NICE changes insulin advice in diabetes guidelines

NICE has changed its recommendations on type 1 diabetes in adults and children, and type 2 diabetes in children, to reflect ‘major recent major advances’ in the management of diabetes.

The regulator last published guidance on type 1 diabetes ten years ago – and the number of people with diabetes has risen sharply since.

The Health Survey for England, published this week, found the prevalence of diabetes increased from 2.4% to 6.2% between 1994 and 2013. Last year there were 24,000 children with type 1, and 450 with type 2 – which is linked to lifestyle and usually develops slowly and in people over the age of 40. There are over 370,000 adults with type 1 diabetes in the UK.

The guidance on diabetes in children and young people recommends those with type 1 should be prescribed multiple daily insulin injections, or insulin pumps to control their blood sugar levels. The guidance for type 1 in adults recommends multiple daily injection basal bolus insulin, rather than twice-daily mixed insulin regimens, as first-choice insulin injections.

Both draft guidelines are now open for consultation until March next year. Professor Mark Baker, director of clinical practice at NICE says: “In the past decade there have been major changes in how we routinely manage both adults and children with diabetes and it is now possible for many to achieve much stricter targets for their blood sugar levels.

“We now want to hear from all those involved in the care of adults and children with diabetes to inform our recommendations and shape the final guideline.”


NICE will also release draft updated guidance on type 2 diabetes in adults in January. The update is expected to include its recommendations on Janssen’s Invokana (canagliflozin), Bristol-Myers Squibb and AstraZeneca’s Forxiga (dapagliflozin), Lilly’s Bydureon (exenatide prolonged-release) and Novo Nordisk’s Victoza (liraglutide), which have all been appraised since NICE published the last version of its type 2 guidance back in May 2009.

http://www.pharmafile.com/news/196372/nice-changes-insulin-advice-diabetes-guidelines?

I've only ever done MDI which I find OK. I would think the twice daily mixed regime must be quite constrictive ? Anyone here tried it ?

Back in the day when I was first diagnosed, I was on two a day. I had to eat to the insulin as it was a mixture of slow and fast acting. You had to shake the vial to make sure it was mixed well. God forbid you missed your two digestives at 10.00 as you would go low.
I lasted about 2 months and asked if there was any other way to do it and was put straight onto MDI thank god.
I was still told how much to eat and how much to take.
Never did follow their advice as I would use the short acting to take more or less as needed by working out carbs and how much insulin suited it.
I worked out that lower carb meant less insulin (I know, I'm a genius) but at the time it was essential that I ate at least 40g or 4 cho? Of carbs with every meal.
Never questioned why, just ate what I wanted and dosed accordingly.

Mrs Vimes wrote:Back in the day when I was first diagnosed, I was on two a day. I had to eat to the insulin as it was a mixture of slow and fast acting. You had to shake the vial to make sure it was mixed well. God forbid you missed your two digestives at 10.00 as you would go low.
I lasted about 2 months and asked if there was any other way to do it and was put straight onto MDI thank god.
I was still told how much to eat and how much to take.
Never did follow their advice as I would use the short acting to take more or less as needed by working out carbs and how much insulin suited it.
I worked out that lower carb meant less insulin (I know, I'm a genius) but at the time it was essential that I ate at least 40g or 4 cho? Of carbs with every meal.
Never questioned why, just ate what I wanted and dosed accordingly.

It was after hearing stories like yours and others regarding feeding the insulin just to avoid constant lows which made me decide to decline Humalin M3 when I was offered it.

I was put on Humulin initially, and I don't think it did me any favours. I asked to change to Porcine Hypurin 30/70 from info I read on Jenny Hirst's IDDM newsletter, and have been on that ever since.

I have never been told about or appraised of any other option. I do find my blood sugar goes higher after food and can take hours to lower. I do seem to have become more resistant over time.

Whilst I was originally diagnosed as type 2, I am pretty convinced I am probably type 1.5, but actually getting tested for it is hopeless. Between not being prepared to provide funding to get the parasite issue dealt with, and hopeless diabetic care, I've all but given up on the NHS.

I just scurry quietly to the surgery for my insulin and strips and try to deal with the rest myself. I don't even bother to have blood tests or owt any more as the less control they have over me, the better.....

So, are some insulins "better" than others then or is it simply how long they are active for ? I have never changed my insulin and wasn't really aware of others. I never had a say in what I take, perhaps I should have discussed this ?

You aren't given a choice, or informed of any other options. The Diabetes nurse or whoever is responsible just seems to opt (probably for whatever is cheapest at the time) for something and just give it to you. As a novice, you know no different so accept it gracefully.

I did ask, back on the old LC forum, what the difference is, but got no real reply, probably because peeps only know the insulin they are on themselves. Maybe they work differently in different people, too.