Friday, 16 September 2011

Hey! I want to be involved

First published on the Diabetes UK blog

Involving patients in their own care is a major trend running through the NHS. People with diabetes have to be more involved in managing their condition, goes the philosophy, as it will save money, resources and improve the patient’s condition.

The way it saves money is through re-organising care. Doctors are pretty expensive as they are private businesses, small business owners with an ambition to deliver great care and make some serious money. There is nothing wrong with that, but the NHS has to save £20bn in the next few years and so money is tight.

With this in mind some of the bigger businesses involved in providing GPs such as Harmoni and Care UK are looking at how they can replace doctors with well trained nurses for certain areas – no doubt an expansion of specialist diabetic nurses will be encouraged and so will more technical aspects such as how a diabetic clinic might run, teaching us how to use testing strips appropriately so we use less, and weight management. A recent study showed that providing free access to Weight Watchers classes helped reduce obesity.

Two issues spring to mind for me, one is that the introduction of the private sector (Harmoni and Weight Watchers) could be a positive thing for patients. I much prefer to see an expert diabetic nurse than a less well informed GP (although all GPs should be better informed). The second is that when it comes to re-organisation of the health service patients are not being involved.

The 7th annual Primary Care Diabetes Society national conference is now advertising itself to GPs and I got to see the programme. There are no patients as speakers and no patient groups involved in any of the sessions. Do they honestly feel that a patients couldn’t provide some good ideas for sessions such as,’ running a diabetes clinic’ (involving issues such as, clinic times and hand held records/personal plans).

Diabetes is becoming a big industry and the customers – us – are being left out of the design of this market. Rather than us telling them what it is we want and having them meet our needs it is happening the other way around. Private sector companies and the NHS are reducing costs and the patient has to fit into that model. There are many things we can do better than the NHS – such as control our own health data.

If I had all my HbA1c, cholesterol, blood pressure and other such results emailed to me so I could upload them to a secure website that my family could access I would have a huge amount of positive pressure on me to keep my HbA1c at good levels. Too many puddings and I’d be letting my family down. And when I did hit my targets we could celebrate together. But that’s all just too complicated for the NHS. What a shame no one gets to listen to our ideas. What a shame the 7th annual Primary Care Diabetes Society doesn’t have a platform for listening to the people they are treating.

Wednesday, 24 August 2011

Post sent to Guardian Comment is Free section for publication

I was diagnosed with type 2 diabetes on the 14 May 2009, my Dad’s birthday. I didn’t mention it when I called him to wish him all the best. Type 2 makes you feel so alone because your first thought is, ‘I have done this to myself’. It’s embarrassing. Subsequently the information you are given about genetics and evolutionary biology give you an argument about why it isn’t all your own fault. You get angry at the supermarkets and restaurants that have thrived on your illiteracy about food. But you can never shake the knowledge that if you watched what you ate and did more exercise you wouldn’t have type 2 diabetes!

Doctors tell you to self manage diabetes but the tools to make it easier aren’t available. I want a single secure place, online, to store all my information about my diabetes. I want to know what my previous HBa1c (long-term blood sugar tests) and cholesterol levels are. I want to know when my last eye appointment was and reminders for the next one, and I want the GPs to be able to see this too so I don’t have to keep pissing around with new prescriptions for the same drugs that they keep getting wrong.

The lack of coordination is staggering. I want to control my information and I can’t. The current system makes my life harder, not easier. I can understand the frustration that drives people who are already depressed and alone to take drastic measures. Give me access to my data in usable electronic form and I will use it better than the NHS.

Saturday, 11 June 2011

Dr Zhang’s miracle cure!

They have found a cure for Diabetes! That’s right, a cure. Sorry, in my excitement I failed to say that ‘they’ is in fact the Dr Zhang Clinic in Crouch End. The Chinese only speaking Dr, whom was never explicitly identified as the eponymous Dr Zhang - or a Dr, through her interpreter told me, to my face, that they can cure diabetes. I was stunned so I asked her to repeat it, just to be clear, and she said, “we can cure diabetes”.

Now the sign outside the shop says, ‘we can help with ..’ and the first thing you see is Diabetes. Now I’m a bit of an old sceptic and so I thought I’d pop in quickly (this wasn’t a consultation) and ask exactly what help they can offer, expecting to get some of the usual ‘woo’ from them to do with shakra and chi, but I wasn’t expecting a cure.

I honestly can’t believe they would stand there and tell me they can cure diabetes. I mean, massive research institutes in the US and the UK are working night and day to cure one of the most costly and growing health problems across the globe and all they actually need to do is to go to the Dr Zhang Clinic, 53 The Broadway, London, N8 8DT, tel 0208 340 8393 and they will mix up some herbal tea and cure diabetes. Please, don’t thank me for passing this on.

So how does it work? Well I have to say they weren’t explicit about this but the tea keeps blood sugar under control and the acupuncture also helps – although they didn’t bother much with this as the tea seemed to be the real money maker – I mean benefit.

When I challenged them and told them I was writing this blog I was told that I don’t understand. You see Chinese medicine, as practiced by the Dr Zhang Clinic, concentrates not on the pancreas but on the real “cause” of diabetes, “heat energy in the liver being high”. I’ve got a hot liver. ‘Heat energy’ is a funny phrase because as we all know, heat is energy. So according to them I have an over energetic liver and that’s the real cause of diabetes.

Now it starts getting serious because they explained the details of how it works. So firstly I have to stay on my western meds and jointly take the herbal tea concoction they put together. I tried asking what is in the mix and how it worked, chemically like. The answer was that it works to cure the diabetes. I abandoned this line of questioning. But the next stage of the treatment is to come off the western meds (metformin and Glicklazide in my case, both drugs I understand and know what they do – chemically like) after about three months of joint use. I could then drink the tea alone – once in the morning and once at night.

So how long would I be on this herbal tea? No idea, they said. It could be an indeterminate period of time because it works very slowly, maybe a year or maybe a few years and then I could stop and would be cured. And how much does this magical tea cost? Well it’s £35 a week. According to them the tea taste horrible and capsules were available – I did not enquire as to the cost of these.

£1820 a year – that’s a lot, but to cure diabetes! So not wanting to fork out such a large amount of money and come off my prescribed pills without a clear reason why I asked them for the evidence that it works, studies, academic papers, people who have been cured by them? Unfortunately the only evidence they could offer was that somewhere, in the great annals of Chinese medicine someone was probably cured, but they don’t know whom. And they haven’t cured anyone themselves because the treatment is so costly no one does it for the full length of time.

I was expecting them to talk about exercise and diet and other lifestyle choices to go alongside the tea – the stuff that, along with my medication, helps keep blood sugar under control, but nothing. Diabetes UK offers helpful information on all these as well as links to research, papers, studies and news about current drugs and developments in diabetes care. Science has produced huge breakthroughs in the care and medication of diabetics. The medicine I take every day, paid for through the NHS, helps me control my diabetes which without any treatment would kill me.

The advice Dr Zhang’s Clinic are offering is likely harmful and definitely costly. Having diabetes is shit. Luckily I don’t suffer from neuropathic pain that shoots up and down legs and arms, but many do. £2000 a year is not prohibitive to someone who is suffering, in pain, and depressed and I am worried that some people might take a chance on Dr Zhang’s miracle cure.

Or maybe it really does work – in which case I encourage everyone who is diabetic or knows someone who is diabetic to call them up or pop in and ask them to explain exactly – and I mean medically – how it works. If you aren’t convinced and you don’t think they are being entirely honest then please call Consumer Direct on 08454 04 05 06 and make a complaint.

Which GP consortia will you be in?

As I’ve mentioned a few times before, and I’m sure you are already aware, the Government is planning a massive reorganisation of the NHS. One of the key changes is that GPs will be banding together into groups to manage the costs of our care, otherwise known as commissioning.

These groups, known as consortia, will be run as businesses and will be held accountable to the Government for the state of their finances. It is yet unclear if they will be able to make profits from managing their businesses successfully, but one would think that might be the incentive. Carrot and stick.

My point has been that diabetic patients, and others with long-term conditions, represent a bigger risk to the budget of these consortia because they are more likely to end up in the hospital than others – and this costs money. So too many diabetics on your books (GP lists) could be costly.

David Stout, director of the Primary Care Trust Network (the current group of commissioners), was reported in the Guardian (March 31 2011) as saying: "I am sure there will be concern about some [consortiums] being the equivalent of 'sink estates', with all the most difficult practices, [and] most deprived populations, coming together."

The Guardian also quoted Frank Atherton, of the Association of Directors of Public Health, who said, “some consortiums could end up "cherry-picking healthier populations" and that "the more deprived and less affluent people [may] get left behind with the poor performing GPs".

I raised this issue with David Stout at a recent talk I went to and suggested to him this sort of ‘risk modelling’, as it is known, could lead to a two, three and even four tier GP system. Consortia are not bound by geography but by relationships. So two GP Practices at either end of the same road might not get on and chose to be part of different consortia.

Or worse, two might apply to be in one consortia and one will get in and the other won’t based on the potential costs of the patients on their lists. I asked David, and others how this can be avoided and short of the suggestion that the Government would monitor this to try to stop it happening, no one could give me a real answer. I guess David is now concerned about this too.

In theory you don’t have to stay with your current GP, but is your current GP the best one or the closest one? Given that we still don’t have any information on how good GPs are, relative to each other, I’m guessing you are with your closest GP – I am. Will we know which Consortia they belong to or how well that consortia performs? Unlikely! Will we know if that consortia has run out of money towards the end of the financial year and therefore decides you don’t need that surgery or appointment for a few weeks, maybe a month? Again unlikely?

In order to track all this we need all this information to be made available to the public. The Government might well do this and has announced a new Transparency Tsar to help drive this through. I have every faith he’ll try, but the Government machine is slow and can be obstinate. I wish him, and all of us, good luck.

