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Hi and welcome back to the Prescribing in Surgery series. Um, my name is Hermione. If you haven't met me before, um, today we're gonna be covering diabetes medications, but before we start, we have a guest with us, uh, Daniel, who's going to give us a few words and he's from the BMA. So I'll just hand you over to him for a little bit. Thank you for my, uh, just share my screen real quick. Um. Ok, cool. There you go. All right. Uh, I'm sure everybody you're watching is, is a membership. Um, so, so don't worry too much about this. Um, but yeah, for anyone who anyone who's not currently, um, if you use that link that I put in the chat and also the QR code on the screen, um, if you join slash rejoin the BMA, er, you'll get your first month membership free. Um, this is a bit of an exclusive for, for mind the bleep. Um, so yeah, you won't find this online anywhere else. Um, so yeah, take advantage of it if you're watching that on repeat as well, it, it should still work. Um, as long as it's not sort of five years in the future. Um, so yeah, go, go for it. Um, so yeah, I'll talk ti just a tiny bit before you start the session. So, um, mainly giving a bit of an update on sort of what's the lay of the land is at the moment. Um, in terms of strikes, not, not too much, um, to, to update you with, um, on this current day. Um, but yeah, just, just a reminder of what, what we do. Um We obviously your union um when time has passed, we sort of get a bit of confusion between um us and, and, and indemnity companies. So people like MDU mps. Um So, yeah, so it's just always worth reminding that um we're sort of the non clinical side of things. Um So anything sort of pay related, um sort of relationships between colleagues, that kind of thing. Um It's us, anything clinical is, is um sort of a MD mps sort of side of things in indemnity. So three ways of looking at us as your union, um we can help on an individual level. So things like your contract um contract checking, I'll, I'll go on to, to looking at so your individual sort of side of stuff, um local issues. So say you're a group of F two S um you were sort of facing a similar um rotor problem or something along those lines. Um We have people on the ground every trust, so we can help, um, sort of trust level. So that's sort of the local side of things. Um, and then obviously on a national level there's what's going on with the strike. So, yeah, 33 ways of looking at, looking at how, how we, how we can help you. Um, so yeah, just a bit of an update on, on what's going on at the moment. Obviously, today is the final day for, um, the re ballot for Juniors. Um So the cut off date for sending the the envelopes back was um Friday. So yeah, we should have an announcement on, on that result. Um early next week, I'd imagine. Um we, we, we have them counting pretty quickly. Um So yeah, so, so tomorrow is the final day. Um It's looking like like it's gonna be AAA A a big turnout once again, obviously, the last two re ballots. Um w what, sorry, the last Reba and the ballot for that um were, were similar. Um I can't give you any news on any strike date scores cos we don't have the mandate as we speak, but obviously next week when we get that mandate back, um that means we can start planning um more strikes if, if the government continues to not talk to us. So I imagine the next round of strikes would be at the end of April at the earliest. Cos we always have to give sort of a free week um notice period, I am consultant. So, but that's just my take on it. It doesn't necessarily mean there will be any strikes at the end of April. By the way, it's just you can sort of tell, everybody can sort of tell by the the pattern of things how things have been going. Um So the consultants are, are currently voting on an improved pay offer as well. There was that marginal no vote um in January, I think it was 51% to 49%. So uh uh and improved offers come in. So we imagine that will go through. Um They haven't till the third of April to vote on that. Um And then, yeah, that would be sort of the first um I wanna say first domino because it's, it's different what, what's going on with the consultants, the juniors there, there's sort of needed tweaking whereas we're looking to sort of overhaul pay and look for something a lot bigger um in terms of percentages for, for, for juniors. Um But yeah, so, so keep an eye on on the consultants um pay offer. So again, we should have results pretty quickly after the third of April um on, on whether that's it. Yes, voting for that offer. Um So yeah, just, just quickly, just round off of just a, a few other things that we can, we can help you with day to day. So there are some of the sort of frequently asked questions that we, that we get on the screen. Um We, we solve, we solve pretty much every, every case that comes in within three months or 85% of, of of cases. Um 22,000 new doctor cases, junior doctor cases alone. Sorry, we managed in 2023. Um So yeah, so just think about the first point of call um for any issues you might have. I know that um hr s aren't always very forthcoming with, with answering queries and, and sorting things out to you so you can get as well. We do have people on the ground. Um, every trust across the country contract checking. I mentioned this earlier. 