The scam, which has been exposed by the New York Post, involves handicapped “guides” in wheelchairs being hired for $130 an hour, or $1,040 for an eight-hour day. Disney allows any visitor to its Florida theme park using a wheelchair or motorised disability scooter, to bring up to six guests to use a “more convenient entrance” at each of the rides.

One wealthy Manhattan mother, who hired a disabled guide through a company called Dream Tours Florida, said her daughter waited just “one minute” to board the It’s a Small World ride. Other children had to stand in a queue for two-and-a-half hours to sample the same attraction.

“You can’t go to Disney without a tour concierge,” the woman said. “This is how the one per cent does Disney.”

The woman said the Dream Tours guide accompanied her one-year old son and five-year-old daughter through the park in a motorised disability scooter bearing a ‘handicapped’ sign. At each attraction, the group was sent straight to an auxiliary entrance that gave them immediate access to the ride.

The Post points out that “black-market tour guides” are actually cheaper than Disney World’s official VIP tour packages. The Disney packages, which offer a VIP guide and fast passes, cost up to $380 an hour.

Exchanging the phone number of the rogue guide service has become a “shameless ritual” among mothers at some of Manhattan’s most exclusive private schools, the paper says.

“It’s insider knowledge that very few have and share carefully,” said social anthropologist Dr. Wednesday Martin, who discovered the trade in bogus guides while researching a book called Primates of Park Avenue. ·

Read more: http://www.theweek.co.uk/us/53016/disney-world-disabled-guides-new-york-mothers#ixzz2TLrvWMVH

It takes place for the first time at the Telford International Centre from 27-29 June. Thousands travel from across the UK, Europe and beyond to see what’s new in the mobility market. Many visiting for the first time say their eyes were opened to a new world of possibilities; many felt less isolated.

Whether you want to test drive, explore vehicle adaptations and conversions, review and compare wheelchairs and scooters or specialist children’s products, find a new gadget for use at home, seek advice from charities and support organisations, or try a new sport – it’s all here.

Meet inspirational guests

Welcoming visitors each day will be Telford’s long-serving town crier Percy Simmonds. Among the special guests visiting are Falkland’s war veteran, Simon Weston; sitting volleyball Paralympian player Martine Wright, survivor of the 7/7 bombings; Rik Waddon, Paralympian medal-winning cyclist and Dave Sykes, award-winning paraplegic microlight pilot and adventurer. The Red Wheelies scooter display team will be performing each day and in the Sports Arena you can join in with members of the GB Wheelchair basketball teams.

Test drive adapted vehicles

The Mobility Roadshow was the first event to offer opportunities to test drive production model vehicles with a variety of adaptations. This year, for the first time in the show’s history, test drives take place on public roads around the venue, offering visitors experience in real traffic conditions. A carefully planned route has been designed in consultation with experienced instructors, who as always will accompany each driver.

Test drives are open to full licence holders only. You can register in advance for test drives at www.mobilityroadshow.co.uk

New products being unveiled

Many new product launches are still under wraps, but already there is much to anticipate.

New models expected in the Motoring Arena include the first public showing of the new Peugeot 2008. New caravans and motorhomes are being featured by Coachbuilt, Lewis Reed and WildAx Motorhomes in partnership with Brook Miller Mobility.

Among new personal products are several new wheelchairs and scooters, from exhibitors including Cyclone Technologies, RGK and TGA. Several new-to-Roadshow exhibitors are adding new product ideas, alongside mobility classics.

Tips to stay fit and active

From simple health and fitness ideas for use at home to the latest bionic walking systems – it’s all here.

In the Sports Arena you can try a variety of individual and team games – wheelchair basketball and rugby league, roller hockey and accessible ‘rock’ climbing are already confirmed – and you’ll gain advice on equipment and how to get involved in your area.

Now a permanent feature of this show Cyclefest is expanding with an array of accessible bikes and trikes, companion and wheelchair models for all ages to try.

Have your say on product design

Vote for your favourite products in the Design Zone and if you have an idea for a new mobility product, you can gain feedback from the very people you are seeking to help, as well as to seek advice from professionals to help you take your concept forward. To take part e-mail Hayley Philippault Hayley@suchandsuchdesign.co.uk.

Register at www.mobilityroadshow.co.uk for free tickets, test drives and to keep abreast of news as it unfolds. Follow us on Facebook and Twitter @MobilityRdShow #mobilityroadshow

Despite the widespread reach of the condition it is surprising that so few of us have any understanding of its nature. In fact, it isn’t just one condition but three: Type One, Type Two and the rarer version that affects pregnant women, Gestational.

Sugar is at the heart of the issue. Sugar isn’t, as you may suspect, always a bad thing. In fact, without it, nothing would be able to live. Sugar is a natural source of fuel for our bodies and it’s the conversion of that fuel into energy that provides the battleground of the diabetes issue.

Diabetes is a disease whereby the body does not produce or properly use a hormone called insulin. Insulin is used to convert sugar, starches and other food into energy, therefore, if the body has insufficient quantities of it or cannot use it efficiently there’s a problem. The cause of diabetes remains unknown although it seems clear that genetics and other lifestyle factors including obesity and lack of exercise have a part to play.

The man versions of diabetes: Type One (T1) and Type Two (T2) are very different and although T2 is more severe, it would be a misnomer to describe T1 diabetes as a ‘milder form’. Comparatively it may be, but the reality is that it is still a condition that isn’t easy to live with.