Rootin’, tootin’ poopin’

So, as anyone who has spent a long time eating unhealthily food will tell you, or anyone who ever saw a Gillian McKeith programme before she lost it in the jungle (I won’t call her doctor as she wrote off for that qualification http://www.badscience.net/2007/02/ms-gillian-mckeith-banned-from-calling-herself-a-doctor/) your bowels pay for it sooner or later.

Now I don’t normally write about the scatological elements in my blog for diabetes UK as it didn’t seem fitting, but mostly because I didn’t understand the potential side effects of metformin. That was until a chap called Terry wrote in to Jo Brodie’s blog on the Diabetes UK website.

Terry’s comments http://blogs.diabetes.org.uk/?p=409 triggered a rash of responses that gave me the confidence to explore the topic from my own personal view. I’ll try to keep this as clean as possible – which is one of the more extreme problems people can have with the side effects of metformin. The ultimate aim of this blog is for people not to feel alone in their struggle with the ‘betes’.

As I have this weird bit of type 1 knocking about in my system alongside the type 2 I had a sudden period (explored in previous blogs) where my blood sugars shot up. At first I put it down to getting over the initial shock of discovery and eating less strictly, but ultimately I just needed more pills. I doubled my dose of metformin from 1000g to 2000g and started taking Gliclazide at the same time.

I guess I heard from someone along the way that metformin can upset your stomach. Some time into this new regime the rumblings started, gentle at first like Mount Etna, but within a relatively short period of time it all went Eyjafjallajökull. Which is both an Icelandic volcano and an onomatopoeia. This kept happening, and in fact the pills were leaving me as quickly as they were going in – I was never quite sure if I should take more to replace the ones that quite helpfully floated (sorry, but it’s true they do)! Ultimately I decided they were slow release so I better had.

It was sometimes quite a desperate race to work. Now I wasn’t sure if this was the metformin or something worse. I’m a Jewish male in my mid (to late) 30s and we are a group particularly susceptible to Crohn’s disease (an inflammation of the intestines with serious consequences), plus my Dad and Uncle both have it. I did get worried when I went through about two weeks with diarrhea.

Then one day I forgot to take my four slow release metformin pills with breakfast as I always do. When I got to work I only had two spare ones in my draw. I took them and, you know what, the rumblings, like the London tube over the weekend, stopped dead. I had also been susceptible to approaching hypos around lunch time and these stopped too. So I kept it up with two. Things went ok for a bit but ultimately I had to step it up to three, which is where I am now.

I recently went for an HBA1C test – which they can do in 6 minutes now with a finger prick, do ask for it where it’s available – and it was 6.5, the lowest it has been since diagnosis. The nurse was happy with my metformin regime and confirmed that we sufferers are the real experts. I do a fair bit of exercise which helps control things too.

So if your stomach is a rumblin’ and a tumblin’ and you feel that urgency no one ever wants to feel, you could try talking to your nurse or doctor about reducing your dose for a bit and see what happens to your sugar levels. If you do some exercise as well it might help enormously. But most importantly, you aren’t alone, speak to someone about it and make the change that is right for you.

The right sort of patient

Are you the right sort of patient? You may think you are, you take your meds, you do some exercise and you try to steer clear of chocolate and fancy deserts as much as possible, but this might not be enough. You might well be the wrong sort of patient.

The NHS is changing and Health Minister Andrew Lansley is introducing a new way of doing things. Our GPs are banding together into groups called ‘consortia’ in order to spend large chunks of NHS money - £80 billion of it. Fair play to them they are spending it on us, but that is also where the dilemma comes in.

The way the money works in the NHS is that hospitals charge for the care they provide, and they can make a lot as some hospitals take over £1bn a year. This money, our tax money, is paid out by Primary Care Trusts (PCTs) whose job it is to keep the amount spent as low as possible. So the hospital wants to get us in and the PCT wants to keep us out. Well now the PCTs are being scrapped and GPs will be doing their jobs – or rather the people GPs employ will do their jobs.

So GPs are looking to keep us out of hospital, which is a good thing and hopefully leads to better primary care and better support in the community for people with long-term conditions such as Diabetes. The problem comes because GPs will be responsible for the amount that is spent on hospital treatment and, let’s face it, as hard as we try diabetics do tend to spend too much time in hospital which makes us a higher risk to the balance sheet.

GP consortia will not be allowed to go into debt, if they do the Department of Health can take them over and sack all the managers employed by the consortia. So to protect their jobs managers will want to make sure they have more of the ‘right kind of patients’ and less of the ‘wrong kind of patients’. GP practices in areas with high levels of diabetes or smoking related diseases are going to be at a disadvantage.

Diabetics may well be the ‘wrong sort of patients’ when it comes to cost but the NHS reforms could have a very positive benefit in putting our care at the top of GPs agendas. They will want to keep us out of hospital for their own budget’s sake and avoid emergency hospital admissions for heart or other problems.

Conversely we may find some unscrupulous consortia trying hard to keep certain GP practices out of their generally low-risk groups because that practice has too many patients with long term conditions. Mr Lansley needs to be very wary these self-defining consortia spread the risk of having diabetic patients or we might end up with a situation where many diabetics are locked in to poor performing consortia that aren’t able to provide the care we need. Already we have seen how variable diabetes care is and these reforms may well exacerbate it.

Diabetes and Doctors

I work for a company that uses data produced by the NHS to provide people with information and knowledge about the NHS. I recently had the opportunity to produce a guide for GPs highlighting some of this data http://www.drfosterintelligence.co.uk/newsPublications/article168.asp . I chose to look at the variation in the numbers of people with diabetes who end up in hospital in an emergency because of their diabetes. If your diabetes is treated well in the community you should not end up in hospital because of it.

So you can open up the ‘GP Practice Index’ and look for your Primary Care Trust (PCT) area and see that there may be one GP practice in the whole area (take Middlesbrough PCT for example) where more people than were expected to are ending up in hospital because of their diabetes. In Middlesbrough this one GP practice shows 127% more people going into hospital than were expected. The one GP Practice who has fewer people being admitted to hospital has 68% fewer people ending up in hospital. I know which GP practice I would want to belong to in Middlesbrough, or rather which one I wouldn’t!

These findings, that there is variation between different GP practices, beg a number of questions;

• How good is your GP at giving you advice, doing check-ups and giving you access to important information and support? Does the GP explain things to you clearly and helpfully and does the practice have a diabetic nurse who can help you? If you are not happy – switch practices or if you feel comfortable, demand a better level of service at your practice.

• Is the local PCT investing in public health awareness campaigns? I remember seeing the ‘Diabetes: A silent killer’ posters around the streets which helped trigger me into getting the test done.

• What are the barriers to you understanding the information you are given? Are there leaflets and support groups with different language options?

Alternatively it may be, as with hardened smokers, that there are always going to be people who will ignore advice and not look after themselves, and they might all live in one particular area. If this is the case and you read my previous post about the latest public health strategy of ‘nudging’ , are these people a lost cause?

I don’t want to have any part of me amputated and I really don’t want to go blind and so I try to do the best I can. I recognise – and so now do doctors – that my sugar levels won’t ever be 100% normal because I have an illness. But this map http://www.guardian.co.uk/news/datablog/2010/nov/25/health-health shows that amputations for diabetic patients are higher in the South West than in London, and the GP Index tells me that Devon PCT has at least three GP surgeries – probably more – where the worst rate of diabetic patients ending up in emergency treatment in hospital is 223% higher than expected.

Data can only tell us so much, but what it shows in this instance is that people in the South West tend to do poorly with managing their diabetes and GP practices aren’t being effective –for whatever reason. Where as in Middlesbrough the area as a whole has high amputation rates but only one GP practice that is seeing high levels of emergency admissions for diabetes.

It is difficult to draw conclusions but I would like to know more. I want the Government, through the Public Health Laboratories http://www.apho.org.uk/, to find out what is going on and why there is so much variation. If you live in the South West and have diabetes or know someone who has the disease you should want to know too – drop them a line and ask.

Choice and determinism

I haven’t written for quite some time, work has gotten in the way and I suppose, like a nun who’s been shrunk, I’ve fallen out of the habit. It’s true that I’ve also become a bit more inured to my diabetes. Nothing has grabbed me to make me feel it’s important enough to share my thoughts. Until now that is.

Andrew Lansley, the Health Minister, has just launched his White Paper on Public Health – which when translated means he has popped all his ideas down on paper about how to stop people getting illnesses such as diabetes though exercise and healthy eating. We then get to discuss it and offer any feedback – I’m sure the good folks here at Diabetes UK will be submitting their well thought out ideas. But we, as individuals can also offer feedback – and I think we should. Read the paper and give your views here http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm

The new Government has called the old Government solution to public health, ‘the nanny state’. Which means Lansley thinks the Labour Party was trying to tut tut us into not eating too many Happy meals, fry-ups and Mars bars. Lansley’s approach is called, ‘nudging’. He’s going to nudge us into making all the right choices. It’s worth saying here that better public health means less time spent in hospitals so less cost to the NHS and everyone’s a winner, so it is a very good thing and something we need to get right.

David Cameron and his inner circle – and therefore any Tory MP who wants to have a political career - are, so I’m informed, very much into something called, ‘behavioural economics’ (BE). As far as I can work out this is the study of how and why we make the choices we do. They have concluded that helpful hints and notices in supermarkets that other people are eating more fruit than you will encourage you to eat more fruit – however where this cycle stops is beyond me. You can see a good explanation of BE here http://www.neweconomics.org/publications/behavioural-economics

As a type 2 diabetic my life is now filled with choices to which I am much more aware then before I was diagnosed. If I eat that chocolate bar my sugar levels will go up by x! If I chose to have that piece of bacon I’ll need to do 30 mins more exercise to burn off the calories and the saturated fats will be bad for my heart. But even being aware of these choices doesn’t override the desire to have that bacon or eat that chocolate bar.

