Balance Magazine Issue 4 2011

balance Your diabetes lifestyle magazine • issue four 2011 • £3.95

IN THE PIPELINE

The latest Type 1 research

15 CARE MEASURES

How many do you get?

KIDS IN CONTROL Life-changing holidays Pioneering research Dealing with hypos Creative cooking

YES, LORD SUGAR

The Apprentice star’s Type 2 warning

TREATING HIGH BLOOD PRESSURE AN APP FOR THAT

Get fit with your phone

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Gallagher Employee Benefits is a trading name of Heath Lambert Consulting Limited, authorised and regulated by the Financial Services Authority. A member of the Society of Pension Consultants. balance issue four 2011 Registered Office: 9 Alie Street, London E1 8DE. Registered No. 0772217 England and Wales. www.gallagherheath.com

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contents issue four, September 2011 • no.242

balance

The UK’s leading magazine for people with diabetes. Produced

by Diabetes UK, the charity for people with diabetes.

10 Parkway, London NW1 7AA 020 7424 1000 balance@diabetes.org.uk www.diabetes.org.uk/balance

EDITOR

Martin Cullen

DEPUTY EDITOR

Angela Coffey

MEDICAL & SCIENCE EDITOR

Brian Burns

PRODUCTION EDITOR

Kate Flagg DESIGNER

John Clarkson EDITORIAL SECRETARY

Melanie Aldridge AD MANAGER

Claire Barber, 020 7878 2319 claire.barber@tenalps.com PRINTER

Pindar plc TRADE DISTRIBUTION

Native Publisher Services 01132 909509 ARTICLES & ADVERTISEMENTS

Products and services advertised in balance are not necessarily recommended by Diabetes UK. Although the utmost care is taken to ensure products and services advertised are accurately represented, it is only possible to thoroughly check specialist diabetes equipment. Please exercise your own discretion about whether or not an item or service advertised is likely to help you personally and, where appropriate, take professional advice from your medical advisor. Please note also that prices are applicable only to British buyers and may vary for overseas purchases.

Paid adverts do not necessarily represent the views of Diabetes UK. Complaints regarding advertised services or products should be addressed to: Claire Barber, Advertisements Manager, Ten Alps Publishing, One New Oxford Street, London WC1A 1NU. Articles in balance written by freelance contributors do not necessarily represent the views of Diabetes UK. Diabetes UK policy statements are always clearly identified as such. ©Diabetes UK 2011 A charity registered in England and Wales (no. 215199) and in Scotland (no.

SC039136).

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45

51

regulars

features

life&health

4 This is Diabetes UK 6 News 16 They say, we say We correct other diabetes news reports 18 Research matters The new name for our research round-up 22 Your views 26 Columnists 62 Recipes Kids get cooking 69 The back bit Imagining diabetes, poem, readers’ hotel offer and more 72 Walk this way Roly goes in search of the Lost Valley 76 Fun and games Prize crossword, etc 78 Arthur’s armchair And his inflexible friends

28 Let’s KICk-OFF with the FACTS Two Diabetes UK research projects helping to tailor diabetes education to the needs of Type 1 teens 34 Give us a break Parents and children lift the lid on Diabetes UK Holidays and Weekends 39 Found in translation From breakthrough to bedside – putting Type 1 research into practice for those who need it 45 Without Sugar The Apprentice star Claire Young on diabetes, her mum and Lord Sugar

51 Health notes The foods that keep you fuller for longer; kids and hypos; how to get a care plan; and get fit with the help of an app 56 Basic care Healthy eating on the go 59 Spotlight on...

High blood pressure 60 Ask Karen All your diabetes questions answered.

This time: pumps on planes, driving after DKA, shoe fitting and needle phobia

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

Your right to good diabetes care

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very person living with diabetes should expect and receive a good standard of care. No one can argue with that. So, what is a good standard of care? There are officially approved measures of diabetes care in all four nations of the UK, which have been jointly developed by clinicians and people with diabetes. Diabetes UK has brought together these measures, and you can find a 15-point pull-out checklist inside this issue of balance (see pages 40–41).

So, the next question is: are you or your family members with diabetes receiving the standard of care that is regarded as good? We know that many people are, but we also know from analysing data that not everyone gets the care they need and should have. For example, The National Diabetes Audit for 2010 showed that there is a growing proportion of patients who receive all annual key care processes recommended by the National Institute for Health and Clinical Excellence, such as eye and foot checks. In spite of that, almost half of people with Type 2 diabetes and two-thirds of people with Type 1 still do not get all these checks. Among children and young people, just over 4 per cent had received all essential care processes. The audit also found a continuing postcode lottery, with big variations in care across the UK. We hope you find the pull-out checklist useful: check that you are getting the right range of care, and talk to your diabetes healthcare team about the care you are getting – and what you need. We hope you will also let us know about the care you receive by filling in our online survey. During the next few months, we will be publishing more information about what standards are being met in services across the UK, drawn from official sources and your feedback. We want to advocate for, and with, people with diabetes wherever standards are in most need of improvement, and we look forward to working with you and service providers to help improve standards of care.

It is excellent that there is general agreement on what good care looks like. Now we need to ensure that everyone gets it.

Join us today Supporting Membership keeps you up to date with diabetes developments and connects you with a network of people who understand your condition. And, of course, you receive balance five times a year. To join us now, call 0800 138 5605 or, for details, call our Supporter Services team on 0845 123 2399, Monday to Friday, 9am to 5pm.

Diabetes UK Careline For support and information, call 0845 120 2960 The Careline is open Monday to Friday, 9am to 5pm.

TypeTalk calls are accepted and an interpreting service is available. Recorded diabetes information is available 24 hours a day via the 0845 number. Please check the cost of calls to 0845 numbers with your phone provider.

You can also write to Diabetes UK Careline, 10 Parkway, London NW1 7AA for a response within 21 days or email careline@diabetes.org.uk for a response within 10 working days. The service is confidential but we are unable to provide individual medical advice.

Tell us what you think Feedback helps us improve If you have any feedback about Diabetes UK services, good or bad, please write to Supporter Services, Diabetes UK, 10 Parkway, London NW1 7AA (marking the envelope ‘Feedback’); call 0845 123 2399, Monday to Friday, 9am to 5pm; or email supporterservices@diabetes.org.uk.

Find your nearest Diabetes UK office Diabetes UK has offices across the UK. To find your nearest, visit www.diabetes.org.uk/contact_us or call 020 7424 1000.

Find us online www.diabetes.org.uk

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www.facebook.com/diabetesuk http://twitter.com/diabetesuk

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Baroness Barbara Young Chief Executive, Diabetes UK i See ‘News’, page 8, for more information, pages 40–41 for the checklist and www.diabetes.org.uk/care-survey for the online survey. balance issue four 2011

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FROM THE EDITOR

news

Doing it for the kids It’s back to school time – for children and parents anyway.

And in this issue we celebrate with something of a kids’ special.

On page 28 we report on two innovative Diabetes UK-funded studies that look at helping children and young people better manage their diabetes. One adapts the successful DAFNE educational course and makes it more kidfriendly, and the other looks at how families – and in particular how they communicate – can affect diabetes management.

Also, we take a look at Diabetes UK’s Care Support Events (p34), after another successful summer that’s seen hundreds of children with diabetes learn and have fun (the two aren’t always mutually exclusive!) on the charity’s holidays and weekends. Incidentally, I shall be organising a Children’s Support Weekend in October and will report back in the next issue.