The risk of developing diabetes increases if we have a parent or sibling with T2 diabetes since genetic markers have been found and traced back to relatives. This means that many of us will be at risk and may not be aware of it until some of the symptoms start to present. The usual symptoms are:

• Frequent urination
• Unusual thirst
• Extreme hunger
• Unusual weight loss
• Extreme fatigue
• Irritability
• Blurred vision
• Slow healing to skin damage such as cuts and bruises
• Tingling or numbness in the extremities (hands and feet)
• Recurring skin, gum or bladder infections 

There are risk factors and demographic markers that can suggest a higher possibility of developing diabetes. Some of these like diet are easy to change whilst others are linked with personal heritage and are unavoidable.

Dietary risk factors can be changed but often is the case that such habits have already been ingrained and will have provided causation anyway such as early exposure to cow’s milk or cow’s milk formula – none of us will have had ‘choice’ in the matter and relatively few parents realise there is any risk here. Similarly, the exposure to cereals before the age of four months is a risk factor for T1 diabetes.

Although diet is often equated to weight and obesity it needs to be pointed ou that we aren’t all the same and that some people carry more fatty tissue than others. Sadly, this fatty tissue, however it occurs, is a risk factor since the more fatty tissue you have, the more resistant your cells become to insulin.

Lack of exercise is another lifestyle factor that can put you in harms way. For one thing, less active people are generally expected to be ‘fatter’ and secondly the physical exertion helps to burn glucose (energy) in your system and makes cells more sensitive to insulin. The world renowned Mayo Clinic has suggested that exercising less than three times a week may increase your risk of T2 diabetes.

As I’ve already mentioned, some of the risk factors are purely demographic and are down to accident of birth and heritage. If you are either white or were born in Sweden or Finland you have a greater chance of developing T1 diabetes. Similarly, if you happen to be Black, Hispanic, American Indian or Asian you are at a higher risk of developing T2.

Age is another unavoidable factor, with an increased risk particularly of T2 as you get older as are other more specific markers to look out for including: high blood pressure, abnormal cholesterol levels and high levels of triglycerides (a fat carried in the blood).

Women older than 25 are at increased risk of developing gestational diabetes.

Gestational Diabetes

As well as T1 and T2 there is a third type of diabetes. It isn’t called T3 because it is peculiar to pregnant women (with an increase in the over 25’s) as a result of the body’s excessive hormone production. Happily it is usually just a temporary form of insulin resistance that occurs halfway through pregnancy – hence the name ‘gestational’. Sometimes it occurs because the pancreas has an inability to provide the additional insulin required during some pregnancies.

Gestational diabetes can occur in women with no history of the disease in their family and will vanish after pregnancy but in some cases it can mean an increased risk of developing T2 diabetes. (Research has uncovered that a very small percentage of diabetes cases are the result of genetic mutations, surgery, chemicals, drugs, malnutrition, infection, viruses and other illnesses.)

Giving birth to a baby weighing more than nine pounds (4kgs) or acquiring polycystic ovary syndrome or being overweight before pregnancy also increases risks of developing T2 diabetes.

Again demographic heritage plays a part with Blacks, Hispanics, American Indians and Asians most at risk.

Type one diabetes and Type Two diabetes are two very different conditions. The only reason why they are linked by name is simply that they both describe issues with the way the body produces and uses insulin.

Type One (T1)

The pancreas is the organ responsible for producing insulin – the hormone that allows blood sugar (glucose) into the body’s cells to be turned into the energy we need to live. (Sometimes T1 diabetes is referred to as juvenile diabetes since it is usually diagnosed in childhood – but can be discovered at any age.)

Technically the process is an autoimmune disease that permanently destroys beta cells in the pancreas leading to nil production of insulin. People with T1 diabetes require regular insulin to manage their diabetes. It is this point that is the major difference between T1 and T2.

If the pancreas stops producing insulin the cells don’t receive the sugar and it builds up in the blood – hence T1 diabetes is often diagnosed via blood tests. Of the blood tests used to diagnose T1, there is one that will test for the presence of autoantibodies. These are often carried by family members with T1 and mark out individuals with a higher risk of developing the condition.

The exact nature of what causes T1 diabetes remains uncertain but it is commonly agreed that it’s likely to be a combination of factors bringing together lifestyle triggers with an underlying genetic predisposition. In other words, even if you have genetic markers relating to T1 risk you may yet avoid developing the condition if you adjust your lifestyle accordingly.

At some point the immune systems starts to destroy the insulin production mechanism. The popular theory is that it is set off by a virus that will stimulate an autoimmune reaction. Once the blood glucose levels get out of control the symptoms of diabetes begin to appear.

The prognosis for patients with T1 diabetes in the short term are good. The condition is easy to control with medication and severe complications are becoming rare. There is, however, the possibility of acute complications later in life. Disorders of the eyes, kidney, circulatory system and nerve fibres are not uncommon and in severe cases – especially untreated can lead to death or other serious outcomes such as amputation of limbs.

As with most illnesses, early intervention is crucial for good outcomes and so people with diabetes should make themselves familiar with the possibilities and take advice at the first sign of any of the symptoms.