It’s fair to say that throughout 13 years of Labour Government I did not adopt a healthy lifestyle. So perhaps the Coalition are on to something with this nudging. Perhaps their sharp elbows and messages of fruit consumption will make all the difference. It’s worth giving it a go. So to summarise, I regularly had no idea why I made the choices I made and even though I am much more aware of those choices I don’t always take the right ones. Perhaps BE will help me to make the right decisions without me even knowing it – now wouldn’t that be a treat.

Tommy the diabetic cat

When my girlfriend moved in she brought her cat Tommy with her. Tommy was the laziest cat I’d ever seen. We bought him a scratching post with a dangling toy mouse that he could toy with, chase around the post and generally relieve high spirits. The closest he got to the mouse was to slump by the post and look disdainfully at it before transferring that same expression to me.

Tommy was also diabetic. He had been allowed to grow too fat, fed tit-bits and human food by those who loved him the most and couldn’t say no. His general lack of movement (his idea of going outside was to sit under a bush for ten minutes and then come back inside) didn’t help him any. He was on insulin twice a day administered through injections.

My girlfriend and I came back from a local bar on New Year’s Eve, about three in the morning, and on seeing him it became obvious Tommy was in some distress as his breathing was shallow and short. We thought it was related to the diabetes as he hadn’t been eating much of late so we rubbed honey on his gums. The vet had told us to do this once before when he slipped into a hypo after having a tooth removed and not eating properly.

But it was worse this time, his little heart was giving up. No doubt it was related to his diabetes and being overweight. He was 13, which wasn’t young but he could have had a few years left if he was more sprightly. And that is the nub.

Having a diabetic cat in a home with a diabetic man caused no end of hilarity to my friends. ‘Do you share the same insulin – one for him, two for me?’ I did find it quite amusing to talk to him as a fellow sufferer and that certainly made me feel better from time to time. Feline diabetes isn’t too different from our own. Losing weight and plenty of exercise is still the key to helping control it. Tommy did neither.

His favourite activity was to lie on our bed with the sun streaming in through the window and fall asleep, although he also very much enjoyed falling asleep by the radiator, and on the chair in the front room when the sun came through in the morning. His approach to life was very calming and he was usually up for having his head stroked but never his belly tickled – I like to think he was a bit sensitive about his weight.

I was certainly guilty of feeding him bits and pieces, some cheese here and some tuna there – you just had to look into his soulful, wistful eyes and you couldn’t resist. He really grew on me, and at the same time his death has been a lesson as to what happens if you don’t get your diabetes under control. It may be slightly high and you see no real side effects, but in the long run it will get you.

I miss Tommy when I wake up in the morning and when I come in from work especially. But my girlfriend, who had him for three years and took him on after her Grandma died, misses him even more. I’m sure we’ve both asked ourselves if we could have done more for him, but I think he was simply enjoying his last few years.

I will always remember Tommy’s soothing, cuddly yet slightly acerbic (in a feline way) nature. However I will also pay attention to the fact that heart disease is a big killer of people with diabetes. His death is a lesson for me and so will not be in vain. He will be missed – a lot – by those that cared for him.

Oh For F*#% sake

“Diet fizzy drinks linked with a higher risk of heart attacks & strokes. Find out more & tell us your view: http://bit.ly/eKqnlo

My views, you want to know my views?! I’ll tell you my frikkin’ views! You have got to be kidding me?!

Or so went my reaction to the recent twitter message by the British Heart Foundation (BHF). Oh that is brilliant. So now we diabetics can’t drink diet fizzy drinks, regular (full-fat) fizzy drinks, fruit juice or milk in any sort of quantity, beer, wine and spirits (beyond the recommended daily allowance), tea and coffee with sugar (I assume you can have some throughout the day but not too much. I don’t drink tea so I’m not sure what the impact is of diabetes on tea drinkers – perhaps DUK can run a forum or you can respond to this blog and let me know). What the heck are we supposed to drink?

Well the BHF website offers the following wonderful suggestions:

“Healthier alternatives people can enjoy are water, un-sweetened fruit juice or low fat milk.”

But hang on just one minute – fruit juice and milk both raise my sugar levels – that’s fructose and lactose and we know that we can have some milk with our breakfast or a glass a day of fruit juice but I wouldn’t recommend them as alternatives to diet fizzy drinks, which leaves – water!

Water, water everywhere; nor any drop to drink – goes the rime of the ancient mariner. Water, water everywhere; it’s all we can drink – goes the tale of the annoyed diabetic.

So the next thing to check is how good was the study? Is it just another one of those ‘apples gives/cures cancer’ stories the Daily Mail are so fond of?

The first thing to note is that it is being promoted by the BHF and that is usually a sign that the study is credible – that said the Lancet published the fraudulent study by the now struck off Andrew Wakefield that MMR gives you autism (there is no evidence to back these claims, and Whittaker was set to make a mint off the controversy). http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece

The study seems to look like it is ok. It was done by credible people, on a large scale and is being used by the BHF. Things we don’t know – is it repeatable? Are there contributing factors – such as many diabetics turned to diet drinks and they are just more susceptible to heart attacks and strokes? Until further research is done and an academic consensus is reached I’ll take my chances with the fizzy stuff (Dr Pepper Zero and Orangina Zero in particular). That said, I’ll keep eating balanced healthy meals and maybe walk up an extra set of steps or two – just as a comfort blanket.

I do quite like fresh mint tea.

Reflections of a diabetic

I am very pleased to say that I just got engaged to my beautiful girlfriend, and part of the reason has to be the strangely positive side-effects of diabetes. We’ve been going out for a year and three months. I was diagnosed with Diabetes one year and eight months ago, although I knew I had the ‘betes’ four months before that.

I lost a lot of weight in a short period of time and it started to give me confidence. Perhaps one of the reasons I didn’t go to the doctor was because I didn’t want that process to be stopped. It was only when the constant need to urinate got too annoying that I actually did something about it. The other side-effect of being diagnosed with diabetes is the impetus it gives you to change your lifestyle and do more exercise.

I was thinner than I’d been in a long time, doing exercise and eating healthily and this gave me the confidence, after a while, to think I might actually be able to get out on the dating scene. I decided to use an online dating service, which is where I met my beautiful bride to be.

The thing about online dating in my mind is that it is all in the profile pictures (although this might be more true of men than women as some women have explained to me – but I don’t believe it). I had previously refused to entertain internet dating because I knew I didn’t have a photograph I was happy with. I was always too big, to shlubby and too pasty. If I couldn’t find a photo I felt good about I was sure no one else would fancy the person in that photo and I would have the humiliation of getting zero dates.

So after returning from a holiday to Turkey with a good friend of mine with a decent camera, I managed to find a couple of shots I was happy with and thought, what the heck – take the plunge. Two dates went by in quick succession before, on my third date, I met the lady who I knew then was the perfect one for me.

We’ve had our issues with diabetes which will have a big effect on any relationship, issues I’ve detailed in this blog previously and are rather too painful to go over again here. It is to my fiancé’s great credit that we have been able to deal with the issues and move forward to such a place that she said ‘yes’. I couldn’t have done it without her - literally.

So I’m planning a wedding, and you know what – nothing about the diabetes is going to affect it. I will have some cake and I will have some champagne, just not too much, however I will do a lot of dancing.

On a sad note my cat, my diabetic cat, who had been living with me since my fiancé moved in, had to be put down due to heart failure. He was a big fella and had been diabetic for quite some time. I’ll write a specific blog about Tommy as he deserves it, but it’s a warning sign. I might sometimes take Diabetes a bit lightly and even present some positives, but keeping it under control is fundamental to a avoiding the complications that led to his passing. He’ll be greatly missed.

The running man

I’m seriously considering doing a 10k run. Running for ten kilometres, without a break, on the road! It might be a bit fanciful but I think I need to set myself a goal in order to push forward my fitness aims.

So I set out last week to see how far I could run on the treadmill. I managed 4.2k. So I am starting from the point whereby I am almost halfway there, this was a big boost. If I can already run 4.2k then getting to 10k shouldn’t be too much of a task – should it? This was all going very well.

So as part of this training schedule (three times a week running in the gym) I decided to join up with a proper 11-a-side football team. This amateur club has been around since 1888 and I had no idea how seriously they take their football. When I got there they had already started their pre-season fitness training. I was asked to run twice around the pitch and then join in.

No problem, not with my new fitness levels – I can run 4.2k don’t ya know. I ran around the pitch and then joined in with the rest of the lads. We were dribbling some balls around, then doing some volley work, then headers – moving all the time. Twenty minutes in and I was finding it pretty difficult going. But the gym work, what about the gym work?

There was a bit more training then three minutes for a water break and then we played a game of seven-a-side. By this point I was wheezing. All of a sudden 10k looks like a long, long way away. There’s no way I’m going to be able to make 10k, it’s impossible. I got home after football training and collapsed into the bath. The next day I went walking with my girlfriend and felt my muscles start to seize up. By Monday walking was painful and Tuesday was almost as bad.

So now it’s Thursday and I’m going to do my first bit of running this week. However I bought football boots so I’m going back training on Saturday. I think I’m still going for the 10k. One thing I have to resolve is which charity do I run for? If I run for Diabetes UK it’s not much of a charitable act, it’s basically one of self-interest. However if I give the money to someone else is that just silly? I’m currently leaning towards prostate cancer and the 10k run in ‘Mo’vember (grow a moustache for prostate cancer month in November).

So any thoughts on who I should run for or how I might get over that massive psychological barrier of 10k, would be gratefully received.

Blog 39. Or ‘How I learned to stop worrying and love chocolate’

You may have seen the film, Dr Strangelove, but if you haven’t I suggest you do. The film is about the nuclear deterrent being that of mutually assured destruction (MAD) – i.e. everyone loses. Well I have a similar relationship to chocolate. This is a bit of a tenuous link but I really liked the title of this blog post, which is a play on the full title of the film, Dr Strangelove or: how I learned to stop worrying and love the bomb).

Chocolate is the evil enemy, disguised as your best and most comforting friend. I used to eat a lot of chocolate. I even went to a chocolate festival in southern Belize (a town called Punta Gorda). It wasn’t very good even for a key part of the former Mayan empire, which at times used cacao beans as currency, so valued were they. The Mayan’s even had a King called Ah Cacao (or King Chocolate). But then Belize is a third world country.