We also let the kids loose in the kitchen (p62), and give some sound advice on hypos in children (p52).

But it’s not all about the young ones. There’s the latest on the search for a cure (p39); how your phone can get you fit (p54); how to have a healthier lunch (p56); Claire Young from The Apprentice (p45); and Roly goes in search of the Lost Valley (p72). See you soon.

Martin Cullen, Editor

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Gear change for driving rules Plans to introduce changes to the rules on driving licences for people with diabetes will see an end to the blanket ban on people being treated with insulin from driving lorries and buses (large Group 2 vehicles).

From October, people with diabetes will be able to apply to the Driving and Vehicle Licensing Agency (DVLA) for an annual medical assessment to hold such a licence, and will need to use a memory meter to record their blood glucose tests and supply three-months’ worth of records.

Diabetes UK is currently in discussion with the DVLA about how other changes will affect people applying for car and

motorbike licences or renewals (Group 1 vehicles). This is because people who experience hypos may have their Group 1 licences revoked if they report two severe episodes in a 12-month period.

Diabetes UK has concerns that this is open to misinterpretation as people can often experience hypos when asleep, and the charity believes night-time hypos have no medical basis of relevance to driving. Diabetes UK is now working with the DVLA to try to ensure the process for applying and re-applying for licences is fair, consistent, transparent and safe. i For more on driving and diabetes, visit www.diabetes.org.uk/driving.

FIGHT FLU Don’t forget to have your seasonal flu immunisation, which is free to everyone with diabetes. When it comes to flu, people with diabetes are a high-risk group, as it can affect diabetes control and cause blood glucose levels to fluctuate. This can leave people open to many health problems, including flu complications such as pneumonia and bronchitis.

If you haven’t already been invited for a free flu jab, contact your GP surgery to find out when they are holding clinics.

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Everyone’s talking about...

The Lucentis decision An appeal has been launched by Diabetes UK and other charities against a decision that could lead to thousands of people with diabetes losing their sight.

The National Institute for Health and Clinical Excellence (NICE) proposes not to recommend the drug Lucentis to treat the eye condition diabetic macular oedema on the NHS, due to concerns about its cost-effectiveness. However, Diabetes UK, the Juvenile Diabetes Research Foundation, Macular Disease Society and the Royal National Institute of Blind People (RNIB) argue that they have not been able to comment on significant new evidence from Novartis – the manufacturer of Lucentis – and are calling for a proper consultation.

Steve Winyard, RNIB Head of Policy and Campaigns said: “NICE has failed to consult with experts from patient organisations on this new evidence, nor have they sought advice from clinicians who treat people with this condition. We strongly believe that some of the assumptions they have made about the cost-effectiveness of the treatment are wrong.” i To register your support, visit www.diabetes.org.uk/ lucentis-campaign.

• For more on eyes and diabetes, visit www.diabetes.org.uk/eyes.

balance rounds up all the latest diabetes news

Diabetes UK to invest £2.5m into diabetes care Diabetes UK has issued a research call for interventions to improve diabetes care and management, and is encouraging applications aimed at children and young people. This follows the release of the National Diabetes Paediatric Audit in June, which revealed that 85.5 per cent of people with diabetes under 25 have dangerously high blood glucose levels, putting them at increased risk of longterm complications including blindness, amputation, heart disease and kidney failure. The audit also shows that the highest proportion of people with dangerous blood glucose levels were those aged 12 to 24.

Barbara Young, Chief Executive at Diabetes UK, said: “Urgent action is needed to improve diabetes care and management for children and young people. Teenagers

{4%

have the worst diabetes control, which can partly be explained by the high rate of not attending clinic and poor transitional care from paediatric to adult services, where many are ‘lost’ in the system.

“We are seeking innovative research proposals that will specifically look into overcoming barriers to patient engagement, such as teenage non-attendance, or projects that will help patients achieve good blood glucose control. Such research projects have the potential to help health services develop care that caters for the very complex and specific needs of younger people.” i Read the National Diabetes Paediatric Audit at www.ic.nhs.uk/nda. • Turn to pages 40–41 for the diabetes care checklist. • Turn to pages 28, 34 and 54 for more features on children and young people with diabetes.

}

of 12–24 year-olds receive their basic annual health checks, including blood glucose, foot and eye checks Source: National Diabetes Paediatric Audit, 2009–2010

Join the Council Diabetes UK is seeking new members for the Council of People living with Diabetes (CPD), which helps to shape the work of the charity.

Made up of 30 people with a wide range of diabetes experience, the CPD acts as a sounding board for Diabetes UK’s Trustees and senior staff. Recent issues include what people want from the charity and the goals it should be working towards. The CPD meets four times a year and travel expenses are reimbursed. i For an information pack, email governance@diabetes. org.uk or call 020 7424 1000. Applications must be returned by 7 October 2011.

JOG ON, JOE Huge thanks to comedian Joe Pasquale, who has raised more than £8,000 running the London Marathon for Diabetes UK. Visit www.diabetes.org.uk/ running for more on the charity’s running events.

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The 15 measures 1 have your blood glucose 2 3 4 5

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What’s your score?

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Earlier this year, Diabetes UK launched Diabetes Watch (see balance issue three 2011, pages 6–7), a programme for holding the NHS to account on behalf of people with diabetes wherever it fails to deliver adequate care. The charity believes every person with diabetes, whether Type 1 or Type 2 – wherever they live in the UK – deserves the best possible treatment and services, and that there is a minimum level of care that everyone should expect. Now you can play your part in making that a reality.

On pages 40–41 you will find ‘Diabetes – what care you should receive’, a pull-out checklist outlining 15 diabetes care measures (see panel, right). There are checks that you should receive annually, together with other services that Diabetes UK believes your healthcare team should provide as and when you require them to help you manage your condition. Use the checklist to make sure you are getting all the care you need. If there are any gaps in your care, raise the issue with your diabetes healthcare team. To help double the impact, there are two copies of the checklist included. Please give the other one to anyone else you know with diabetes.

Diabetes UK wants to hear from you about the care you are receiving. So, please, either complete the online survey or write in

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(see information, below, for details). The charity can’t always follow up individual complaints, but can use this vital information to get a clearer picture of gaps in services and to lobby the NHS to improve diabetes care across the whole of the UK. Dr Gerry Rayman, Consultant Diabetologist at Ipswich NHS Trust, told balance: “Having good diabetes control is essential. It helps to let you know your risk of developing complications, and knowing you have a complication may help to stop it progressing to a more serious problem. The checklist helps people with diabetes know and keep track of the care they should be receiving and the information they need. It will empower people with diabetes to have a greater say in their diabetes care.” i To complete the survey online, please visit www.diabetes.org.uk/care-survey. Alternatively, please write to Diabetes Watch Measures, Diabetes UK, Macleod House, 10 Parkway, London NW1 7AA to share your experiences.

• To find out how to make a complaint about your care, go to www.nhs.uk. • For support and information, call the Diabetes UK Careline on 0845 120 2960. • Diabetes Care and You provides crucial, practical information on what care you should expect from the NHS and your diabetes care team. Download it for free from www.diabetes.org.uk/care-to-expect.

