education is key!

1: Longer duration of Type 1 diabetes means higher cumulative exposure.
So risk increases with:
2: Early onset T1D
3: Decades of living with T1 diabetes

Key clinical takeaway is that:
In T1D, cognitive risk is less about “classic dementia pathways” and more about:
“Brain exposure to extremes of glucose over time.”

How you might explain this is:
“In Type 1 diabetes, it’s not just high glucose we worry about — it’s the swings.
1: Repeated hypos,
2: Chronic hyperglycaemia, and
3: DKA episodes
Which all place stress on the brain over time.”

Practical implications:
1: Avoid over-tight targets if causing hypos.
2: Prioritise Time In Range, (TIR) and Hypo prevention
3: Be alert to cognitive changes in long-standing T1D which might only be noticed from a change in the persons self-management ability.

In summary: Meta-analyses show that people with Type 1 diabetes have small but measurable cognitive differences over time, with the strongest evidence linking recurrent hypoglycaemia, chronic hyperglycaemia, and longer disease duration to worse outcomes.
Please comment if helpful.