So far I’ve gone from Stanley Kubrick to ancient Central American civilisations, so broad and complex is my relationship with chocolate. Lately this tangled web has gotten even more strange thanks to the threat of the hypo. I’m now on new medicine and it brings my blood sugar levels down low. So low in fact that my last HBa1c was a very promising 6.8! But one of the side effects of this is that I now regularly experience the early stages of a hypo – the shaking hands, the disorientation, the cold sweat. You can see where this is going.

The oncoming hypo became an excuse for a bite of chocolate, which quickly went from a bite to a bit to a bar, which turned into a preventative cookie at about 11.00am. As enjoyable as this is I know it can’t be good for me as a try to lose weight to help control the diabetes. It’s all so confusing.

Alternatives to chocolate are; try to eat an apple or some fruit at regular intervals to avoid the hypo in the first place; or even a bit of a sandwich; or drink a bit of fruit juice which is quicker in tackling the hypo then chocolate. Or mix this up a bit so you can have a bit of chocolate every now and then in which case you don’t have to worry about it. This approach has also stopped me obsessing about chocolate, which likely makes me a bit easier to live with.

So there you have it, how I learned to stop worrying and love chocolate. I haven’t really stopped worrying that much as I’m guessing this all means my blood levels are a bit all over the place. But as I’m doing quite a bit of exercise too (I just joined a football team) things are bound to be a bit unstable until I learn more about my changing body. More football news later. I’m back from Disneyworld, and I was right about the food – processed rubbish.

the time difference

As you know I'm in America, Florida to be exact, or at leas I was when this blog was written. Florida is five hours ahead of the UK. So my whole schedule with my pills has been shaken up.

Since being diagnosed this is the first time I've been outside of an hour's time difference and I was a bit worried about the affects in the immediate term. I figured I'd just have to put up with having a high blood sugar level for a few days before things settled down. I'm here for a week so that means a couple of days where things would be messed up.

I have compounded this worry with the fact that all food in Disneyworld would be processed sugary rubbish. So keeping my blood sugars under control was, I thought, going to be a problem. However the first day of the new routine (taking my breakfast pills – 4 metphormin, 2 glicklaside – at 13:00 our time and 7.00am Florida time) led me to approach a hypo at about 11.00am Florida time.

This is sounding more like a police report, and at about 12.00pm the body was discovered by Goofy, me lud.

I suppose what I'm trying to say is that it would seem to me that I have no real idea of what I'm doing yet. It's been just over a year of being diagnosed and I have no real idea of the impact of any of these things; eating late, eating pizza, taking my pills late, eating chocolate. It's a bit weird and confusing.

Building on from my last blog about trying to pass this information on to others – well, if I don't seem to get it then how will they. The good news is that I seem happier to roll with the punches then ever before. I am confident that I can handle what my diabetes throws at me. But it can get a bit worrying for the people around me.

My Mum and Dad were with me as the affects of the hypo started to show – shaky hands and a bit of sweating – although it was in the low 40s temperature wise so you couldn't see any excess sweating. I had the chocolate bar I brought with me as an emergency and I ate it. It had melted. I felt like a weirdo desperately licking melted chocolate from the ripped wrapper in Harry Potter Land. Just one more strange day in the life of a diabetic.

I like writing these blogs – it's like when the cast of a TV programme go abroad – like East Enders or On the Bus's.

But the Doctor said …

It's my parent's 40th wedding anniversary in a couple of days time and they have taken the whole family away to Disneyworld. So I'm spending a lot of time with them as we wait together whilst my nephews exploit the rides and everything else on offer. Ok, I've been on a few rides too.

My Dad suffers from a very rare condition called CIPD, it's where the nervous system is attacked by your own body and the protective coating around the nerve is damaged. It affects many different functions and is basically a pain in the arse … leg, back, feet, hands and most everywhere else. To combat this syndrome you have to take a bunch of pills, including steroids and they mess you up pretty well too.

So because my Dad is getting a load of medical advice from a load of different specialists and I'm not hearing it first hand, it's difficult not to believe that when my Dad passes this information on it hasn't been enhanced with hyperbole first. And at times it probably has – see, I don't always believe it!

I don't know why I think he might exaggerate occasionally, I guess it's just human nature to think that. It dawned on me just now that perhaps this is the reason why I feel my girlfriend doesn't believe everything I tell her about the affects of diabetes. She believes I'm a bit of a hypochondriac.

One thing I've noticed in the last year of being diagnosed is that diabetes, when not under control, can make your knuckles crack and bleed, your sex drive disappear, your feet fall off, tiredness, a drunk feeling as you approach a hypo, eye problems and a whole host of other equally annoying things. When I pass this information on it doesn't have the same credence as when the Doctor says it.

To compound the problem further the Doctors and diabetic nurses don't really seem to fully understand it either and there are a range of opinions on a host of matters. And to complicate it even more there isn't always one type of diabetes (I have mostly type 2 with a tiny bit of type one-ness thrown in for good measure – as far as I can make out). On top of all that, diabetics can get a range of no symptoms to anything and everything under the sun.

If I were to pass on advice I would say, where ever possible, have your partner come with you to the doctors to have it explained to you. Having diabetes means you take an interest in it but that you are also getting first hand advice to help you make sense of it. Family and friends are just reading about it online. They can't have the same level of knowledge as you but they also won't believe you entirely whey you explain it to them. I know I don't with my Dad, so why should they?

What’s this food labelling all about then?

On Monday morning I read in the Guardian that the Government is about to disband the Food Standards Agency (FSA). ’So what?’ you might ask. Well the FSA has been behind the championing of the traffic light system that tells you the dangers associated with how much carbohydrate, salt, sugar, fat and saturated fats are in your food. This made me furious. But the Government’s White paper on health came and went and no mention was made of the FSA. That got me wondering, what’s this food labelling all about then?

The food industry has lobbied hard against the traffic light system (Guardian 12 July, Food Standards Agency to be abolished by health secretary) and I could only imagine it’s because they don’t want to make it as easy as possible for consumers to understand their products. So I asked the Food and Drink Federation (FDF) who represent the food industry and they said, “When consumers make better-informed choices for themselves, through higher levels of food literacy, we believe they are more likely to stick with those good habits, rather than when someone ‘tells’ them to make such choices (by sticking coloured blobs on their foods).”

They went on to say, “FSA colour coding offers an opinion and makes assumptions about consumer’s diets. GDA labelling is based on per portion information whilst traffic light labelling is applied per 100g.” Which is a fair point about the traffic light labelling. What we should be getting in the traffic light system is a representation of exactly what is in the food product. Each one should be labelled according to its total ingredients.

According to the article in the Guardian the food companies have spent over £800 million lobbying against the traffic light system in Europe as they are more in favour of the ‘Guideline Daily Amounts’ system (GDA) http://www.gdalabel.org.uk/gda/home.aspx . That seems to be money well spent as the European Parliament, last month, voted in favour of the GDA system.

So how does GDA work? It tells you what your total recommended daily rate of intake should be for carbs, sugars, fats, saturated fats and salt and then how much of that total the food you have in your hand is going to take up. Keep a tally of what you are eating and it’s golden, no problem. Actually, quite a big problem because I’m diabetic (the clue is in the blog title) and the GDA is based entirely on an ‘average’ person.

‘GDAs have been developed for healthy adults, over 18 years of age of normal weight. GDAs are not targets for individual adults to aim for, but provide additional information to statutory labelling requirements which can be used as a guideline to help people understand how many calories, and how much fat, saturated fat, carbohydrate, protein, total sugars, fibre and salt can be eaten for a healthy diet.’ (Report of the IGD/PIC Industry Nutrition Strategy Group Technical Working Group on Guideline Daily Amounts (GDAs) p.5)

SO the FDF are against the traffic light system because it makes assumptions about consumers’ diets, where as their system makes assumptions about the consumers. From what I have learnt neither of these systems is perfect and each one is a guideline or opinion.

What GDA does is to make me think I can have that chocolate bar because it’s under my GDA for chocolate for the day. Don’t get me wrong, GDA is helpful, important even, but it doesn’t allow me to make a real choice about the healthiness of my overall diet – it provides no context. What the traffic light system does is encourage me to pick up an apple instead. The FSA has played a fantastic role in trying to help us glance down at our supermarket trolleys and understand the overview of our diets – are they generally red, amber or green?

The NHS spends over £100m each year (source, http://www.drfosterintelligence.co.uk/newsPublications/localdocuments/DFT%201.pdf) on treating emergency admissions to hospital for conditions, such as diabetes, that should have been better managed in the community, and much more again on paying for my daily intake of pills alone. The Health Secretary will launch his White Paper on a platform of patient choice – food labelling is key to giving us the information we need.

So here’s what I propose, keep the GDA measures because they are helpful and combine them with the traffic light system based on the ‘whole’ food product you have in your hand. That way you have even more food knowledge. Should it produce “some confusing results” as the FDF told me, well, that’s only where most of us are at now. There should be no debate about one or the other – it has to be both. So come on Mr Lansley, help out a diabetic who wants to stay out of hospital. Please.

where does diabetes rank?

Where does diabetes rank in the list of terrible illnesses? Can you look a cancer sufferer in the eye and say, yes, I too am suffering from a life-threatening illness? Can you stare down someone with MS, crutches in their hands, as you debate who’s sicker? The truth of it is that before Leonard Thompson was injected with ox insulin in 1922 diabetes was killing thousands of people yearly, and quickly, since recorded time.

So it was that a good friend of mine and his wife were down for a visit. At about the same period that I’ve been going through my illness (perhaps longer) they have been dealing with Hodgkin’s lymphoma. They live quite far away and I’ve felt bad that I haven’t been in touch very much since I found out. I’m not sure why I hadn’t been. So when we met up again last month they asked me about my illness and I asked them about theirs.