Most complications only present after time since they are usually as a result of fluctuating blood glucose levels and in particular, increased blood sugar levels over long periods of time. Medical practitioners sight control of blood glucose levels and blood pressure as highly important in reducing the risk of complications.

Long term complications include:

• Heart disease
• Kidney damage – nephropathy
• Eye damage – retinopathy
• Nerve damage – neuropathy
• Stroke
• Limb amputations
• Thrush
• Short stature
• Gastroparesis – partial paralysis of stomach action

There are also a few short term complications that should be monitored with care:

Hypoglycemia – low blood sugar levels impairing function as a result of a shortage of glucose reaching the brain. In serious cases it can produce a seizure. It is not a result of diabetes but from the treatment for diabetes – pills and insulin.

Diabetic ketacidosis (DKA) – A dangerous (potentially life threatening) condition that presents high blood sugars as a result of insufficient insulin and non-compliance with insulin medication. The body starts to burn fatty acids producing acidic ketone bodies that cause symptoms like vomiting, dehydration, gasping for breath, confusion and sometimes coma.

Diabetic lens – vision distortion again as a result of high blood sugars – usually reversible when sugars are controlled.

Type Two

About 90% of adults with diabetes in the UK have T2 diabetes. The condition occurs when the body doesn’t produce sufficient quantities of insulin to function properly or when cells don’t react to insulin at all – insulin resistance.

T2 diabetes usually affects people over the age of 40 although increasingly, younger people are also being diagnosed. Early diagnosis and is important because although T2 diabetes cannot be cured, control of symptoms will help to avoid complications in later life. T2 diabetes is progressive and will probably lead to the prescription of medication taken in pill form initially but later by injections of insulin. If it is left untreated the health problems can be serious and could include damage to blood vessels, nerves and organs. People with T2 diabetes also run a higher risk of developing other conditions such as cardiovascular (heart) disease and stroke.

In the shorter term T2 diabetes patients are given recommendations to amend their lifestyle choices in order to prevent episodes of hyperglycaemia or hypoglycaemia. They are also encouraged to look after themselves and take action against catching viruses and the like by getting an annual flu jab.

Treatments

Diabetes cannot be cured but it can be managed very effectively; not because it is a mild condition (in either T1 or T2) but because therapies are well designed and the numbers of patients in the UK mean that there are plenty of medical practitioners with good experience in the field.

The success or failure of management methods is as much to do with decisions made by patients as it is by medical practitioners. Some responsibility on the part of the patient in making sensible lifestyle choices and listening to the advice of experts is required but if all that is put together there is every reason to be confident that a relatively normal day-to-day lifestyle can be achieved.

The treatment of diabetes is likely to be through medication or insulin (or a combination of both). Since diabetes cannot be cured, the therapies selected by the patient and doctor working together are likely to be a permanent life fixture of the patient’s life (although open to alteration in time as symptoms change or develop). The upside is that the correct treatment of diabetes can relieve symptoms and make the patient less exposed to the risks of complications later on.

Medication and lifestyle choices are equally important. One will not help without the other. Diet and physical activity remain important indicators to health.

Insulin

Although T1 diabetes and T2 diabetes are very different they are both linked to the ability of the body to produce and use a protein (hormone) called insulin. All patients with T1 diabetes will require insulin and eventually, as the illness progresses many people with T2 diabetes will also find that their blood glucose levels are too high and insulin treatment is the best way forward (beyond the efficacy of adjustments to their medication regime).

Unfortunately insulin cannot be taken in tablet form because it would simply be digested like any other protein in the stomach before it had time to take effect and fulfil its role of allowing blood vessels to absorb it. The good news is that injecting insulin is not like having a blood test where the needle has to pierce a vein. The insulin needs to avoid being broken down by the stomach but does not have to be strategically delivered. To this end, insulin is usually delivered with a very small needle to anywhere just underneath the skin (subcutaneously). Tummy, buttocks, thighs or upper arms are all fine – the insulin is then absorbed properly and taken into the bloodstream.

The process is surprisingly simple and the principle is identical from patient to patient even though there are six main types of insulin for doctors to choose from (and that can be mixed in different combinations).

Whilst it is important to trust your medical practitioners and their input regarding your medicine, it is always a sensible move to find out what it is and how it works. This will have the benefit of avoiding any clashes with existing therapies you might be taking for other conditions and knowledge of any side effects. Similarly, if you find that your symptoms are not as you would normally expect, it may indicate that you haven’t remembered to take your medication properly. In a similar sense your healthcare practitioners may also advise increasing your medication. This isn’t always to suggest that your condition is getting worse; it may be that they want to ‘attack’ a certain aspect of it to improve outcomes for you. (Your diabetes care team will be able to discuss all aspects of your treatment and advise accordingly.)

Standards Of Care

There are national standards and guidelines for the treatment of diabetes that have been agreed across the UK. This means that no matter where you live, you’ll receive a good level of care. In England and Wales, the guidelines are known as the National Service Frameworks for Diabetes and National Institute for Health and Clinical Excellence (NICE) Guidelines and in Scotland they are known as the Scottish Diabetes Framework and the Scottish Intercollegiate Guidelines Network (SIGN).

Although there are no national standards for diabetes in Northern Ireland, there is a cardiovascular framework with a diabetes section relating to screening, education and psychological support and annual reviews.