25% of the contracts we checked last year were, were wrong in some way often it's the wrong pay. Um So even if you've got your contract now and you're quite happy with it, you can just send it to us any time and we'll just check and if there is anything and you are owed anything, um, then then we can help get, get you any money back or, or get that contract changed. Um Retrospectively. Um It doesn't necessarily matter if you've signed the contract because if you're given something wrong, then it should have been wrong in the first place. So you're not buying just because you've signed it, we negotiate the contracts for, um, for doctors in the UK for better or worse. Um So we know what should be in them and we didn't, we didn't negotiate them just so they could be tweaked and, and you could be tricked. Um So yeah, so always worth getting it checked. Um Ro checking as well should be more standard. I'm sure if you, you'd know by now if you wrote was possibly incorrect, but again, it's something that we can check and, and look over if, if you're unsure, you just wanna expect to get it checked. Um BMA library. So BMA library has moved entirely online now. We also used to have the library um in Central London, but everything's sort of turned into. Um it's a, it's an E library essentially now, but you can still go to BMA House if, if you're a London based um to sort of the study space and whatnot, clinical key, that's AAA point of care tool. Um breaks down um conditions, gives you videos, links to all journals and books related to anything. Um So yeah, really useful to, to use standalone app. Um It's his own thing, but you log in through, through your BMA credentials. We run a series of webinars as well. Um throughout the year which, which you can watch B MJ learning obviously um obviously free as part of part of your membership and the B MJ, it's worth knowing that if you wanna switch the BM Js off, you can do just by giving us a quick call and saying I'd rather read them online because you have access to them now, especially explor at all. Um So yeah, it is essentially a psychometric test. Um If you guys are thinking about um what, what specialty to go into? This is essentially um a, a little test which will, which will break down at the end. Um All the specialties that was to you according to the answer you've given um and it gives you lots of pie charts and, and, and graphs and reasoning why such specialties will suit you. Um We've got a good wellbeing service um confidential, of course, of, of the, of the trust uh that you, that you're working at. Uh the unique thing about this webbing service is that you can speak to either a counselor or, or a peer support doctor. Um So somebody who's perhaps been through similar situations to you and, and is a doctor themselves. Um So yeah, free to use um for everybody, regardless of whether you're a membership, a member or not. That's it. Um I'll, I'll let you get on the session, I'll pass you back to Hermione. Um And yeah, thanks for listening and yeah, that's it. Thank you very much. Ok, great. So I can get going with this now. So just a few things to say about today, there are lots of guidelines on diabetes and they do vary from trust to trust. Um So just to be um aware, you should always check your local policies and follow your hospital guidelines. Um And the other thing says, I know sometimes it can feel a little bit one sided with these webinars. So to address that if you have any questions or any discussion points, please put that in the chat and we can do our best to explain any of the answers. This is the calendar for the next half of the series. So just a note here that there are two weeks off, um, until the next webinar, which is on the ninth of April. Um, before we start, I thought we'd just go back to basics with insulin and other oral hypoglycemic medications. Um, so type one diabetes occurs when your pancreas makes small amounts or no amount, no insulin. Um, just to recap on that, it's a hormone producing in your pancreas that helps you store your sugar from your food. Um And obviously, if you don't have any, you're not making any, then we need to replace it. So that's what we do with insulin. Um, just providing exogenous insulin to prevent your hyperglycemia. This is some of the brands that are commonly used. So the short acting ones, um, up here in Scotland, we use Novorapid. Um, but there are plenty of other ones, intermediate acting acting ones. Uh HumuLIN is the one that I'm most common with. Uh, but there's plenty of other ones and long acting ones here, Lantus, Levemir and Tresiba. And again, just to recap on the modes of insulin as well. So we've got the pens that have premeasured amounts of insulin, um, insulin pumps which are automated and syringes which are sometimes used um to draw up the specific amount. Ok? And then just to recap this graph, which I'm sure you will see in plenty of times as well, just to remind you of the durations of various insulins. So rapid acting, that's what it says on the label. Um It acts very quickly within 5 to 10 minutes. Uh So we normally use this before meals. So it's the insulin that patients will need just before meals as a quick burst of insulin to deal with the carbs from the upcoming meal. Um and in hospital, this is the kind of insulin that we prescribe um before meals. Um