The great news is that, to all intents and purposes, her cancer is in remission. But I felt uneasy talking about diabetes when they had been dealing with something much more immediately life threatening.

“I’m taking nine pills a day” said my friend’s wife
“Me too!” I exclaimed, then immediately felt bad. She’s taking nine pills a day, NINE! And I ruined the moment. That should be one of those instants when the person you are telling gasps, their mouth opens, and they utter those immortal words – ‘no way!’ But instead I normalise it, in fact I trump it because with luck she will be able to come off those pills in due course – I’ll be on them for the rest of my life or until I start injecting insulin.

Of course I didn’t say that, not even I’m that thoughtless, but although some camaraderie was indulged in once the shared pill popping was revealed I couldn’t help but think I should have kept my mouth shut and just said – ‘no way!’
And then of course, as always, type 2 can cut you down because suffering from cancer is unfortunate (unless you smoke or worship the sun too much) where as type 2 is pretty much your own fault. I know people will argue it’s not, but I feel it is and obesity is certainly a catalyst for developing diabetes.

So as much as the pill popping and life-threatening nature of our illnesses was the same, one was preventable and the other not. I lose. And so I played down my diabetes, I said I was fine, that I was in the best shape of my life and that it really wasn’t a hassle at all, but as I was saying it I felt the opposite. I feel as if diabetes has turned my life upside down and what I really wanted was to do some moaning and complaining and maybe get a hug.

I’m doing much better now as us hardy diabetics roll with the punches and take the life-changes in our stride. I’m also literally doing much better as my new medication has stabilised my blood sugars and brought them right down, occasionally too low, but that’s for the next blog.

lessons learnt

It’s coming up to a year now since I started this blog and in many ways I really don’t feel like I know that much more about this disease and its effects on me. For instance I haven’t worked out the lag time between me eating something and my blood sugars going up, or between me having an hour long work-out and my bloods going down. There would appear to be an immediate correlation but then something different seems to happen the day after that I find difficult to explain.

I am only just starting to find out what happens when I sleep in and miss taking my meds till mid day – answer – my blood sugar levels shoot straight back up. So does this mean that from now on all my lie-ins need to be planned so I can have breakfast, take my pills and go back to bed?

I don’t know why it is that alcohol brings down your blood sugar levels but isn’t supposed to be that good for you. I understand it has calories and so forth – but how does it bring blood sugar levels down – it makes no sense?!

This is not to say I haven’t learnt a lot over the last year. I’ve learnt that exercise is very good for you and makes you feel better, not just because you look better (which is a subjective view) but carrying less weight around makes you feel better physically. Exercise releases endorphins that make you feel good and you know that every sep you take is kicking the diabetes in the ass.

I’ve learnt that low-fat yogurts are stuffed full of sugar and that labels on cans of soup make you get your calculator out to find out the real content – thank you Heinze. I’ve developed a whole new way of eating and that pasta pushes my sugar levels through the roof, as does white bread such as Chiabattas and such Italian delicacies. Noodles do too. I’ve learnt that food labelling is, on the whole, not too bad but that simple rules should be enforced to make it easier to understand.

I’ve learnt that diabetes has an effect on those around me. As I’m concentrating on the skin that’s cracking and sore on my hands through the dehydration others are worried about me and also suffering.

Having diabetes opens up a whole big scary world and one that it’s quite tempting to hide away from. This vast chasm of knowledge seems too large to even attempt to cross and I’d like to say it’s not, but the truth is I still worry about it all the time. I’d like to say there’s an easy answer and if I follow X, Y and Z then I’ll be fine but it’s not like that. I’d like to say that I put aside an hour a week to read up on Diabetes but who wants to bring themselves down when you could be watching the opening ceremony of the World Cup?

It’s been a year and to tell the truth it feels like I’ve climbed up on to the first step of a very steep and rather long staircase.

Sex

I’m writing this because it’s the hardest thing to talk about and I have spent almost a year ignoring it on my blog, however now it is time to speak out. Sex and diabetes are not comfortable bed fellows when your diabetes is not under control. This problem has reared its ugly head again for me and it is having an impact on my relationship. The embarrassment I feel talking about this now is second only to the fact that I said I would be honest in this blog and so far I haven’t been.

I was in a relationship when I was first diagnosed with diabetes and it was one of the reasons I ended that relationship. Not the main reason I might add, but one of them. Another reason was that I was finding it difficult to maintain an erection and I ran away from addressing the problem as fast as my legs would carry me. It was more comfortable not to have to face the issue than to have a partner.

Even though it (I can’t even bring myself to say erectile dysfunction – ‘it’ will have to do) was recognised as a common symptom in the DESMOND diabetes training day my doctor got me booked on, I still did not think it applied to me. You see, I’m a man who likes football and the pub and big machines and Top Gear and I have no idea at all about how to deal with that sort of thing.

I assumed the problem would go away and I started dating and met a wonderful woman. But the problem hadn’t gone away. I could see a pattern about to repeat itself and didn’t Einstein say, madness is repeating the same thing over again and expecting the result to change? Well my partner, who I’m still with, doesn’t work like that. She meets things head on and metaphorically led me by the nose into the doctor’s surgery to talk about it.

Sitting on that cold plastic chair, one on one with the doctor is often an intimidating position. I can’t remember my exact words but they were as round-about as I could make them. He was very matter of fact and even light hearted about it and the tension disappeared, I couldn’t believe I hadn’t sorted this out sooner. He ran through the options for me and we decided on Cialis. Cialis is a little pill you take once a day that builds up in your system and ‘it’ disappears.

Everything was going great, but if you’ve read my latest blog posts you’ll know my blood sugar levels have been high, up to 21 on occasion. I have been suffering from the old symptoms and one of them is a lack of drive and physical lethargy. This has impacted on my desire for sex. I can’t believe I’m typing this or that I’ll then post it. Push on through.

Since that desire has dropped off it has impacted not just on my self-esteem but on my relationship and on my partner. I like to solve problems, I’m a problem solving kind of guy but once again I could recognise a problem and didn’t deal with it. I find sex a difficult subject to talk about openly. This is extremely difficult, but if I’m honest I hope this blog will resonate with others who might not be as intractable as I am about the whole thing and do something about it.

What I didn’t realise was that my sudden-ish lack of drive made my partner feel as if she was no longer desirable, a completely unintended and until just recently, unacknowledged symptom. Now I’m typing this I can’t believe I didn’t spot it. Diabetes has for the last year (my anniversary is May 14th) been, apart from this blog, a pretty solitary disease – but guess what, it isn’t. It affects those closest to you as well. So instead of communicating more fully about what I was feeling and why, I ignored it and it got worse. Once again it was this incredible woman who tackled it head on.

I’m going back to the doctors to talk about this with my partner even though I still feel uncomfortable. More than anything I want her to be reassured it’s just a medical thing and closely following that I want to get back to being a happy and football loving guy – if you know what I mean!? I’m doing it again. What I’m trying to say is that I realise diabetes isn’t something that only affects me and although I’m fine to feel uncomfortable talking about sex in this way it’s not fine to let it ruin your relationship when a trip to the doctors could quickly and easily knock it on the head.

Knowing the unknowns

It’s fair to say that my last blog might have seemed a bit panicky. I had a letter telling me my GAD antibodies definitely made me type 1, not type 2. So I showed the letter to my GP surgery and got myself an appointment as soon as I could with the diabetic nurse. I also went down the hospital to get my HBA1c test done. The GP nurse confirmed the diagnosis and wrote a letter to the diabetes clinic at the hospital where I was to be treated. Apparently type 1 patients are treated through the hospital and not at the doctor’s.

In the spirit of ‘doing it myself’ I phoned up the diabetes clinic at the hospital and asked for an immediate appointment. Stuff it if I was going to wait for the letter of referral to get lost in the post. The clinic were very helpful and when I called them on the Thursday I got an appointment for the following Monday. In the mean time I was to monitor my blood sugars four times a day – before each meal and before bed and write down everything I had to eat.

I felt terrible. All the old symptoms were coming back – tiredness, apathy, constantly going to the toilet (number one not number two – how appropriate), and the dehydration. I was controlling my diet but the numbers were high, from 12 in the morning up to as high as 21 in the evening at one point. The only good news was that as I now had type 1 I could explain it. I was going to need insulin and once I got it things would change. Well change they did, or not, depending on your point of view.

I turned up for my appointment fifteen minutes early. The bloke next to me had turned up for his 15 minutes late. He got seen and I got bumped by half an hour. I wasn’t in the best of moods anyway. Whilst waiting for my bus to the hospital a driver of the W7 heading to Crouch End wouldn’t wait an extra two seconds to let a woman board who was buying her ticket. That’s broken Britain! He couldn’t wait two seconds before he pulled up five yards down the road to stop for the traffic lights. I demonstrated my displeasure by banging on the door and making certain obscene gestures. It’s fair to say I was on edge.

Ellie, the diabetic nurse, was great. She sees people with type 1 diagnoses regularly and obviously spotted something wasn’t right about my type 1 diagnosis. Ketones! The key is in the presence, or otherwise, of Ketones. The way Ellie explained it to me was that when your body can’t access the sugar from food it takes the energy it needs to prevent starvation from the fat in your body. Unfortunately a by-product of getting thinner is that the process of breaking down the fats leaves ketones which are acidic. This increases the acidity of your biological system and makes you pretty sick.

My urine was tested and not a single ketone was found. According to Ellie I definitely had type 2 and not type 1. Definitely! The only suggestion that I was type 1 were the increasingly high sugar levels and the presence of GAD antibodies.

Sugar levels increasing are relatively common in Caucasian people with type 2 and they commonly need to go on to Gliclazide or some such drug to help produce more insulin. She also upped my dose of Metphormin from two 500mg tablets, to three. I’m currently on day two of taking the full regime and things are stabilising but still high.

