Improving the Management of Diabetes for Patients and Healthcare Professionals [Interview][Transcript]

glen_maberly_fitter4diabetes_techniquesGuest: Dr. Glen Maberly
Presenter: Patrick Reyes
Guest Bio: Dr. Glen Maberly is a Senior Staff Specialist Endocrinologist at Blacktown and Mt Druitt Hospitals, and as a Program Lead currently he is the driving force behind the Western Sydney Diabetes (WSD) initiative. Together with Western Sydney Local Health District, they formed a Diabetes Prevention Alliance to slow the progression of diabetes in people living in our district.

Segment overview: In this segment, Dr. Maberly talks about the Forum for Injection Technique & Therapy Expert Recommendations (FITTER), which provides the most up-to-date diabetes treatment and therapies based on research evidences leading to improved health outcomes, well-being, lower healthcare costs and reduced burden on care providers and wider society.

Health Professional Radio – Improving the Management of Diabetes

Patrick Reyes: Hello and welcome to Health Professional Radio, my name is Patrick Reyes and on today’s show we have Dr. Glen Maberly. He is a Senior Staff Specialist Endocrinologist at Blacktown and Mt. Druitt Hospitals, Program Lead. Currently he is the driving force behind the Western Sydney Diabetes or WSD Initiative. Welcome to the show Glen.

Dr. Glen Maberly: Thank you.

P: Alright. Now can you give us a little bit more background on who you are and what it is you do?

M: So Western Sydney Local Health District is located around Parramatta, Blacktown two major centers, and the surrounding suburbs we look after a population of about 1 million people. Our population is very culturally diverse and we are in a diabetes hotspot. What I mean by that is that if you’re living in patch compared to the seaside suburbs or maybe the northern suburbs of Sydney, you have twice the chance of having diabetes. So our local health district along with the primary health network funded by the commonwealth have come together to form an alliance around addressing and beating diabetes in our area.

P: And now one of our topics for today is FITTER or Forum for Injection Technique and Therapy Expert Recommendation, can you tell us what that’s about?

M: Okay, so about a year or so ago I was invited with 3 other people in Australia, a GP and a nurse practitioner to attend an international conference in Rome which was organized as FITTER. FITTER stands for Forum for Injection Technique and Therapy Expert Recommendation, I’d rather say FITTER than that. And it actually connected through different means, through different ways of communication from major countries and this was I think the third meeting of FITTER coming up with recommendations on injection techniques and infusion techniques around diabetes. You would think that that was a pretty dull subject and I thought it was a little being an endocrinologist usually I left that kind of discussion to my diabetes educator to work out with the patients. But I found out that the injection technique is really very important in ensuring that you can have patients get good control of their diabetes.

P: And how does that research prevent progression on diabetes?

M: Well it was a consensus meeting from input from people all around the world, as I said a second meeting and it actually came out through presentations of the data from the literature plus working groups to over 20 different recommendations. So the main thing that I learned through that process is that remembering the normal anatomy of the skin and the subcutaneous and muscle tissue is that the way you are wanting to inject insulin and other injectables to help manage diabetes is into the subcutaneous tissue and the skin is only a couple of millimeters thick and if you get beyond 6 millimeters you are often going into muscle. And so if you are injecting into muscle then the absorption of insulin and the whole dynamics changes. So it’s really important to use good injection technique and essentially one of the key messages is that these days very thin needles, 4 millimeters in length, are preferred and in kids and in very thin people you actually have to lift up the skin fold, pinch together the skin folds so you don’t actually penetrate into muscle. So that’s the key I think basis for lot of the recommendations. Some of the other recommendations relate to the fact that if you inject insulin and other insulin-like solutions into the space you get a lot of fat and skin disorder, so you get bumping as it’s called, the lipid dystrophy, if you inject into those areas the absorption of what you put in there is very variable. It can vary up to 30 to 50% of the effective dose so 1 day you’re injecting into normal area, the next day you inject into the lump and the variation in dose you’re getting can be 30 to 50% different and explain why blood sugars are not well-controlled. I guess so in trying to avoid that, you have to feel the skin, identify where these lumps are, look at it, inspect it and feel it and avoid them and with a small needle you can actually inject into a much wider area than a lot of people usually think about. So you’ve got the whole of the abdomen, you can inject into other sides like the buttocks and the legs and the arms but that’s probably not really that preferable and you’re much more likely to have to get into the muscle tissue to do that. So injection technique can be really very important and there are, as I mentioned about 15 other recommendations or tricks associated with getting this right.

P: How does FITTER benefit those with diabetes?

M: Well FITTER is just this organization which was sponsored by a company called BD but the people came together as independent scientists. They came and made these observations and looked at the literature and the outcome of that meeting in Rome and all these work has been published in a peer reviewed journal in the Mayo Clinical proceedings, September… So FITTER is really a coalition and it has some coalition of members in various countries. In Australia we don’t have a particular FITTER group but a few of us went to the FITTER conference.

P: What’s the biggest misconception that comes with your line of work?

M: Well, in the past we’ve tended to think that you tend to use longer needles in people that may be overweight or obese, so the bigger the person the bigger the needle. In fact the skin thickness is just the same and so you don’t have to use larger needles in bigger people and that everyone including kids and adults these days probably do much better with a smaller needle. The second thing is that you should only use the needle once as people trying to save money. The government in Australia covers their costs anyway but a blunter needle tends to cause these lumps and injecting into lumps continues to make them grow bigger so you need to avoid them. You need to clean the skin but you don’t have to disinfect the skin unless there is an infection problem. And it’s important then when you bring your insulin out so that warm up to room temperature because cold insulin from the fridge is more painful and injections into the abdomen with these very fine needles usually do not cause pain, occasionally it can cause pain if you hit a nerve but it’s a minor irritation. And putting insulin into the abdomen is less painful than pricking your finger to find out what the blood sugar is. A lot of patients with diabetes are scared of the needle, scared of getting … and I think once they get going with the needle it’s going to be near the end of life for most, that’s not true. It is actually a preventative way of controlling blood sugar and should be introduced earlier and when needed.

P: Alright and now before we end our segment how can our audience reach out to you or learn more about FITTER?

M: I think that there is a FITTER website now that has the publication, so just the good old Dr. Google will get you FITTER, we’ll get you information and if you want to know more about what we’re doing in Western Sydney and we’re working in primary prevention of diabetes, more screening for identified people that don’t know they have diabetes, about half the people with diabetes don’t know that they have it and they can measure it with a simple test or the management of diabetes. You can also use Dr. Google to look up Western Sydney Diabetes.

P: Alright, well thank you for joining us today Glen.

M: Okay.

P: Now you’ve been listening to Health Professional Radio, I’m your host Patrick Reyes and we’ve been in conversation with Dr. Glen Maberly as we talked about diabetes and FITTER which is a Forum for Injection Technique and Therapy Expert Recommendation. Now if you’ve missed our conversation or if you’d like to listen to this interview again, transcripts and audio of this program are available at and also at and you can subscribe to this podcast on iTunes.

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