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levels measured annually (HbA1c test) have your blood pressure measured annually have your blood fats (cholesterol) measured annually have your eyes checked annually have your legs and feet checked annually have your kidney functions monitored annually have your weight checked annually receive support if you are a smoker receive care planning to meet your individual needs attend an education course receive paediatric care if you are a child or young person receive high-quality care if you are admitted to hospital get information and specialist care if you are planning to have a baby see specialist diabetes healthcare professionals get emotional and psychological support.

“The 15-point checklist is a great yet simple way for people to engage with their own care.

Ultimately, it will help them to improve their lives and health.

I would encourage everyone with diabetes to use it and spread the word to others.”

Sarah Ambrose Willson, Nurse Consultant in Diabetes, Homerton University Hospital

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news

have changed name to Freestyle Optium Test Strips. No coding is required on the new packs. People who use these strips do not need to change their current blood glucose meter but are being advised to check that their next prescription is for Freestyle Optium Test Strips. i Call Abbott Diabetes Care for more details on 0500 467 466.

The European Medicines Agency (EMA) has announced new guidelines for the use of a tablet to treat Type 2 diabetes, after recent studies indicated a small increased risk of developing bladder cancer.

The EMA’s Committee for Medicinal Products for Human Use (CHMP) carefully reviewed these studies and confirmed that pioglitazone (Actos) remains a valid treatment option for patients with Type 2 diabetes.

However, the CHMP concluded that pioglitazone should not be used for patients with active bladder cancer or a history of bladder cancer. Healthcare professionals are being advised to review the treatment of

NHS Shake-up The Government’s ‘pause’ in the passage of the Health and Social Care Bill through Parliament ended in June with the report of the ‘Future Forum’ to Government. The Bill was returned to Committee Stage in the House of Commons, where Diabetes UK’s Chief Executive Barbara Young gave evidence on the proposed changes. The importance of health services being joined-up for people with diabetes was highlighted, as was making sure people with the condition receive the key care processes of diabetes care.

The Bill continues its progress through Parliament with an opportunity for all MPs to debate it, and then moves to the House of Lords for further debate.

Outside Westminster, changes to the commissioning organisations continue as primary

care trusts and strategic health authorities begin to ‘cluster’ their functions under the guidance of the new NHS Commissioning Board. These organisations are designed to deliver ‘transition’ – to keep a tight control on expenditure and develop the new ‘clinical commissioning groups’, which will take over in 2013.

Diabetes UK is working in coalition with other charities on amendments to the Health and Social Care Bill, to ensure that the needs of people with diabetes are represented.

Diabetes UK is also monitoring Department of Health guidance to understand the transitional structures and emerging clinical commissioning groups, to enable the charity to advocate effectively for joined-up diabetes services.

Photo: Dr P Marazzi / SPL

Optium strips New Actos Optium Plus Test Strips recommendations patients on pioglitazone regularly to ensure that only patients who are benefiting from this drug continue using it.

Simon O’Neill, Director of Care and Advocacy Services at Diabetes UK, told balance: “If anyone taking Actos has concerns, we recommend they should not stop taking it without talking to their diabetes healthcare team first.” i If you are affected by this issue, you can contact the Diabetes UK Careline on 0845 120 2960. • Read the EMA’s full announcement at www.ema.europa.eu.

Pressure on the parties Diabetes UK will be making sure diabetes is kept high on the political agenda during the party conference season, which starts this autumn.

The charity will meet with key decisionmakers and link with other organisations to influence the policy of the main political parties, to ensure the issues affecting people with diabetes, eg the importance of diabetes specialist nurses, are heard.

Diabetes UK will also be working at each of the conferences with the lobbying organisation London Councils to highlight the importance of joined-up health and social care, and the wider benefits in cost saving to local communities and the NHS. For the first time, Diabetes UK’s Healthy Lifestyle Roadshows will be visiting the Labour and Conservative party conferences in Liverpool and Manchester to highlight the importance of reducing the number of people developing Type 2 diabetes. issue four 2011 balance

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AA tribunal

The Automobile Association (AA) has been found guilty of discrimination against an employee with Type 1 diabetes.

An Employment tribunal in Exeter unanimously found that patroller Paul Bailey, 41, was being ‘performance managed’ out of his job. Mr Bailey, a previous top performer, has been working for the AA since 1998 and, after his diabetes diagnosis in June 2009, was advised to take a more measured approach to his work. His performance subsequently dropped and he was subjected to distressing assessments, even though Mr Bailey remained an average performer within the company.

Simon O’Neill, Diabetes UK Director of Care and Advocacy, said: “We are contacted every day by people who report incidences of discrimination at work. It is unacceptable for anyone to be discriminated against because of their diabetes.” i Visit www.diabetes.org.uk/advocacy for an information pack on Employment and Diabetes. • balance will feature more on this in a future issue.

Michael Barry Former balance columnist Michael Barry has died after a short illness, aged 69. BBC2’s Food and Drink regular, Barry, who had Type 2 diabetes, shared his views with readers for five years until 2005. We send condolences to his family and friends.

Meet about medicines A free NHS service in pharmacies for those who have been newly prescribed a medicine to treat conditions such as Type 2 diabetes will help people get the maximum benefit from their medicines.

Launching in October, the New Medicine Service allows people to discuss any concerns with a pharmacist, eg side effects or what to do if you miss a dose, either over the phone or in a pharmacy consultation room for approximately 15 minutes. You will receive a telephone call a couple of weeks later (or meet at the pharmacy) to resolve any outstanding issues – or you can be referred back to your GP if you need more

help. The service is also available for people with hypertension (high blood pressure), asthma, chronic obstructive pulmonary disorder and those on medication to thin the blood.

If you are taking two or more prescribed medicines for diabetes, the NHS Medicines Use Review is another free NHS service that can help you get maximum benefit from your medicines. i Ask at your local pharmacy for more information or, your GP can refer you to your pharmacist.

Fundraising focus Julia Matthews from Leicestershire has raised £2,000 for Diabetes UK and The Prostate Cancer Charity by holding a fancy dress day and ‘waxathon’ at work, which involved many brave men getting their legs and chests waxed to raise as much money as possible. Julia, who has diabetes, also organised a quiz night abd BBQ at her local pub. She says: “I hope this will make a difference in someone’s life.”

Seven-year-old Louis Howard has raised more than £1,623 by cycling an impressive 12.5 miles with his dad and brother at the Big Bike Ride, Cannock. Louis, from Shrewsbury, was diagnosed with Type 1 diabetes last year.

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members of the Hamilton branch of Soroptimists International in South Lanarkshire have done themselves proud by raising £1,200 from a quiz night, attended by 150 people. They managed to raise so much by asking teams to pay for a joker in every round, selling clues to questions and holding a raffle.

Diabetes UK’s Glevum Voluntary Group in Gloucestershire was delighted to receive £1,200, thanks to the fundraising efforts of a local hairdressing salon.

Brother-and-sister team Daniel Gray and Anita Dallimore from Shades Hair Design completed a 10k run, held a hair-grip contest and a half-price Bank Holiday open day.

Daniel Anita and stylist Briony Overthrow wanted to mark the 10th anniversary of the salon by giving something back to the community. For more about the voluntary group, visit www.glevumvg.org.uk.

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What a Week Diabetes UK thanks everyone who contributed to its annual awareness-raising week. Many events across the UK during 12– 18 June helped to raise £97,000 (and counting) for the charity.