As for the GAD antibodies, well, people with type 2 aren’t tested for GAD antibodies so it might well be that such low levels like mine (16 rather than being in the 100s as is usual) are pretty common. It was interesting to me that such a thing is not commonly known, neither by the Oxford team or by either of the two diabetic nurses I saw. GAD antibodies, by the way, are the bombed out buildings left after the war between the antibodies and your pancreas.


So there you have it, type 1 for a week!

dawn of a new day

Just five hours ago I discovered that I am indeed suffering from late onset type 1 diabetes. I feel just like I did the first time I was diagnosed with type 2 diabetes – shell shocked. I mentioned some blog posts ago that I attended a study in an Oxford based diabetes clinic looking into MODY – Mature onset Diabetes in Youth. Well they sent my bloods away to be tested but it was highly unlikely I had MODY as the common symptoms and family history were not there, so I forgot about it. I opened the random white letter plucked from my post box and everything changed, ... again!

I’ve spent the last eleven months talking about the effects of type 2 diabetes, about what I’ve learnt and the problems associated with learning about it. About the fear that comes with it, the feelings of regret and disappointment about getting myself into the position. However, it turns out none of that was true. I mean, it was true because that was how I felt, but in fact I have naturally occurring antibodies so it wasn’t just my appetite for all the wrong things.

I’m a bit stumped. The good news is that instead of having early onset type 2 diabetes, which means I got the disease 23 years ahead of time, I actually have late onset type 1 diabetes, which means I gained 25 to 30 years of being diabetes free.

The bad news is that I built up injecting insulin as the one thing I did not want to be doing, that if I ate well and did loads of exercise, drank less and lost weight, that I would avoid having to stick myself for as long as possible. In fact those years have been stolen away from me like the runs a batsman could have scored if it weren’t that his wicket was cart wheeling out of the ground behind him. Truly this news has really stumped me.

It took me a good twelve months to start really getting to grips with type 2, and to be honest there was still a lot more I needed to learn. But if you noticed in my last few blog posts I’ve been complaining that my blood sugar levels weren’t dropping. I couldn’t get them under control. Well I guess now I know why. This little conundrum has now been solved. The problem is I have no idea about how type 1 works.

I’m sure there must be similarities and I’m pretty sure the complications are the same. I’m not sure about how insulin injections work or when to take them. I’m also not sure if I’m now at risk of hypoglycaemic coma and the effects of exercise. If it has nothing to do with lifestyle then how do I treat this bugger? And if I have to do it myself, where do I get to learn about when to inject and how often to monitor my bloods? I don’t mind admitting this is a real bloomin’ pain in the arse that I just didn’t need right now.

Oops, bit of anger there. At least I can recognise the patterns. I think I’ll re-read my old blog posts. I also suppose this gives me more to blog about – I can start again. The only guy to have blogged about having both type 2 and type 1 diabetes! All I need now is some genetic mutation to be discovered in me in a year’s time and more material will present itself – hmm, is this denial!

Get Involved

Politics affects all our lives whether we want it to or not. As diabetics we have to be even more aware of government policy than others as the amount of money committed to research and treatment is going to be directly reliant on the amount of pressure that can be brought to bear on which ever government we elect. It’s estimated the NHS will have to save between £15 – 20bn over the next three years, so money is going to be tight.

It might be that politics is not your thing, and the MPs expenses scandal has put you right off all of them, but this is missing the point. Politics for me is just like self-management of my diabetes: if I want to influence my blood sugar levels I have to do something about it; if I want to take an HBa1c test I have to book it in myself; and if I want the next government to make diabetes a priority then I have to act on that too.

Diabetes UK are running a campaign to email your Parliamentary candidate, you can find out how in the ‘get involved’ section of this website. So if you are reading this I implore you to do so. I did and it took about 90 seconds – and I personalised my letter to suggest the candidates look at my own manifesto published in my last blog post – it’s the narcissistic streak the gets me writing this thing in the first place!

As diabetics who self manage our condition you might say we are predisposed to being more active politically. Many people go through life expecting things to be done for them. Diabetics quickly learn that we have to do it for ourselves, although with a little support. We have to learn about food, the disease itself and how to live with it, we have to push our doctors and nurses, employers and family to recognise the condition we are living with and we have to take action to make the changes we need to make. The same applies to politics.

I’ve looked through the manifestos of the parties and I’ve seen three key things, a commitment to public health, tackling chronic diseases in the community and a desperate need to save money. The good news is that treating people in the community and increased self management is a fantastic way of saving money. It means that as people become better at managing their condition they stay out of hospital – which costs the NHS less.

However the flip side of less people being admitted is they don’t need as many hospital beds and so wards get closed. We have a strange situation in this country where we automatically think closing wards is a bad thing. I would argue that if done for the right reasons – the quality of care is not up to standard or there just aren’t as many people being admitted – closing wards is a very good thing.

The Lib Dem’s declare in their manifesto that more people should be treated in the community and that no more departments should be closed. Doesn’t that mean loads of empty beds and nurses underutilised? That said I’m writing this after the first election debate where Clegg did really well. So I am confused about who to vote for, but that is separate from the fact that I want to influence whom ever gets elected to push diabetes to the top of their health agendas.

I believe everyone should vote. I worry that a lack of people turning out to vote will lead to extremist parties getting elected on tiny, unrepresentative levels of voting. So I would encourage everyone to vote. But, just as important is that we get our voices heard by all of the prospective Parliamentary candidates. Once they are elected, and deliberating on future policy or chatting in the lobbies with senior ministers, we want diabetes to be in their thoughts. Please do get involved.

My manifesto for avoiding diabetes

I could have written a blog post about food during Easter and I could have written a blog post about how I can’t seem to get my blood sugar levels down at the moment but quite frankly that all seemed a bit whiney. I would like to say thank you to everyone who has left positive messages for me after my last few blog posts. I’ve basically decided not to worry about it all that much and get on with eating healthily and exercising and waiting on HBA1C tests.

So, as election season is upon us I thought I would draw up my four point election manifesto and see what you thought. I am fed up with often being fooled by how much sugar is in a product. You can buy a tin of soup thinking you’re doing yourself a favour by avoiding bread and then discover the sugar content listed applies if you only eat 3/18ths of the carton. I also feel it’s far easier these days to get diabetes then to avoid it.

I also don’t think we really do enough to promote public health and to push it high enough up the agenda. The Conservatives have said they will rename the Department of Health, the Department of Public Health. This is great but is it any more than a name change, lip service if you will? Well below are four points that I think will give us the information we need to make decisions on what we eat and some to help us make the right lifestyle choices.

1. All food should be labelled with the sugar, fat, saturated fat, and salt content in the most appropriate way, so not for half a can or 100g leaving shoppers getting out their calculators to see what a 40g bar contains. I want to know what each individual Weetabix contains, what a full can of soup contains, or how much sugar is in a slice of bread.

2. I want all restaurants to list on the menu the same four indicators so we all know what’s in the food. That way I can feel comfortable going out to eat without facing something of a lottery. I include within this all the chicken joints, kebab houses and burger vans. No food should be sold without giving the customer the knowledge they need before eating it.

3. Foods high in fat, salt and sugar should have an appropriately high tax on it. This can be on a sliding scale that comes down as the unhealthy contents come down until there is only the regular VAT. This has the duel effects of encouraging food companies to make their food healthier and also means we will eat less of the bad stuff, thereby making it harder to get diabetes. Romania is implementing this right now – Romania!

4. Build cities and towns in a way that makes it easy to walk to the shops, school and parks and difficult to drive there. Stop building out of town shopping centres and cookie-cutter estates off the M4 with no culture and no facilities. Build streets that are wide enough to create vitality such as outside tables for sipping coffee, hosting fruit stalls and German markets – not just roads for cars. Basically start thinking about towns and cities as places we want to live in not drive through.

I would value any comments you have, or suggestions. Maybe if this gets enough support we’ll submit it to Diabetes UK and ask them to take any appropriate manifesto points up as part of their campaigning work.

In sickness and in health

When I’m feeling healthy and fit I still worry about my blood sugar levels, what are they up to now, is my treacle-like blood destroying my organs even as I type this, are my eyes macularly degenerating, blink, blink? No joking matter to be honest, but at the same time you have to balance these concerns with living life. I recently decided to up my dose of metphormin because my blood sugar levels were too high and they weren’t coming down. I’ll monitor this new dose and see how things go.


However when you get sick, and I mean flu rather than something more long-term, the balance shifts. I started with a cold and runny nose on Friday night and gradually slipped into a dozy, light headed, no-appetite, slightly feverish dose of sickness by Saturday evening. I cancelled my plans and went straight back to bed – only I hadn’t eaten, and don’t they say as a diabetic you shouldn’t miss meals?


So my trippy, worried, in-and-out sleep revolves around what might be happening with the levels of sugar in my blood – tiny high-pitched globules of sticky sweetness with munchkin faces, wielding strange clubs and pitchforks and setting about my luckless kidney – I said it was feverish..


Of course I know that missing one meal isn’t going to play any real significant part in my chronic condition but sickness presents a new and more confusing picture – like adding exotic spices to a long practiced recipe. The diabetic researcher at the MODY clinic in Oxford (see posts passim) told me that illness gives you a stress reaction that reflects in higher blood sugar levels, so I figured that the stress reaction combined with the missed meal would in fact counteract each other – and so it seemed as my levels came down from 13 that evening to 7.9 the next morning.


Self management is the key process behind treating diabetes in the NHS – and rightly so, but at the same time it means you end up experimenting on yourself as you learn to live with the disease. I’ve had a cold since being diagnosed but nothing like how I felt for that weekend. It took a few days for the appetite to come back but I did make sure I had something for each meal, even if it was just soup and a roll.


Like my illness the worry gradually faded, in my normal overly dramatic flourish, ‘I had survived’, ‘made it through to the other side’, ‘I had stared mild discomfort in the eye and lived to tell the tale’. My point is, and the point to this post, diabetes is all a little confusing and illness muddies the waters further, but in the end, it’s really not such a big deal so don’t worry yourselves unnecessarily.