The standards vary in their precise content but we are far from talking about a ‘postcode lottery’ since all of the guidelines take in the necessary information on:

• Prevention and early identification of T1 and T2 diabetes.
• Encouraging partnerships and shared decision making between diabetes patients and their respective healthcare teams’.
• Improving clinical care, personal care plans and provision of education about diabetes.
• Prevention, early detection and management of complications relating to diabetes.
• Improving care of children and young people with diabetes.
• Better treatment of diabetes when patients are admitted to hospital.
• Health and social care where needed.
• Support for women with diabetes about pregnancy – not just relating to gestational diabetes.

The Quality and Outcomes Framework (QOF) was introduced in 2004 and supports diabetes treatment by rewarding GP practices that can demonstrate good care.

Emergency scenarios

It is important that people with either T1 or T2 (and other illnesses) make sure that friends, families and colleagues know about your condition and what might happen to you in the event of a short term exacerbation. Although, you’re likely to spot the symptoms before you need to take emergency actions, anybody can miss vital clues and things can spiral out of control. The worst case scenario is that a fluctuation in your blood sugar might cause you to pass out, meaning that you are absolutely unable to explain what’s happening and what action you need people to take in order to help you.

Some diabetics will carry a card on their person that describes their condition whilst others might have a ‘medic alert’ bracelet or necklace. Clearly, in all cases, staying on the cautious side of the issue makes good sense. The patient should see a doctor as a matter of urgency and if they become unconscious, an ambulance should be called immediately (telephone: 999). If a person loses consciousness it is sensible to continually check that they are breathing and gently place them in the ‘recovery position’ whilst help is summoned.

There are two emergency scenarios that can occur:

Hypoglycaemia (low blood sugar)

This is the more common diabetic emergency. The main symptom is confusion and feeling weak. (The patient may also pass out.) Other key symptoms include: hunger, sweating, shallow breathing and dry/pale skin.

Action:

Sit the patient down – this prevents falling if they pass out and can prevent shock from setting in.

If the patient is conscious, give them a sweet drink (non-diet) or something sweet to eat such as chocolate. The idea is to raise blood sugar. (Offer more if you see an improvement but in all cases make sure that the patient sees a doctor as a matter of urgency.)

If the patient becomes unconscious dial 999 for an ambulance immediately. (In all cases of unconsciousness do not attempt to give the patient food or drink but do continue to monitor breathing and prepare for resuscitation where necessary.)

Hyperglycaemia (high blood sugar)

This scenario is truly beyond the skills of even a trained first-aider and requires immediate hospital intervention. The symptoms can be alarming and include: thirst, vomiting, fruity/sweet smelly breath and a rapid, weak pulse. The patient may well lose consciousness.

Action:

Dial for an ambulance immediately.

If the patient loses consciousness place them in the recovery position, open the airway and prepare to give resuscitation.

Lifestyle and Self Care

Sometimes, people with T2 diabetes are able to control their symptoms by altering certain aspects of their lifestyle such as eating a healthy diet, stopping smoking and increasing the amount of exercise they do. Even if the impact of such changes isn’t dramatic it will make treating your diabetes easier and reduce the risk of further complications in the long term.

People with T2 diabetes can start to integrate measures for health simply and immediately into their lives and will, over time, start to see rewards in terms of wellbeing. The term self care is likely to be mentioned by your doctor or by members of your diabetes care team (to whom you’ll be referred after diagnosis). This isn’t to say that you’re abandoned or told to ‘get on with it’ but it does mean that you can preserve a large portion of your independence and reduce the inconvenience of diabetes (to an extent).

No doctor or care team can monitor a group of patients 24 hours a day, telling them what to do, what to eat and so on and so a large part of the responsibility belongs to the patient. Self care is about putting good advice about diet and activity into practice. The usual outcomes are usually that the patient is able to maintain good physical and mental health, prevent illnesses and accidents (as the result of better physical prowess and mental agility). They also have a tendency to overcome minor ailments and are stronger when they are faced by a more severe or longer term ailment.

Diabetes care teams are set up to give people with diabetes a channel to communicate their concerns and ideas regarding the way that their condition is impacting on their lives. The team will continue to monitor and advise accordingly. The best advice on offer here, is to cultivate a good relationship with medical practitioners so that you feel uninhibited when speaking with them. Being on friendly terms makes talking about difficult and personal matters much easier. Asking someone you trust a question that you might feel silly about asking is much easier than asking someone you don’t feel you know so well. As you ask more questions and accept more advice, both you and your practitioners will learn more about the specifics of your condition that will be used to inform action on maintaining your lifestyle.

With the support of your diabetes care team and your own continued ‘self care’ you’re likely to feel less pain, anxiety, depression and fatigue, which results in a better quality of active and independent living (and a longer lifespan).

What To Eat

It is a common myth that people with diabetes have to eat a specially formulated diet. Actually, it’s just a question of eating a healthy balanced diet containing plenty of fibre, fruit and vegetables and low in fat, salt and sugar.

Alcohol and diabetes are not easy bedfellows. People with diabetes should drink alcohol in moderation and never on an empty stomach. Depending on the amount you drnk it can cause a fluctuation of blood sugar levels resulting in either hypoglycaemia or hyperglycaemia. It can also disturb your ability to conform to insulin treatments and make it difficult to accurately monitor blood glucose levels.

The recommended daily alcohol limit is 3-4 units for men and 2-3 units for women.