This year’s theme – Let’s talk diabetes – focused on people experiencing diabetes discrimination and encouraged people to not keep their condition a secret. As a result, June was the busiest month for Diabetes UK Careline calls in 10 years.

In Wales, Health Minister Lesley Griffiths launched a two-week campaign on 13 June to offer Diabetes UK’s diabetes risk score assessments in pharmacies, to assess a person’s risk of developing the condition in the next 10 years – 17,500 people attended. And Diabetes UK Cymru and 35 volunteers visited the Welsh Assembly to talk diabetes with 20 Assembly Members.

The week began in Northern Ireland with a launch in Stormont to raise awareness of the difficulties children with diabetes can have in school. More than 100 people attended, including parents and children affected by difficulties.

Conall McDevitt MLA, who sponsored the event, spoke of the need for current guidelines to be updated to take account of the increase in daily injections for children with diabetes.

Diabetes risk assessments were also offered at 11 Boots stores across Northern Ireland throughout the week.

Diabetes UK Scotland took its Live4it! roadshow to the Scottish Parliament to showcase a new project with the Edinburgh International Science Festival. It raises awareness of diabetes in schools and encourages pupils to learn about healthy lifestyle choices.

Welsh rugby players Scott Williams and Dan Lydiate in Diabetes Week T-shirts

Caring community A project between Diabetes UK South East and NHS Berkshire West has been aiming to improve the care of people with diabetes in care homes. It began with a survey to assess the training needs of staff in the area, followed by a meeting with care home managers to discuss real needs and issues. Two one-day training courses for staff were held, a resource pack for both staff and residents was produced, and training for chefs and catering staff was provided. It is now hoped that the successful project will be repeated in other areas. i Information for carers and care homes: www.diabetes.org.uk/carehomes.

PUMPING TREND Staff from NHS Lothian, Edinburgh Napier University and The Funky Fone Sox Company Limited have launched a not-for-profit company selling insulin pump covers.

Proceeds from the sales are reinvested in the Metabolic Clinic at the Western General Hospital in Edinburgh. Money raised will be used to help support diabetes care and research, including funding research into lifestyle issues when using an insulin pump.

The covers help to stop rubbing on the skin and come in a wide variety of styles, so there’s something to suit everyone. i Take a look at the designs and find out more at www.ipsox.co.uk.

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CONTRAINDICATIONS: The CGM sensor and transmitter must be removed prior to magnetic resonance imaging (MRI). Use of acetaminophen-containing medications while the CGM sensor is inserted may affect the performance of the CGM system.

WARNINGS: The CGM system is not designed to replace a blood glucose meter. The CGM system must be used with a blood glucose meter. You must take a fingerstick test with your BG meter and use that BG value to make any insulin or treatment decisions. Insulin dosing decisions should not be based solely on results from the CGM system. Symptoms related to low or high blood glucose levels should not be ignored. If you have symptoms of low or high glucose, use your blood glucose meter to check the CGM results. You should update the CGM system’s calibration every 12 hours at a minimum. CGM sensors may fracture on rare occasions. If a CGM sensor breaks and no portion of it is visible above the skin, DO NOT attempt to remove it. Seek professional medical help if you have symptoms of infection or inflammation—redness, swelling or pain—at the injection site. If you experience a broken CGM sensor, report this to Customer Support or your local Animas distributor.

CGM is NOT APPROVED for use in children or adolescents, pregnant women or persons on dialysis. The safety and effectiveness of the CGM system has not been evaluated for sensor probe insertion sites other than the abdomen.

For important safety information about pump therapy and use of the Animas Vibe insulin pump, please consult your healthcare provider and the Animas Vibe Owner’s Booklet. ®

®

Find out more at animascorp.co.uk.

™

™

Contact Animas at 0800 055 6606 (UK) or 1800 812 715 (Ireland) or visit www.animascorp.co.uk for detailed indications for use and safety information.

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31/08/2011 12:30

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IN YOUR AREA North West England

Ambassador Scheme Diabetes UK North West has launched a volunteering project that is going from strength to strength. The Ambassador Scheme involves recruiting, training and supporting volunteers to go out and deliver awareness presentations, attend events and work with local communities. Volunteer Development Officer, Jo Cunnuh, who is leading the project, told balance: “We have six ambassadors and they’ve attended more than 18 events. We’re very proud of the Scheme – the possibilities are endless.”

The North West office is holding additional recruitment and selection days in September and January, and is hoping to achieve a total of around 35 Ambassadors by the end of 2012. For more details, call Diabetes UK North West on 01925 653281.

Shoot up or put up!

Former Diabetes UK board member Alison Finney writes a blog about diabetes – www.shootuporputup.co.uk – taking a well-informed but light-hearted look at life with the condition. Alison, who lives near St Helens, has spent some of her favourite diabetes-related time speaking at the North West’s Family Weekends about what it’s like to live with the condition, and has had diabetes since she was 4.

Roadshows

EVENTS

WIRRAL Hamilton Square, 8 and 9 September.

MANCHESTER Albert Square, 19 and 20 September.

OLDHAM Market Place, 4 and 5 October.

Family Support Weekend, Altrincham, 23–25 September 2011. For more details, visit www.diabetes. org.uk/careevents or email careevents@diabetes.org.uk.

• Turn to page 34 for more on Diabetes UK Holidays.

Liverpool Marathon, 9 October 2011. 12,000 runners take to Liverpool’s streets, and actress Suzanne Collins is running for Diabetes UK. Call Diabetes UK North West on 01925 644572 or visit www.runliverpoolmarathon. co.uk for more details.

Next time: The Midlands. Send inspiring stories of care, fundrasing & events to balance@diabetes.org.uk.

Home insurance discount Diabetes UK Insurance Services is offering a 25 per cent discount on home insurance premiums in September. Insurance specialists for those living with diabetes, other pre-existing medical conditions and disabilities, the company provides no-obligation quotations and a friendly and experienced team on-hand to answer any queries. The offer is for new customers only, subject to a minimum premium of £138 and underwriting criteria. i Call 0800 731 7431, quoting ‘pro’, or email diabetes@heathlambert.com.

14 balance

UK DIARY 25 SEPTEMBER 1-Mile Swim, Llyn Tegid, Bala Registration is free, but swimmers must be aged 15 or over and wear a wetsuit to take part.

Diabetes UK Cymru: 029 2066 8276 or visit www.diabetes.org.uk/wales.

23 OCTOBER Avon Gorge Abseil, Bristol Entry fee is £12 per person (must be over 14 years old to take part).

Diabetes UK South West: 01823 448260 or visit www.diabetes.org.uk/avongorgeabseil.

29 OCTOBER Halloween Disco, Whitchurch Rugby Club, Cardiff 8pm–12am. Guests are welcome to wear Halloween fancy dress and will be treated to spooky-themed music. Tickets cost £5.

Diabetes UK Cymru: 029 2066 8276 or email wales@diabetes.org.uk.

Ba

Re

29 OCTOBER Halloween Ball, The Derek Randall Suite, Nottinghamshire Country Cricket Ground 7pm–1am. Drinks reception and threecourse meal. Entertainment includes an auction, raffle, magician, music and dancing.

Dress code is smart attire and seasonal accessories are optional. Tickets cost £45.

Diabetes UK East Midlands: 01922 614500 or email midlands@diabetes.org.uk.