Thursday, 14 April 2011

Dolphins and polyols

So apparently, according to an article in the Guardian(http://www.guardian.co.uk/science/2010/feb/19/dolphins-humans-diabetes), dolphins can turn on and off a diabetes gene. I lay in bed last night, shut my eyes tight and tried really hard to do the same thing, but alas I think I might just have turned it up a bit. My blood sugar levels have been high for ages. I can’t seem to get them down, or I’m doing something stupid like having the odd pint. It’s really, really depressing.

I learnt many new things recently, firstly that my HbA1c level was 7.8%. It should be, according to the nurse at my GP surgery, between 4% and 6% so it’s still high. However my last test was 10%, so 7.8% is a decent improvement. I also learnt that your HbA1c level can only ever drop by a certain amount each time, not something the diabetic nurse told me as it’s likely she doesn’t even know. Maybe she’ll read this blog and find out this rather vital piece of information.

I found out because I volunteered to take part in a study performed by the Oxford Centre for Diabetes, Endocrinology & Metabolism looking into MODY Maturity-onset Diabetes of the Young. MODY is not quite Type one and not quite Type 2. I’ll discuss this further in later blogs.

I also learnt of a study published in the Lancet suggesting the target rate for HBa1c test for diabetics should not be set as low as 4%-6% but should, as the evidence seems to show, be set at between 7% and 7.5%. One of the authors of the report called for GP targets to be scrapped immediately.

Truth is that I wrote some of this first post some time ago but never got around to finishing it off. I’ve been down lately and lack the original fight and positivity I had in the first six months since being diagnosed. I get a lump in my throat when passing cream eggs in the supermarket and now the larger Easter eggs are appearing, it hurts, I want one – but not just because I like the taste – I want one because I know I can’t.

Work has been stressing me out. I had a great fun and exciting project about providing health information for the fans of all 92 league clubs and it got canned for business reasons. Normally I’ll be gutted and then get over it and move on but I can’t seem to let it go. I seem to be feeling things more than ever before. I know depression is a risk for people who have just found out but I’m 10 months in – I wonder if I am still at risk, perhaps others might be able to share their experiences.

So I’ve given up drinking alcohol for three months to see the effects that has on my levels. I still don’t eat chocolate but I did try a Belgian plain chocolate ‘Sugar Lesss...’ bar on Valentine’s Day and it was pretty good. It contains something called ‘polyols’ – no, I’ve no idea what they are either but seem to be alcohol sugars. This is getting confusing now! No drinking but alcohol sugar is ok? Apparently polyols don’t break down in your mouth so tooth decay is not a problem but they constitute 37.2 % of the bar. My question is, are the manufacturers hiding 37.2% of the sugar in the bar by claiming “carbohydrates 40.5%, of which sugars: 0.9%”? I’m going to write to them and find out. Watch this space.

7.8, not too bad but not that good

I learnt many new things this week, firstly that my HbA1c level was 7.8%. It should be, according to the nurse at my GP surgery, between 4% and 6% so it’s still high. However my last test was 10%, so 7.8% is a decent improvement. I also learnt that your HbA1c level can only ever drop by a certain amount each time, not something the diabetic nurse told me as it’s likely she doesn’t even know. Maybe she’ll read this blog and find out this rather vital piece of information.

I found out because I volunteered to take part in a study performed by the Oxford Centre for Diabetes, Endocrinology & Metabolism, more of which in my next blog post. The other key thing I learnt was that I will end up using insulin. This has never registered with me before. Maybe I was told and I just didn’t take it on board. Without wanting to be rude to type one sufferers, this freaks me out. It might not be for ten years, it might not be for thirty, but it seems it is more than likely to happen.

The researcher at Oxford told me she considered anything around 7% to 7.5% to be a good rate for diabetics and between 4% and 6% to be the level for non-diabetics. My nurse would seem to have no understanding of the difference and it made me feel better to hear the simple truth that diabetes makes it harder to control your blood levels. Amazingly simple! Diabetes makes it harder to control your blood sugar levels and because of this having an HbA1c around the 7% mark means you are doing well. The comedian Lenny Bruce once said, ‘the truth is what is’, in other words what’s real is what’s right. I have diabetes therefore it is unlikely by blood sugar levels will be anything other than high.

That doesn’t mean that I can’t try to get them into the normal range as the more normal the levels the longer I get to put off injecting insulin. However I’m not going to be too hard on myself if they aren’t and if my nurse tutts at me or makes a comment I’ll remind her, I’ve got diabetes!

I also learnt that the blood sugar measuring device that you get with the finger prick test isn’t as accurate at the lower levels as it is at the higher levels. I measured my blood levels after work the day I had my HbA1c test for which I had to fast in the morning and it came back with 2.2. I panicked a little and went and ate a pizza. I didn’t feel poorly or have a headache or feel tired or grumpy – all signs of low sugar – so it may just be that the reading was wrong.

One last thing, my girlfriend warned me about something in the paper relating the danger of exercising for diabetics, I haven’t seen it but I did ask the diabetic expert at Oxford, Katherine, who said exercise was the best thing any doctor can prescribe any diabetic patient. She told me a story of a man who within three months of seeing his doctor got much healthier, got his blood sugar levels down, his blood pressure down and lost weight – the miracle wonder drug he prescribed – get a dog and walk it twice a day.

So to surmise, diabetes makes it hard to control your blood sugar levels, your HbA1c level can only go down by a limited amount each month, exercise is good, and blood sugar monitors don’t work as well at the lower end as they do at the higher end. I think these things are worth knowing and I’m surprised my GP and nurse don’t. I hope this information helps you in some way, maybe you can pass it on.

HbA1 oh I see

In my last blog I wasn’t sure how the process for getting an HbA1c test goes. That’s the test for measuring your longer term blood sugar levels. Well I found out and it’s not like a dentist’s where they remind you to make an appointment, it’s all down to you. My advice is to put a date in your calendar six months in advance and hope you don’t lose the diary, computer or phone.

I woke up at 8.00am, as my test wasn’t till ten, only to discover the water to my flat had been cut off. I had enough left in my glass on the bedside table to take my pills as instructed and that was it. No shower, no brushed teeth, blagghhh!

Then of course I couldn’t eat as you have to fast for the HbA1c and my stomach was making a few grumbling noises. So hungry, grumpy and unwashed I headed to the doctors. Now lately my blood sugar levels have been a bit haywire and I haven’t thought properly about why, so as I was sitting in the rather bland GP waiting room I got to thinking, and thinking, and thinking, because the nurse was half an hour late.

What I concluded was that as I now have a lovely girlfriend I’ve been eating out more than when I was single, and although I have been going for a relatively healthy option and certainly no desert, you just can’t tell what they put in your food. As I enjoy going out, rather than eat in more, I made the decision to eat more salads when I’m out.

The problem with salad is that I begrudge paying for it. I can make a salad at home, and for a fraction of the cost, and it taste just the same because there are no special sauces I can put on them. Take today, I had a buffalo mozzarella salad from Carluccios in Smithfield, with about nine pieces of rocket, three small pieces of mozzarella, three slices of tomato, two pieces of fancy bread and some olives - £5.30. It tasted great, but I could do that at home for half the cost and make it more filling.

But I digress; I was worried about the test. The last time I took the test, also my first time, the nurse read out the result of 10, which I thought was good as I had only just been diagnosed and so I was bound to be a bit high. Only she shuck her head, apparently 10 is not good, it’s bad, as it turns out long term blood sugar levels are conveniently measured on an entirely different scale from the finger pricking test I do most days. There would seem to be some confusion as to what the normal range is and it varies according to the lab used to measure it. But it would seem that somewhere between 5% and 7.5% is the normal range. I’ll find out more if I can. (Diabetes UK says below 6.5% is good).

Long story short, the nurse couldn’t get at my deep veins so sent me to the hospital, which meant I’d run late for work. I wasn’t having the best day. They stabbed me in the arm and I left. But as I watched the large metallic doors grind open it struck me that I’ve been doing pretty much everything I should be doing. I’ve lost about four stone in weight, do loads of exercise and have had only three bowls of ice cream in the nine months I’ve been diagnosed. I have not eaten a chocolate bar nor any sweets or cakes in that time. If it comes back high I have no idea where to go from there. I think it might crush me if it’s too high. I’ve been working hard at beating this disease and if I’m failing I would be very distressed. I get the results on Tuesday night so I’ll let you all know.

Medical news

Two bits of medical news jump out at me from this week’s, Pulse magazine. It’s aimed at doctors but I have to look through it as part of my job. Drug companies often target doctors with adverts and one struck me this week. It’s an advert for a Testosterone test to see if you need testosterone therapy which I assume is being given added testosterone – I should point out it’s aimed at men.

So the advert shows a babushka doll (Russian doll) with three top halves of an overweight, sad looking man. In the first the half man holds a sign saying, “Inside this type two diabetes patient”, the second holds a sign saying, “is a man with low testosterone”, the third – a somewhat happier man, still chubby but obviously smaller – holds a sign saying, “waiting to be found”.

According to the advert, “men with type 2 diabetes commonly suffer from testosterone deficiency syndrome (first I heard of it) leading to: Loss of libido, fatigue, erectile dysfunction.” So now I’m scared but I’m also intrigued. The advert goes on, “Testosterone therapy can address these symptoms as well as reducing HbA1c, waist circumference and improving insulin resistance (which I’m sure they mean reducing insulin resistance).” Wow, that’s some good stuff, but in the light of last week’s posting about fraudsters surely this is a little too good to be true.

Well they reference every point they make to a paper written based on studies, and although I don’t know who all these people are I can take a look if I feel the need. Secondly they don’t offer a price, you and I can’t buy this, it’s aimed at doctors, and it’s not selling the therapy it is only selling the test.