Physical Activity

Everyone should aim to do at least 150 minutes of moderate aerobic activity every week. This might be walking, swimming or cycling that will keep your weight down and keep you trim and fit. The added incentive for people with diabetes is that it will also lower blood glucose levels. The sensible starting point is a chat with your GP or diabetes care team since there will be a knock-on that will mean an adjustment in either your diet or insulin treatment as appropriate to keep glucose levels steady.

Feet

People with diabetes can sometimes bring associated problems for feet, eyes and nerves and so your diabetes care team will take specific interest in these parts of your bodies. Of course, feet are used in many of the activities that are key to good health through exercise so it’s doubly important to keep them in good shape.

Diabetes is associated with poor circulation, particularly in the extremities and glucose can damage nerves in the feet. Problems including ulcers, foot infections and minor cuts and grazes are not unusual but need to be taken seriously.

The poor circulation will limit the supply of blood to your feet and cause a loss of feeling in cases of nerve damage. People with diabetes have a far greater chance of having a limb amputated because of poor circulation due to gangrene than other people.

Fortunately, measures such as keeping blood sugar levels under control and keeping blood pressure and cholesterol properly monitored are major indicators to health in this area. (Again, because of it’s links with poor circulation and heart disease, smoking is a big ‘No’.)

Prevention is far better than cure and it starts with the basics. Keep your feet clean through daily washing with warm water and keep toenails short. Checking feet regularly for cuts, grazes and blisters is sensible since because of any associated nerve damage, there is every possibility that you won’t feel the warning ‘pain’ signals. A GP should be your first port of call for any minor foot issue that does not heal within a few days (and mention it to your diabetes care team the next time you see them for their views).

Here are a few tips on foot care for people with diabetes:

Keep your feet clean and free of infection.

See a podiatrist at least once a year. Ask your GP for a referral.

Wear well-fitting shoes that do not rub or squeeze your feet.

Never walk without something on your feet (especially outside).

Cut your toenails and file away hard skin and corns regularly.

Seek advice on any blisters or marks that do not heal within a few days.

Seek immediate advice from a GP on foot ulcers, particularly where there is swelling or redness in the local area.

See your doctor if your skin breaks or you note discharge or a change in the colour of your feet (becoming more red, blue, pale or dark).

See your doctor regarding any swelling at the site of a previous injury.

Myths About Diabetes

Diabetes UK, has listed some of the more common myths about diabetes.

Type 2 diabetes is a mild form of diabetes.

All diabetes is serious and if not controlled properly can lead to serious complications.

People with diabetes should not eat sugar.

Well, nobody should over-indulge and people with diabetes are encouraged to follow a balanced diet low in fat, salt and sugar – but they don’t have to completely avoid it.

There are special foods for people with diabetes.

There are but this isn’t the limit of what people with diabetes can eat. Foods labelled as suitable for people with diabetics can still affect blood sugar levels. In fact, Diabetes UK does not recommend them since they are expensive and often give people diarrhoea. If you fancy a treat, moderation is the watchword – go for the real thing.

People with diabetes will eventually go blind.

Diabetes is a leading cause of blindness but if steps are taken to control blood pressure, glucose and fat levels you can reduce the chances of developing complications.

People with diabetes cannot drive.

Assuming people have control of there symptoms and are not likely to faint at the wheel, there is no reason why people with diabetes should not drive.

Having diabetes prohibits you from playing sport.

Well nobody told five times Olympic Champion, Sir Steve Redgrave. In fact, keeping active is really important for people with diabetes. Naturally, there are a few considerations to make before getting into a sport or organising an exercise regime but your doctor will be able to advise you (and will certainly not want to hold you back).

Having diabetes will mean that I can’t get a job.

Diabetes should not stop you from getting a job. There are however a few areas of employment where there is a ban on employing people with diabetes such as the British Armed Forces. Diabetes UK is campaigning to end the ban.

People with diabetes cannot wear flight socks.

If you have circulatory problems or complications with your feet, such as ulcers then it’s best to consult with your doctor before travelling. If your feet and legs are generally healthy, there shouldn’t be a problem.

Grapes, mangoes and bananas are off the menu.

Just because something tastes or smells sweet doesn’t mean that you can’t eat it. In fact, fruit is a great source of fibre, vitamins and minerals and should be part of any balanced diet.

People with diabetes can’t cut their own toenails.

It is advised to keep your toes ad feet in good shape and inspect them daily. People with diabetes should cut their own toenails but if they can’t a carer might be able to help.

Equipment

Specific equipment is available for people with diabetes to monitor their own conditions and regulate their medication.

Blood glucose monitor

A hand-held gadget that detects blood glucose levels. Simply apply a droplet of blood to a test strip and wait a few seconds for a reading from which you can make decisions regarding your diet or medication.

Insulin pump

The proper name for this piece of kit is ‘continuous subcutaneous insulin infusion’ (CSII). Insulin pumps therefore constantly deliver a dose of fast-acting insulin throughout the day and night in accordance with a setting based on the patient’s needs.

Since they use fast acting insulin, patients are able to give themselves a dose after meals to mimic the action of the body (were it able to produce/use insulin properly).

The insulin pump does not monitor blood glucose levels and therefore provides no guidance as to the doses required, this is done by patients testing themselves around four times a day. The advantage is that the consistency prevents episodes of either hypoglycaemia or hyperglycaemia.