20 NOVEMBER Taunton Santa Dash (1.5 miles) The town’s first ever Santa Dash to raise sponsorship for Diabetes UK Children’s Care Support Events. Entry is £8 for adults and £3 for children (8 years and under).

All participants will receive a free Santa suit.

Diabetes UK South West: 01823 448260 or email www.diabetes.org.uk/santaintaunton.

ROM

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BAT BLA BRI CAR CAT DEW HEN LET

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ROM ST. SOU STO

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31/08/2011 12:30

they say, we say Thinking about stopping your daily aspirin? Think it’s safe to eat as much salt as you like?

Read on, as balance clears up some of the mixed messages that have appeared in recent news

Salt: do we need a limit?

They say…

We say…

In July, The Daily Express declared: ‘Salt is safe to eat – and cutting our daily intake does nothing to lower the risk of suffering from heart disease, research shows.’

For years, the article went on, doctors have been ‘telling us that too much salt is bad’, with the National Institute for Health and Clinical Excellence calling for average daily adult intake to be cut to 6g by 2015 and 3g by 2025 to prevent heart disease and stroke.

Now, however, Professor Rod Taylor and his team at the University of Exeter, in a review of seven studies looking at 6,489 people, ‘could not find enough evidence for the theory’. Prof Taylor is calling for ‘health professionals to find more effective ways of reducing salt intake that are practical and inexpensive’, adding that it’s ‘really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake’.

The Daily Express reported on this research with the headline ’Now salt is safe to eat’. The benefits for blood pressure of reducing the amount of salt in our diet are well established, so this research focused on whether salt reduction is associated with fewer deaths and reduced rates of cardiovascular disease (heart attack and stroke).

The Express’s headline is puzzling and misleading, because the results of the study in question suggested, in fact, that there was not enough information to understand the effect of reducing salt intake on either death rates or cardiovascular disease, and not that ‘salt is safe to eat’.

One of the researchers has called for further study in this area, suggesting that they would need to look at data from at least 18,000 people before they could identify any clear effects.

Diabetes UK, meanwhile, continues to advise all adults to reduce salt in their diet, limiting their intake to 6g a day.

Now salt is safe to eat The Daily Express’s somewhat misleading headline

16 balance

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they say, we say

Aspirin: worth the risk?

They say…

We say…

In late July, BBC News reported that, against medical advice, up to half of all people prescribed daily aspirin to protect against cardiovascular disease (heart attack and stroke) stop taking it. This may be because, in the past couple of years, there have been mixed messages around the drug, with suggestions from some quarters that its side effects (including bleeding ulcers) might outweigh the benefits.

The findings, reported in the British Medical Journal, come from a UK database of nearly 40,000 patients prescribed the drug. In a one-year period, for every 1,000 patients, there were about four extra cases of nonfatal heart attack among those who had recently stopped taking low-dose aspirin compared with those who continued taking it.

Ellen Mason of the British Heart Foundation was quoted in the item as saying: “If you’ve had a heart attack then stopping taking your aspirin increases your risk of having another heart attack and this can result in permanent damage to your heart. Don’t simply stop taking your meds, always talk to your doctor first.”

This research, which used data from UK patients, showed those who stopped taking their prescription of aspirin had a 63 per cent increased risk of having a non-fatal heart attack compared to those who continued taking it.

The research also suggests that the increased risk was higher in those patients who simply stopped taking their aspirin as prescribed or switched to another treatment, but not in those who stopped over safety concerns or because they switched to taking aspirin bought over the counter.

While this particular element of the research, looking specifically at who might be at increased risk of non-fatal heart attack, is interesting, the results should be interpreted with caution, because it is based on small numbers, which makes it difficult to draw any firm conclusions. Also, it doesn’t tell us why some people stop taking their prescription. Why people do so is an issue that needs further investigation.

In the meantime, because cardiovascular disease is a major diabetic complication, Diabetes UK recommends that people with diabetes with established cardiovascular disease be offered aspirin treatment, and that those currently prescribed aspirin should not stop taking it without first speaking to their diabetes healthcare team.

For every 1,000 patients, there were about four extra cases of non-fatal heart attack among those who had recently stopped taking low-dose aspirin.

BBC News reporting findings from the British Medical Journal

issue four 2011 balance 17 16-17 TSWSkf3.indd 17

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research matters CAN DIET ALONE REVERSE TYPE 2?

Research funded by Diabetes UK and carried out by a team from Newcastle University has discovered that, in a small group of people, Type 2 diabetes can be reversed by an extremely low-calorie diet alone.

In an early stage clinical trial, all 11 participants reversed their diabetes by drastically cutting their food intake to just 600 calories a day for two months. Three months later, seven remained free of diabetes.

The study was led by Professor Roy Taylor of Newcastle University, Director of the Newcastle Magnetic Resonance Centre, who said: “To have people free of diabetes after years with the condition is remarkable – and all because of an eight-week diet. This is a radical change in understanding Type 2 diabetes. It will change how we can explain it to people newly diagnosed with the condition. While it has long been believed that someone with Type 2 diabetes will always have the disease, and that it will steadily get worse, we have shown that we can reverse the condition.”

Under close supervision by a medical team, the participants’ diet consisted of liquid-diet drinks and non-starchy vegetables. They were matched to a control group of people without diabetes and monitored over eight weeks, during which time pancreatic insulin production and liver fat content were studied. After just one week, the Newcastle University team found that participants’ pre-breakfast blood glucose levels had returned to normal.

A special MRI scan of their pancreases revealed that the fat levels in the pancreas had returned from an elevated level (8 per cent) to a normal level (6 per cent).

In step with this, the pancreas regained its normal ability

18 balance

A two-month diet of non-starchy vegetables and liquid-diet drinks has been found to reverse Type 2 diabetes – but is it sustainable? to make insulin; as a result, blood glucose levels after meals steadily improved.

The volunteers went back to eating normally and received advice on portion size and healthy eating.

Dr Iain Frame, Director of Research at Diabetes UK, said: “We welcome the results of this research because it shows that Type 2 diabetes can be reversed, on a par with successful surgery without the side effects.

“However, this diet is not an easy fix and Diabetes UK strongly recommends that such a drastic diet should only be undertaken under close medical supervision.

Despite being a very small trial, we look forward to future results, particularly to see whether the reversal is sustained long term.”

Diabetes UK is keen to note that, while encouraging, this is an advance in the understanding of the nature of Type 2 diabetes rather than a clinical trial of a treatment at this stage. People with diabetes who want to lose weight should consult their diabetes healthcare team before undertaking any eating plan, and read Diabetes UK’s information on how safe dieting can help manage diabetes (see below). i www.diabetes.org.uk/managing_your_weight.

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31/08/2011 12:26

Diabetes UK’s specialist research magazine Research matters has now been incorporated into balance and replaces our ‘research round-up’ section

Take part in research

Reducing risk of DKA at diagnosis Many children have diabetic ketoacidosis (DKA) when they are diagnosed with Type 1 diabetes, which can, if left untreated, lead to fatal coma.

Researchers at the University of Cambridge reviewed 46 research studies involving more than 24,000 children from 31 countries, which suggested that the lower the age of the child at diagnosis, previous infection, lower body mass index and being from an ethnic minority group all increased the risk of DKA at diagnosis. Factors that reduced the risk included having a first-degree relative with Type 1 diabetes, higher levels of parental education and a higher rate of Type 1 diabetes in the surrounding area.