“Data presented at the Diabetes UK Annual Conference in March last year revealed that Testosterone Deficiency Syndrome (TDS) is found in over 50% of men with Type 2 diabetes, more than double the rate in the non-diabetic population. TDS is associated with a 42% additional risk of developing Type 2 diabetes, and up to 60% additional risk of all-cause and coronary heart disease (CHD) mortality.” http://www.medicalnewstoday.com/articles/142252.php

No one has mentioned TDS to me in any conversations with any diabetic specialists. It looks like a real problem and I for one will be asking my doctor for a test. In fact I haven’t been called for an HbA1c since my first one in June and I’m more than due. I do find I have to do all the pushing to get appointments, I still haven’t seen an eye specialist (although I have had the test and now wear glasses in order to type this). I know they say you have to self medicate with diabetes but I didn’t know you had to self consult, self advise and self organise. Perhaps the NHS does so much for us we don’t always think to push hard ourselves. In this case it’s good to be pushy.

And finally, one other story stood out, according to one news story giving up smoking increases the risk of developing diabetes. A study by Johns Hopkins University Hospital in Baltimore (one of the top hospitals in the world) found that weight gain after stopping smoking contributed to a 73% increased risk of developing diabetes over three years, compared with non smokers. The researchers followed nearly 11,000 subjects for over a decade. The good news is that the risk gradually decreased until after 12 years there was no more risk. The top boffin leading the study suggested GPs offer quitters lifestyle counseling. You’re damned if you do and you’re damned if you do and then quit.

Don’t fall for it

I have a twitter account, it’s twitter.com/andykliman. I know it doesn’t make me special and to be honest I really don’t use it that much. I only have 39 followers and there is a reason for this, I don’t just accept anyone. Take Diabetestools, the username for someone or some group who are providing information on tackling diabetes. Great, you might think, there is more help and advice out there and I’m happy to take a look. Is it harmless or is there more to it than that?

They say a little information is a dangerous thing, but they should say a lot of information about bogus health claims is a dangerous thing . The first link I saw was to this address http://www.diabeticwarrior.com/eBook.html?hop=rpgincarls and a man who calls himself The Diabetic Warrior (a.k.a Patrick Lecky). Patrick claims to have cured himself of type 2 diabetes and can show you how to do it too – for a fee of course as you have to buy his book, ‘how to fight type 2 diabetes and win’. And the best thing is that on his plan you can lose weight without doing the work! Pow! Take that diabetes.

Now, for legal reasons, I’m sure Mr. Lecky has undergone a host of scientifically rigorous tests and can prove everything he is saying – although he does not say anything of the sort on his website nor does he reference anything he says on his website. For all I know, everything on his website could have been made up as a scam to exploit diabetics who suffer from real and debilitating problems. So how would you spot a scam?

There are always a number of red flags that point to a problem.

Firstly, if the person claims to be able to offer a miracle cure – such as ‘Reduce or Eliminate the Insulin Resistance of Your Body Cells’ or ‘lose 119 pounds by doing less exercise than before’ as much as you want to believe it – it’s crapola.

The second red flag is if these miracle claims are mixed in with things that are true if you just do the basics of staying healthy and eating well – such as losing weight, regulating blood sugar levels, preventing the threat of amputation and so forth.

The third red flag is when the answer to all these problems comes in one super duper special capsule/food/supplement/potion – it’s all just snake oil. So in this case the red flag would be PRIMAL foods. You have to ask, which foods are not PRIMAL?! If you read down to the bottom of the page Mr. Lecky claims a British farmer lived to the age of 152 by eating fermented milk products. I guess if you have read that far down the page you will believe just about anything – and who knew what he was eating? Did someone record his diet? RED FLAG! RED FLAG!

The forth red flag is when they claim they are fixing something ‘modern medicine’ couldn’t help them with, as if modern medicine is stupid. Modern medicine doesn’t claim to have all the answers – and if it does the claim is peer reviewed, tested and re-tested until the evidence points to it probably being true or not. Where is the evidence? Always look for the evidence – and don’t use testimonials, they’re hearsay not evidence.

And the final red flag is the charge – only $99.99 – or whatever.

The supplements industry is a multi billion pound concern and yet so many of these red flags exist – where’s the evidence? And don’t fall for the ones that reference their evidence from organisations they set up themselves. Con artists abound on the internet praying on our wish to find answers and cures that don’t exist – it’s called magical thinking. As difficult as it might be, the only real answers we have at the moment are to exercise, eat healthy and balanced meals and talk to your GP. Snake oil salesmen need to be put out of business, but Governments aren’t going to do it so we have to, through spotting those red flags. That’s why I won’t be adding Dibaetestools to my list of people I’m following – I have integrity.

A diabetic Christmas

The Christmas just gone was my first as a diabetic and I have to say I was hesitant about it. Food features highly at Christmas, Lindt seem to only advertise their chocolate at Easter and Christmas and it all looks so good, melted inner goo with crisp chocolate ... well, you’ve seen the ads. Gone was my festive chocolate orange, Terry can keep it now! And it’s not just the chocolate and sweets, it’s the glorious Christmas pud and the ice cream and the nuts and the wine and the beer.

I know Diabetes UK recommends you do treat yourself now and then, that you don’t live the life of a food monk or flagellate yourself for having a Quality Street. But my problem has always been that I can’t stop at one. Interestingly I was re-watching the ‘West Wing’ on DVD when one of the characters, who is an alcoholic, explains that his problem is not that he wants one drink, it’s that he wants ten. I feel the same way about sweets. I couldn’t have just one section of a chocolate orange, or one Cadbury’s Hero, I want ten, or fifteen or .. oh, it’s all gone, how did that happen?!

So I do give the chocolates a miss, I’d rather not have any then torture myself. On reflection I noted that my parents, whose home I was in for the festive period, also didn’t have any. They would normally have a selection of sweets and chocolates out, but I guess they were thinking of me. Funny the subtle changes diabetes makes to the lives of those around you.

One thing I did ask for was a Christmas pudding. I was determined to have some Christmas pudding with some ice cream on Christmas day. Then I looked at the sugar levels – 1/8th of the pudding was 65% of your daily sugar intake. This thing was packed full of sugar. I was so disappointed I wanted to cry. Surely there must be a pudding out there with a lower sugar level than this! I wanted to ask my Mum why she had gone for this one over any others, hadn’t she checked, didn’t she know? After all those subtle changes this felt like a kick in the teeth. But I smiled and I had about 1/16th of a Christmas pudding and three scoops of ice cream. I think there is a lesson here about communicating more clearly, I work on that one for another blog.

Then I picked at the pudding, a little here, a little there. And I went a bit mad with the turkey sandwiches by adding a splash of ketchup. Oh the sin of it all, bits of Christmas pudding and a splash of ketchup, it just feels so bloody unfair. I tested myself blood sugar levels and I was at 17. I hadn’t been at 17 since I was first diagnosed and it was a bit of a blow. So I stayed away from sugar as much as possible the next few days (except I did have some more ketchup with next day’s turkey sandwiches – to heck with it I thought, let them take my foot).

The thing is I need my foot, and my eyes, kidneys and pretty much everything really. I did feel guilty about letting things get out of control. I also felt bad that my Mum had put so much effort into thinking about my first diabetic Christmas and I had been so damned stupid about the Christmas pudding. I could have gone for a run if I was so bothered. As it was I did little exercise over the whole of the festive period. But it’s back to work now and back to the routine. Structure makes living with diabetes much easier. My bloods are back under control now – at last test 6.8, but this Christmas has shown me how easy it is to slip.

I hope you had a good Christmas and any experienced diabetics out there who want to leave some tips for us newbies – please do let us know.

Work and Diabetes: part 2

Over the last few weeks my diabetes has come second to work. Since being diagnosed in May I’ve been running my life in a way that suits my diabetes best – getting to the gym, eating balanced meals regularly and staying away from chocolates, sugar and excessive amounts of fat. I’ve just hit the 14 stone mark for the first time in, in, it’s been so long I can’t remember! I’ve turned down drinks and I’ve passed up dessert and all because I’ve changed much about my life.


However the past few weeks have been completely dominated by work. I do the PR for a company called Dr Foster and we put out the 2009 Hospital Guide. I worked 83 hours on the week of the launch, literally finishing work at nine or ten at night and getting up at six, or even on occasion five thirty. The launch was huge and the story was far bigger than I imagined.


The effect it had on my diabetes was that I was missing dinners and not eating until late, whereupon I’d have a sandwich or something light. I also found I couldn’t eat much on an early morning so I’d grab some toast from a local shop – just butter – around 10.00am if I could get out. It threw my routines completely out of whack. When I did get home in time to eat I’d have a take-away, a throwback to the lifestyle that got me in the diabetes trouble I’m in now.


I’d often think about measuring my blood sugar levels but then something would come up and I’d forget. I’ve been told that with type 2 you don’t have to worry about hypoglycaemic coma but I did begin to worry that I wasn’t taking care of myself. Getting to the gym was impossible and I’m sure I formed a small groove in my seat at work I spent so long in it.


When I did manage to measure my blood it was fine, well within limits. Occasionally my blood was in the low 5s but that’s good, not bad. As it turns out the diabetes affected me in other ways. I got a mouth infection and it seems as though bits of me were falling apart. I got a couple of rashes that would not go away, obviously an effect of stress but maybe made worse by the sugar that stays in my system making me a Petri dish for bacteria.


It culminated in the astonishingly painful throat infection I now have as I type this. It’s two weeks after the launch and this infection came on Tuesday night. By Thursday I could not eat, and even breathing was painful. I finally got an appointment with the Doctor for Friday but the nurse had put the wrong day in the diary and I was not scheduled till the following Friday. I would have shouted but I couldn’t. As it was they fitted me in as an emergency patient and I got the Penicillin I so desperately needed. I should have gone in as an emergency patient two days earlier and I wouldn’t still be in pain today.


So I guess the effects of Diabetes are much more long term than the effects of stress and exhaustion, but long term periods of stress and exhaustion will ultimately have an effect on my diabetes. Stress doesn’t have to come from work, it can come from family, from kids, from relationships, from friends and from so many other areas of life. I suppose being aware of these stresses is the key, and making sure they don’t play too big a part in your life. Roll on Christmas – that’s never stressful. 