The unit is about the size of a mobile phone with a thin plastic tube and needle (or thin plastic cannula) inserted just under the skin. They can be worn 24 hours a day although they may be removed for a short time to prevent damage during sports or other activities. (In any case a new needle and injection site needs to be found every two to three days.)

Pumps are prescribed on an individual basis. NICE (the National Institute for Health and Clinical Excellence) has published guidance on their usage and includes criteria that they recommend an individual meet before they start using one.

On The Horizon

New research continues to suggest new ideas.

Pancreatic Islet Transplant

The pancreas is the organ responsible for producing insulin that helps the body digest and use food as energy. Cells known, as islets of Langerhans are located throughout the pancreas and are made up of other cell types including beta cells – that make insulin.

The transplant procedure is still largely experimental and involves islets taken from the pancreas of a deceased donor, purified and transplanted. The theory is that eventually there may be a way for people with T1 diabetes to avoid having to inject insulin.

Although current research is promising, in that many transplant recipients are able to reduce their need for insulin and reduce episodes of hypoglycaemia, it appears that the islets lose their ability to function over time. In any case, there are risks with major surgery and anti-rejection drugs also have their own side effects, particularly when they are prescribed over the long term.

Growing beta cells.

Diabetes researchers have been aiming to develop a better grasp of the exact nature of what regulates the growth of islet beta cells in the pancreas. When the cells die the body can no longer control blood sugar levels. Some scientists are aiming to find out how to encourage the reversal of cell decline or activate re-growth. If successful, any therapy that can manage such a feat could have applications for certain cancers as well.

Understanding Medication

People with T2 diabetes usually take medication to lower blood sugar levels. You don’t need to be a pharmacist but it is helpful to have an understanding of some of the medications you might use and what they actually do.

Treatments for T2 diabetes reduce blood sugar levels via the following methods:

• Stimulating the pancreas to produce and release more insulin.
• Inhibiting the liver from producing and releasing glucose.
• Preventing stomach enzymes from breaking down carbohydrates.
• Improving the sensitivity of cells to insulin.

The following is a quick guide to the main groups of medication. The list isn’t exhaustive and the medicines will, in all cases, be known by several different brand or manufacturer names. (The details are reproduced from the renowned Mayo Clinic.)

Oral medications

Meglitinides

Stimulates the release of insulin.

Works quickly.

Possible side effects include severely low blood sugar levels (hypoglycaemia), weight gain, nausea, back pain and headaches.

Sulfonylureas

Stimulates the release of insulin.

Works quickly.

Possible side effects include hypoglycaemia, weight gain, nausea and skin rash.

Dipeptidypeptidase-4 (DPP-4) inhibitors

Stimulate the release of insulin and inhibit the release of glucose from the liver.

Possible side effects include upper respiratory tract infections, sore throat, headaches and inflammation of the pancreas (sitagliptin)

Biguanides

Inhibit the release of glucose from the liver and improves sensitivity to insulin.

May promote modest weight loss and modest decline in low-density lipoprotein (LDL) sometimes referred to as ‘bad’ cholesterol.

Possible side effects include diarrhoea and more rarely, the harmful buildup of lactic acid (lactic acidosis)

Thiazolidinedione

Improves sensitivity to insulin and inhibits the release of glucose from the liver.

May slightly increase high-density lipoprotein (HDL) or what is sometimes referred to as ‘good’ cholesterol.

Possible side effects can be severe and include heart failure, heart attack, stroke and liver disease.

Alpha-glucosidase inhibitors

Slows the breakdown of starches and some sugars.

Although they don’t cause weight gain the possible side effects include stomach pain, flatulence and diarrhoea.

Injectable Medications

Amylin mimetics

Stimulates the release of insulin. This may suppress hunger and promote modest weight loss.

Possible side effects include hypoglycaemia, nausea or vomiting, headache, redness and irritation at the injection site.

Incretin mimetics

Stimulate the release of insulin, suppresses hunger and promotes modest weight loss. Possible side effects include nausea or vomiting, headache, dizziness, kidney damage or failure.

Interview

Libby Dowling is a clinical Advisor with Diabetes UK and was able to share some of her insights with Able.

Can you outline the role of Diabetes UK?

Diabetes UK is the leading charity that cares for, connects with and campaigns on behalf of every person affected by or at risk of diabetes. There are currently 3.8 million people in the UK with diabetes, including an estimated 850,000 people who have Type 2 diabetes but do not know it.

We help people manage their diabetes effectively by providing information, advice and support. We also campaign with people with diabetes and with healthcare professionals to improve the quality of care across the UK’s health services. Our work includes funding pioneering research into care, cure and prevention for all types of diabetes. We are also working to stem the rising tide of Type 2 diabetes – through risk assessment, early diagnosis, and by communicating how healthy lifestyle choices can help many people avoid or delay its onset.

What do you think peoples’ understanding of diabetes is? (Is there too much focus on lifestyle and weight issues such as obesity?)