The research, published in the British Medical Journal in July, suggests that while there are many factors associated with the risk of DKA at the time of Type 1 diagnosis, awareness of the early symptoms could be key to preventing it or reducing the risk of onset.

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Of the annual NHS drugs bill is now spent on diabetes medication Source: NHS Information Centre

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P eople over 18 with impaired glucose tolerance and a body mass index of 25–35 are wanted in the London area for a Diabetes UK-funded clinical trial investigating whether a fermentable carbohydrate fibre supplement can prevent progression to Type 2 diabetes.

Contact Nicola Guess at Hammersmith Hospital; call 07951 252 395 or email n.guess10@imperial.ac.uk.

R esearchers in the Reading area are looking for males aged 18–35 with Type 1 diabetes to undertake eye and blood glucose tests on several occasions to help develop a meter that measures blood glucose through a low-powered beam of light into the eye rather than with a finger-pricking device.

Contact Jan Luff at the University of Reading; call 0118 378 7771 or email j.e.luff@reading. ac.uk. i For more information, and news of other opportunities, visit www.diabetes.org.uk/diabetesresearch-trial-opportunities.

‘Lean gene’ increases risk of Type 2 and heart disease Having a leaner body may not lower a person’s risk of Type 2 diabetes and heart disease, according to a Medical Research Council study.

The study, published in Nature Genetics in June, examined data on more than 75,000 people, looking for the genes that determine body fat percentage.

The researchers found that the gene IRS1 is linked with having less body fat. On further investigation, they found that

this gene also leads to having unhealthy levels of cholesterol and glucose in the blood, especially in men.

To understand why a gene linked with being lean carried an increased risk of Type 2 diabetes, the team of international scientists looked at body fat distribution in people with the gene. They found that the gene only reduces the fat under the skin, not the more harmful fat surrounding the organs.

Dr Iain Frame, Director of Research at Diabetes UK, said: “This robust study, with further investigation, could shed light on why 20 per cent of people with Type 2 have it despite being a healthy weight.

“It is also clear that people who appear slim should not be complacent about their health. Eating well and being more active are the most effective ways of reducing the risk of developing Type 2 diabetes.” issue four 2011 balance 19

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research matters: new grants

Unlocking the secrets of C-peptide When insulin is produced in the pancreas, it is bound to an extra molecule called C-peptide, which helps the developing insulin molecule assemble itself in the correct way. C-peptide is then removed from the insulin molecule and eventually released into the bloodstream at the same time as insulin, and in equal amounts.

When C-peptide was first discovered, researchers were interested in it because it was a good indication of how much insulin someone was secreting. There has been much speculation, however, over whether C-peptide has biological functions of its own. A growing body of evidence now suggests that it does, and specifically that it is important in glucose control and protecting against complications.

In this project, Professor Nigel Brunskill aims to find the ‘holy grail’ of C-peptide by identifying which proteins it binds to within cells. If successful, this research could be the first to reveal the secrets of C-peptide in diabetes and open up entirely new approaches to improving diabetes control and protecting against complications. It could be possible, for instance, to add C-peptide to insulin treatments if it was shown to benefit people with diabetes.

Prof Nigel Brunskill of the University of Leicester; £223,635.62; three-year Project Grant.

Equipping the immune system for prevention A major goal of diabetes research is to prevent the immune system attacking and destroying the insulin-producing beta cells, causing Type 1 diabetes. Research has shown that protecting even a small fraction of beta cells in Type 1 can help to improve blood glucose control and reduce complications. Unfortunately, current experimental treatments to prevent Type 1 often block a wide range of immune functions, making them dangerous in the long term.

In people without Type 1, the diabetes-causing immune cells are kept in check by another type of immune cell known as T-regs. Research looking at animal models of diabetes has demonstrated that it is possible to prevent or even reverse Type 1 using T-reg cells that have been grown and enhanced in a laboratory.

With funding from Diabetes UK, Dr Tim Tree will supervise a PhD student to harness natural populations of T-reg cells from people with diabetes, with the aim of reprogramming them to be more powerful at preventing islet destruction.

This exciting research has the potential to lead to a safe, powerful and longlasting approach to preventing and reversing Type 1.

Dr Timothy Tree of King’s College London; £90,600; three-year PhD Studentship. i For more new grants, go to www.diabetes.org.uk/research-grants.

20 balance

MOTHER, FATHER AND BABY Professor David Dunger’s team hopes to find associations between mothers’ glucose concentrations in pregnancy and the genes that offspring have inherited from their fathers.

This could help to identify additional potential risk factors for gestational diabetes and help scientists develop new treatments.

Prof David Dunger of the University of Cambridge; £121,153; 12-month Project Grant.

EARLY ETHNIC DIFFERENCES IN TYPE 2 RISK Professor Peter Whincup aims to identify the factors during pregnancy and early life that contribute to the greater risk that people of South Asian or African-Caribbean origin face of developing Type 2 diabetes.

Prof Peter Whincup of St George’s Hospital; £70,324; 12-month Project Grant.

NEUROPATHY PAIN RELIEF Dr Lucy Donaldson aims to find out as much as possible about the effects of the molecule VEGF165b, which is a potentially safer version of a drug currently being tested to treat neuropathy in diabetes.

Dr Lucy Donaldson of the University of Bristol; £183,331; three-year Project Grant.

EARLIER SIGNS OF KIDNEY DAMAGE This study will measure levels of proteins called polyclonal free light chains (PFLCs) in the urine, with the aim of identifying an earlier indicator of kidney damage.

Dr Marie Parsons of Colchester Hospital University NHS Foundation Trust; £5,915; 18-month Small Grant.

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research matters: people in research

Martin Lodemore The Diabetes Research Network gives people with diabetes the opportunity to become involved in shaping diabetes research.

Martin Lodemore encourages everyone to take part

W

orking closely with the research community, the Diabetes Research Network (DRN), based at Imperial College in London, exists to encourage high-quality clinical research throughout the UK, and to make sure that effective treatments make their way to people with diabetes as quickly as possible.

Martin Lodemore joined the DRN as Patient and Public Liaison Officer shortly after the organisation was established in 2005. Having previously worked in adult education and as a research administrator with the Diabetes, Endocrinology and Metabolism team at Imperial College, Martin now helps people with diabetes, and their parents and carers, to become involved in shaping the UK’s diabetes research agenda.

“People living with diabetes have a unique insight into their condition, which they can use to help push important issues higher up the research agenda,” Martin explains. “But it’s not always about the bigger picture. The patient perspective can also help to improve the design of clinical trials – from the wording that researchers use to explain trials to participants, to interpreting the results and getting them out to a wide audience. Researchers and patients discussing these details in the same room can have powerful outcomes.”

So how exactly does the process work? “It varies enormously from week to week. We have a number of national and regional lay panels, as well as online groups, which respond to requests from researchers looking for patient and carer input into research proposals. I might ask our ‘online reference panel’ of around 20 people with diabetes, or one of the local network groups, to comment. They’ll look through proposals and study designs, suggesting tweaks to make sure the research really will benefit people with diabetes. Sometimes the panels

even end up influencing the fundamental questions researchers are trying to answer.”

To help raise awareness of diabetes research and make contact with people wanting to get involved, Martin often speaks at Diabetes UK voluntary group meetings about the DRN and the opportunities it offers. “The groups are always really keen about research and getting involved,” he says. “Those meetings spur me on for weeks afterwards.”

