Karen Hirth is a pharmacist in the Cardio-thoracic Unit at the Alfred Hospital.  She has also had diabetes for 22 of her 28 years.  In her new column, Kaz will bring us the best and the brightest snippets from the latest medical journals, simple answers to tricky questions, and news of doctors discovering things we’ve known forever!

Diabetes, Depression And Stress
Although depression is not a recognised side effect of diabetes, diabetics have a higher incidence of depression compared with our beta cell functioning colleagues.  Depression and anxiety may increase blood glucose levels, thus making the whole situation even more frustrating.  Signs of depression include decreased pleasure in normal activities, weight loss or gain, feelings of guilt and worthlessness, low energy, difficulty making decisions or concentrating, difficulty sleeping or needing significantly more sleep, and suicidal thoughts. Interestingly, it is easy to attribute some of these symptoms to the diabetes rather than the depression. For example, panic attacks may resemble hypos. 
Reference: www.ncpamd.com/dmdepression.htm

Having Problems With Hyperglycaemia In The Morning?
When was the last time you rolled or agitated your pen before injecting? I am in particular talking about your cloudy one eg Protaphane, Monotard, NPH etc.
    There was recently a very interesting paper published in The Lancet, a very reputable medical journal, looking at how well diabetics resuspend (shake) their insulin.  They found that only 9% of participants tipped their pen more than 10 before use.  Also, the amount of suspended insulin left in the dregs of the vials was very high.  In other words, if you don’t shake your insulin, some of what you’re injecting is just liquid without insulin.  It will then not last as long as if you had shaken it.
     So, lesson of the day was to make sure you tip your cloudy pen at least 20 times before use.  P.S.  Try it out and let us know!
Reference: Jehle PM, et al. ‘Inadequate suspension of neutral protamine Hagendorn (NPH) insulin in pens.’ The Lancet 1999;354:1604-7

New Insulins In The Pipeline
There are two new insulins currently on trial that we may see in Australia later this year. Both are made by Novo Nordisk. The first is an ultra short acting insulin with a very similar profile to the currently available lispro, aka Humalog?. The second is something really new: a long acting insulin which supposedly has a flatter peak and hence a decreased risk of overnight hypoglycaemia. Stay tuned ……. 

Cortisone Chaos
Sports and other injuries are often treated with injections of cortisone into the site.  It is a well proven medical phenomenon that significant quantities of cortisone can cause sharp increases in blood glucose levels for up to five days.  You may like to mention your diabetes to your doctor before you have the jab.