The media often talk about ‘diabetes’ without specifying the type, which can lead to confusion and lots of misconceptions. Type 1 diabetes has nothing to do with weight or lifestyle factors and people with Type 1, especially children with diabetes and their parents, can get very upset when it’s assumed that their diabetes is due to weight. Some children get bullied and told it’s because they ate too many sweets or they must have been overweight or are overweight. Being overweight is a risk factor for Type 2 diabetes but it is only one of several risk factors, others include family and medical history and age. We also often come across a real lack of understanding about the serious nature of Type 2 diabetes. Because it is often treated with diet and physical activity or tablets rather than insulin, some people assume it’s a mild form of the condition but it carries the same risk of long term serious health problems as Type 1 such as strokes, blindness, heart disease, kidney disease and amputation.  

What general advice do you have for people who already have a diagnosis?

All people with diabetes will need individualised advice from their healthcare team to help them manage their diabetes. It is really important that they know the care they should be getting. For adults Diabetes UK has produced the “15 healthcare essentials” www.diabetes.org.uk/15-essentials and for children the “Type 1 essentials for children and young people” www.diabetes.org.uk/Type-1-essentials

Should T1 and T2 diabetes be more popularly defined to help with peoples’ understanding of the conditions?

Some people with diabetes feel it should, to reduce the amount of confusion over the two types.

Diabetes affects so many people, and that might mean that thorough care levels may become unsustainable due to a limited amount of resources – is there a suggested timeline for a cure?

At the moment there is no prospect of a cure in the near future. A lot of research is going into a cure but in the meantime there is also a lot of research directed at better ways of managing the condition.

 More:www.diabetes.org.uk/

Have a look at the digital version via this link.

Able Magazine, the specials big sister, will be hitting the streets next week. Absolutely jam packed with fantastic information and advice – a must read for disabled people, their carers or professionals in the satellite healthcare industries.

To make sure you secure a copy of our future specials just subscribe to Able today and, at no extra cost our spiffingly good mags will wing their way to you come print time.

Wolbachia

Via: http://www.sciencemag.org/content/340/6133/748

Dr. Richard Lee, director of regenerative medicine at Brigham and Women’s Hospital, and Amy Wagers, of the Department of Regenerative Biology at Harvard, made the discovery when they were working with younger and older mice.

They took an older mouse with the most common form of human heart failure and merged the mouse’s blood stream with that of a healthy young mouse using a Siamese twin technique known as parabiosis. They found that the older mouse’s diseased heart was able to reverse to a younger healthier condition.

They later identified a protein in the blood of young mice called GDF-11, which diminishes with age. They injected this protein directly into the older mice and had the same positive results. They are using this protein to restore other aging/diseased tissues and organs. Their results are published online today in the science journal Cell.

Via: http://hereandnow.wbur.org/2013/05/09/protein-heart-disease

Edinburgh University research suggests sunlight helps reduce blood pressure, cutting heart attack and stroke risks and even prolonging life.

UV rays were found to release a compound that lowers blood pressure.

Researchers said more studies would be carried out to determine if it is time to reconsider advice on skin exposure.

Heart disease and stroke linked to high blood pressure are estimated to lead to about 80 times more deaths than those from skin cancer in the UK.

Production of the pressure-reducing compound, nitric oxide, is separate from the body’s manufacture of vitamin D, which rises after exposure to sunshine.

Researchers said that until now vitamin D production had been considered the sole benefit of the sun to human health.

During the research, dermatologists studied the blood pressure of 24 volunteers under UV and heat lamps.

Full story: http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-22433359

The “heart patch” grown in the laboratory from human cells overcomes two major obstacles facing cell-based therapies – the patch conducts electricity at about the same speed as natural heart cells and it “squeezes” appropriately. Earlier attempts to create functional heart patches have largely been unable to overcome those obstacles.

The source cells used by the Duke researchers were human embryonic stem cells. These cells are pluripotent, which means that when given the right chemical and physical signals, they can be coaxed by scientists to become any kind of cell – in this case heart muscle cells, known as cardiomyocytes.

“The structural and functional properties of these 3-D tissue patches surpass all previous reports for engineered human heart muscle,” said Nenad Bursac, associate professor of biomedical engineering at Duke’s Pratt School of Engineering. “This is the closest man-made approximation of native human heart tissue to date.”

The results of Bursac’s research, which is supported by the National Heart Lung and Blood Institute, were published on-line in the journal Biomaterials.

Bursac said this approach does not involve genetic manipulation of cells.

“In past studies, human stem cell-derived cardiomyocytes were not able to both rapidly conduct electrical activity and strongly contract as well as normal cardiomyocytes,” Bursac said. “Through optimization of a three-dimensional environment for cell growth, we were able to ‘push’ cardiomyocytes to reach unprecedented levels of electrical and mechanical maturation.”

The rate of functional maturation is an important element for the patch to become practical. In a developing human embryo, it takes about nine months for a neonatal functioning heart to develop and an additional few years to reach adult levels of function; however, advancing the functional properties of these bioengineered patches took a little more than a month, Bursac said. As technology advances, he said, the time should shorten.

“Currently, it would take us about five to six weeks starting from pluripotent stem cells to grow a highly functional heart patch,” Bursac said.

“When someone has a heart attack, a portion of the heart muscle dies,” Bursac said. “Our goal would be to implant a patch of new and functional heart tissue at the site of the injury as rapidly after heart attack as possible. Using a patient’s own cells to generate pluripotent stem cells would add further advantage in that there would likely be no immune system reaction, since the cells in the patch would be recognized by the body as self.”

In addition to a possible therapy for patients with heart disease, Bursac said that engineered heart tissues could also be used to effectively screen new drugs or therapies.