Sometimes the panels even end up influencing the fundamental questions researchers are trying to answer Does he, though, ever encounter obstacles?

“One of the biggest challenges we’re facing is making sure that people from Black, Asian and minority ethnic communities have their say in research. We need to tailor our approach, so we recently sent out a questionnaire in North East London to find out how people in South Asian communities feel about research, and got more than 500 responses. One of the main findings was that people prefer to discuss research face to face, rather than read about it in written materials. So, we’re hoping to follow Diabetes UK’s strategy and identify some Community Champions, volunteers representing Black, Asian and minority ethnic communities, who might use their community links to help us raise awareness of diabetes research.

“Another challenge is that although people with diabetes tend to be very enthusiastic about research, the research community isn’t always aware that this is the case. The DRN helps to make that connection, which can come as a pleasant surprise.” i To find out more about the DRN, and to get involved, visit www.ukdrn.org.uk or www.diabetesresearchnetworking.org. issue four 2011 balance 21

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your views

01 The Cover KF3

23/5/11

11:13

Page 1

balance Your diabetes lifestyle magazine • issue three 2011 • £3.95

The artificial pancreas

LET’S TALK IT OVER

STAR LETTER I know, but…

7.30am Blood glucose 13.8mmol/l. Oops. Small correction dose from pump.

8.30am Time for delicious first cup of coffee of the day.

8.32am Milk sour. Never mind. Sun is shining. Will go to the village for milk.

9am Blood glucose 4.1mmol/l. Bit low for a walk. Eat apple and yogurt. Reduce basal rate to 25 per cent.

10am Blood glucose 5mmol/l. Still too low pre-exercise. Black coffee with sugar.

10.30am Blood glucose 4.9mmol/l. Oh, come on!

11am Blood glucose 8.6mmol/l. That’s better. Tell dog we are going for ‘walkies’.

11.01am Sky black. Monsoon rain falling.

11.30am Blood glucose 12.2mmol/l. What to do?

12pm Sun shining again. Dog on lead, grab meter and jelly babies. To the shops.

12.30pm Village shop has no milk. In desperation, buy dried.

12.45pm Caught in thunderstorm on way home again. Soaked through.

1.10pm Kettle on. Blood glucose 13.8mmol/l. Small correction dose from pump…

Déjà vu?

1.15pm Husband arrives home early and asks if I’ve had a productive morning.

He has bought milk!

I know worse things happen at sea. I know if you have to have a condition, diabetes is the one to have. I know that life with diabetes can be fulfilling, happy and wonderful, but there are days…

Gillian York, via email

22 balance

In defence of GPs

Needless new needles?

Columnist Andrew Fenner’s contentions that some GPs are ‘rejects from the hospital system’ and that ‘the top doctors stay in hospitals’ (‘Why not get everyone working together?’, balance issue three 2011) fly in the face of all reality. GPs are doctors who choose to follow rigorous, lengthy and robust training to qualify in their chosen field. They are not rejected by the hospital system once they’ve finished their training – rather, they have chosen a different clinical context. Those who remain in hospitals are not better doctors than those who choose to be GPs. Bill Rea, via email

Dawn Thornley complained that she had to push for her right to have unlimited supplies of needles for her 16-year-old son (‘Prescription restrictions?’, Your views, balance issue three 2011).

But is it really necessary to use a new needle every time? This also applies to the lancets used for the blood sample. Of course, all the manufacturers insist that a new one must be used every time, for they will sell more.

I have multi-used needles and lancets for the last 11 years with no adverse effects, and my original diabetic nurse said this was fine.

We diabetics must remember that we cost the NHS a lot –

THE NEXT BEST THING TO A CURE

Why ignoring your diabetes can damage your health

SUMMER SOUPS

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How to care for them and the treatment available

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When doctors get it wrong

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balance Diabetes UK 10 Parkway London NW1 7AA balance@diabetes.org.uk Please state if you would like an acknowledgement. Letters may be edited and may appear on the Diabetes UK website.

The views expressed on these pages are those of readers.

The writer of the balance star letter wins a £50 book token thanks to our friends at Heath Lambert, which provides insurance services on behalf of Diabetes UK.

multi-using needles is just a small way of reducing this cost.

Peter Edwards, via email Editor’s note: Diabetes UK is aware that people do use needles for more than one injection, but they are recommended for single use only. Very fine needles may blunt more quickly and re-using them may cause injections to be more painful and increase the risk of the needle bending and breaking.

A miseducation Our son was diagnosed with Type 1 diabetes three years ago, aged 9, and we quickly became aware how important education and awareness of the condition is.

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your views

I was pleased when helping my daughter with her revision for her science GCSE to see that diabetes is covered. However, I was dismayed when reading her textbook (AQA Additional Science) to see that Type 1 and Type 2 diabetes and the causes of the condition are not mentioned. Instead, it talks about ‘a mild form’, which involves ‘managing your diet to keep you healthy, avoiding carbohydraterich foods’ and ‘other people with diabetes need replacement insulin’.

How frustrating that such an opportunity to educate people results in misinformation.

Francesca and Max Higdon, via email

Quiz master woes I organised a quiz evening for Diabetes UK in Letchworth Garden City in June. I did all the promotional work – posters, letters to my MP, local shops, the media, etc and collected 10 raffle prizes from local shops and organisations. I sold just 30 tickets in total, with no one from the local diabetes support group attending.

They have a membership of about 30. I went to one of their meetings in May to publicise the quiz and I find it bizarre when those we are trying to help don’t give their support. I intend on doing another quiz and would be interested to hear other people’s tips.

Pauline Stilges, via email

Let’s help ourselves There is no doubt that tremendous work is done by professionals and volunteers to assist diabetics, and a considerable depth of support is

Pen problems – and solutions My wife has had Type 1 for about 50 years and, until recently, had been using the Sanofi prefilled pen with Lantus insulin. This was then replaced by the SoloStar pen, which my wife has been using for some weeks. The designers seem to have forgotten the basic requirement of the instrument as a vehicle for dispensing the insulin in a manner that is most convenient to the user. The dose has to be fully drawn-up every day – an unnecessary chore compared to the pre-set facility on the old pen. The pen is graduated in single units, which seems unnecessary with the large doses involved, and the graduation marker on the barrel of the pen is virtually invisible.

The designers also seem to have forgotten that the majority of diabetics are over 45 and, like the rest of us, their eyesight is not what it used to be.

I view the SoloStar as considerably inferior to the pen it has replaced.

Bill Douglas, via email I have had no trouble using conventional vials and syringes over the last 20 years. When my arthritis worsened, I hardly noticed any problem in holding the syringe and depressing the plunger, due to the two finger lugs on the syringes. Why did the manufacturers of modern insulin pens decide to omit such finger trigger points from the new devices?

Being a yachtsman, I wondered if a dinghy fitting could be adapted and fixed to the insulin pen to act as finger lugs. After some thought, I found just the thing – a pair of deck clips – and now my reusable pen is much easier to use. If anyone has similar problems and would like help, you can contact me on an email address I have created for this purpose: pen.boshier@btinternet.com.

John Boshier, via email

available. There are also excellent suggestions in balance. Despite this, I do feel that we diabetics could do more to help ourselves.