Full story: http://www.news-medical.net/news/20130507/Biomedical-engineers-grow-3D-human-heart-muscle-that-acts-just-like-natural-tissue.aspx

We’re nearly at a post-antibiotic era (because antibiotics no longer work), according to Congresswoman Louise Slaughter, a microbiologist.

As the main force behind the effort to limit antibiotic use in food animals, I am astonished by the letter from Bernadette Dunham, the director of the Food and Drug Administration’s Center for Veterinary Medicine, especially since she told a House committee on April 9 that she was unsure how antibiotic resistance develops.

The F.D.A. itself said in 1977 that feeding antibiotics, one of medicine’s greatest breakthroughs, to farm animals indiscriminately was dangerous to human health. Evidence on this is so clear that the American Medical Association, the World Health Organization, the Union of Concerned Scientists and 450 groups support my legislation to save eight classes of antibiotics for human health.

Scientists say strep throat could soon prove fatal. Everly Macario, a doctor in public health who lost her 18-month-old son to a MRSA infection, said it best: “I don’t know why people aren’t freaking out about the fact that we’re nearly at a post-antibiotic era.” The F.D.A., tasked with protecting the public’s health, should understand that, given the 70,000 deaths a year that are due to antibiotic-resistant infections.

Via: http://www.nytimes.com/2013/04/30/opinion/limiting-antibiotics-in-animals.html?_r=0

• ·         Wheelchairs can reach a max racing speed of up to 19mph.
• ·         Racing wheelchairs have a 20” carbon front wheel with a total wheelchair weight of 8kg.
• ·         The first wheelchair games in the UK took place in Richmond, Surrey in 1923.
• ·         The first wheelchair marathon took place in Toledo, Ohio in 1974.
• For more information about this infographic please visit: http://www.unitedresponse.org.uk/what-we-do/how-we-work/supported-living/

The afflicted man, now a straight-A college student, tried to kill himself five years ago, when he was 19 years old, said Dr. Leslie Solyom, a psychiatrist at Shaughnessy Hospital in Vancouver, British Columbia. Effects of His Behavior

The man, identified only as George, washed his hands hundreds of times a day and took frequent showers, Dr. Solyom said. The behavior had forced him to drop out of school and quit his job.

Dr. Solyom treated him for more than a year before he tried suicide.

Full story: http://www.nytimes.com/1988/02/25/us/brain-wound-eliminates-man-s-mental-illness.html

The body’s cells typically use glucose, a kind of sugar, for their energy. The hormone insulin helps cells take up glucose, in turn regulating the level of glucose in the blood. In people with diabetes, the system doesn’t work properly. In type 1 diabetes, an autoimmune response kills the β cells, and so the body lacks sufficient insulin. In type 2 diabetes, β cells are still present, but a complex set of factors keeps them from working as well as they should. Patients with type 1 diabetes and advanced cases of type 2 have to inject themselves with insulin to make up for what the pancreas can’t produce.

Full story: http://news.sciencemag.org/sciencenow/2013/04/could-new-liver-hormone-treat-di.html?ref=hp

The researchers cautioned that the study found an association between trophoblast inclusions and autism risk, rather than a direct correlation with autism itself. The study is published online today in Biological Psychiatry.

“There’s no evidence that the trophoblast inclusions themselves have any direct impact on neurodevelopment,” said Cheryl Walker, assistant professor in the UC Davis Department of Obstetrics and Gynecology and lead author for the study. “Rather, they are likely a symptom of altered physiology or a genetic predisposition, particularly given their association with other genetic abnormalities, and are almost certain to be triggered by environmental exposures.

“Given that they appear to result from dysregulation in cell proliferation, candidate exposures that we may explore in the future include physiologic states that can promote growth excess, including maternal obesity, excess gestational weight gain, diabetes, nutritional factors and exposure to endocrine disrupting chemicals — all of which may influence growth in fetal tissues like the placenta and brain.”

Trophoblasts are specialized cells present as the earliest fetal tissue that are critical in embryo implantation and form the conduit for interaction between mother and fetus. Trophoblast inclusions are unusual microscopic findings marked by cell clusters that appear to represent abnormal tissue-folding within the placenta. They have been associated with a wide range of chromosomal abnormalities.

Full story:http://www.universityofcalifornia.edu/news/article/29388

Researchers from Tel Aviv University have developed a way to diagnose schizophrenia by examining nerve cells from the nose.

Schizophrenia, the leading reason for admission to psychiatric hospitals, is currently diagnosed subjectively, using clinical observation and medical questionnaires that evaluate the patient’s functioning. The medical community has long sought a biological marker that would offer a more accurate diagnosis.

The Israeli researchers said they have found a quick way to arrive at an early diagnosis by examining nerve cells from the nose that are part of the system responsible for our sense of smell.

“The olfactory system consists of nerve cells that are located in the inside top of the nose, which are the only nerve cells that can be removed from a healthy person without killing him,” explained Dr. Noam Shomron, director of the Functional Genomics Laboratory at Tel Aviv University’s Faculty of Medicine, who led the research team. “We believe these cells are a window to understanding the activity of nerve cells in the brain.”

Full story: http://www.haaretz.com/news/national/israeli-researchers-find-new-way-of-diagnosing-schizophrenia.premium-1.517009