All too frequently one reads of people complaining about a lack of resources and appealing for Government funds, which we provide as taxpayers. Yet I frequently meet diabetics who ignore most of the advice given to them, eat whatever they like, drink to excess and take little or

no exercise. These people are the first to complain if the services that they will certainly require as a result of their foolishness are not available. We all need to take care of our health ourselves.

Colin Hasson, via email

Ear’s the answer?

In response to Janet from Aberystwyth (‘Testing is a pain’, Ask Karen, balance issue two 2011), who says her 10-year-old niece

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your views

» has very sore fingers from blood

Testing, testing The testing supplement (Testing, testing) sent out with balance issue three 2011 was interesting. However, I wonder if meter manufacturers attend to the concerns of their potential customers. They seem to compete lavishly to see which meter can produce the fastest result, use the least amount of blood, be the smallest, or have the best method to dispense the strips. They compete on warranties, batteries, cases and ways to record results.

Why, then, can’t they listen to users who would like to be able to use open-source software? All that I have seen require a Microsoft PC or, latterly, a Mac. It should not be beyond their ability to increase the availability of record-keeping software.

Lawrence Johnston, via email I tested twice daily, for 12 months, and modified my diet to try to reduce weight. I found the discipline of daily testing helped me develop a sense of what raised my blood glucose levels, and what I could still eat and enjoy yet keep my levels under control. Over a year, I lost about 19lb, bringing my body mass index down to only just over the magic score of 25.

However, the medical authority made the decision that people with Type 2 diabetes should no longer get test strips or lancets on repeat prescription, due to costs. With my GP’s support I do get prescriptions to enable me to test two days a week, but not repeat prescriptions. Sadly my weight has crept back up, and my levels are not quite so well controlled as when I was testing daily.

Derek G Corner, via email

Blogs, tweets & posts www.facebook.com/diabetesuk

http://twitter.com/diabetesuk

“For a blissful moment I’d forgotten I was diabetic and was about to leave the house without a bag. Oops. Back to reality!”

Emma Starr, via the Diabetes UK Facebook page “Daughter says there are two good things about having diabetes: glucose tablets and going on @DiabetesUK holidays.”

Angela Coles, via Twitter (see page 34 for more on Diabetes UK Holidays) “If someone was watching me having a hypo and didn’t know I was diabetic, what on earth would they think?!”

Daisy Shaw, via her first blog post for Diabetes UK, at www.diabetes.org.uk/hypo-superhero

24 balance

tests, I have the answer: ear lobes.

In nearly 50 years of Type 1, I have never pricked my finger, and my hospital notes state that ear lobes are to be used for my blood sugar tests. Although this takes a little bit of practice, I can vouch for it. The fleshy part towards the bottom of the ear lobe is the best site, and what’s more, ear lobes are a virtually pain-free area.

Bridget Edwards, via email Editor’s note: The ear lobes are indeed an alternative site for testing – very well provided with blood – but this site is mainly used in hospitals, as it’s not easy to use yourself. The usual alternative site is the back of the forearm, and some meter companies can provide an adapter with the lancet to make testing easier.

Lessons learnt My husband Philip was diagnosed with Type 2 diabetes in the mid1990s and was put on medication a few years later.

In early 2006, Philip became frighteningly anaemic and his stools contained blood. He had tests for bowel cancer but they came back negative. The anaemia continued and tests found no cause.

Then, in January 2009, Philip lost 7lb in one week. Tests confirmed he had bowel cancer, which had spread to his liver and lungs. My beloved husband died in December 2009 after months of misery.

Philip’s father had Type 2, and his mother later said that her father had also had diabetes, ‘but we don’t mention it’.

Lessons I have learnt: • Tell your children if there is diabetes in the family. Give them the chance to choose healthy living

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SoundBites

Let’s remove the stigma I recently had to start taking my insulin at work just before lunch, but the couple of people I sat with suggested that I should go to the toilets to inject. They said they didn’t want to see blood and that they could pick up germs. Does anyone else have problems like this?

Also, because I am Type 2 and underweight, I have had several people say to me that it doesn’t look like I have diabetes. The media always mentions that if you are overweight you have a good chance of getting Type 2, but there are still 20 per cent of us who have Type 2 who are either ‘normal’ or underweight.

Pamela Hanson, via email It came as no surprise to me that there are an estimated 1 million people with diabetes who don’t tell people about it. When I was diagnosed with Type 2 diabetes, I had a body mass index of 19 (almost underweight). I have always taken regular exercise and had a good diet. The first person I told about my diabetes replied: ‘Oh, that is the disease for fat and lazy people,’ and looked at me as though I must have done something really wrong. My mother advised me that I’d certainly not got it from her side of the family and implied that I must tell no one who knows her (oh, the stigma of having a diabetic daughter!). The leader of the staff representative group at work included the fact that I had got ‘it’ in a meeting, and everyone treated me as if I was dreadful afterwards. I changed jobs.

Will I be tempted to talk about my condition openly again? No, I won’t, not until there is some compassion and attitudes change.

Karen Rigg, via email Responding to Katie’s fears about letting her university friends know about her diabetes (‘Scared at uni’, Ask Karen, balance issue three 2011), I would like to reinforce Karen’s advice that there should be nothing to fear and much to gain. Adults are generally very sensible about people’s medical conditions, and I can assure you that in my years at university and subsequent career, I have encountered no problems. People are always understanding and often interested to know more.

Andrew Nash, via email

options and recognise the disease at an early stage, when it can be controlled by their own behaviour.

• If you develop diabetes, take control and learn about it. Don’t rely on your GP and demand to be referred to a hospital diabetes clinic.

• If you suffer odd symptoms, insist on a second opinion; side

effects of medication can mask other problems, and if test results are ambiguous, request more tests.

• Finally, don’t rely on your spouse/ partner to nag you about your health or blame them if they do.

You may then, unlike my husband, live beyond the age of 64.

Diana Carpenter, via email

“I haven’t seen an insulin pump, I’m never going to have one, but a lot of people do have them – why not me?”

Tracy Brily, Wincanton, describes the diabetes care she receives as ‘hopeless’ “The York District Diabetes Group is always looking for new members. To find out more about the group, please email yorkdiabetes@hotmail.co.uk.”

Keith Chapman, committee member, via email “It would be helpful if the Department of Health could be persuaded to issue a note to all GP practices, informing them that Charcot’s foot is regularly misdiagnosed, as it was with me, leading to potentially serious consequences.”

Roger Thomas, Nottingham, identified with Keith Hardcastle’s experience of medical negligence (‘Legal aid’, balance issue three 2011) .

“I too am limited to Slimline tonic while non-diabetic friends can enjoy a selection of J2Os, etc. Even the new ‘lighter’ versions would necessitate taking extra insulin to compensate.”

Gill Maltby, via email, agrees with Esther Hill (‘Sound Bites’, balance issue three 2011) “My wife and I recently stayed at a four-star hotel in Spain and had to pay a further €20 (£17.40) for the room’s refridgerator to be turned on for my insulin, despite us explaining I required it for medical purposes. Check before you book.”

R New, via email issue four 2011 balance 25

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columnists

Family matters with Patricia Debney

I

As Eliot finds the confidence to open up about his diabetes, Patricia reflects on life’s lessons

t was teenage school-trip time before the summer holidays arrived: in six weeks Eliot completed his Duke of Edinburgh (D of E) Bronze expedition, flew to Northern Ireland (first flight since diagnosis!) for a three-day history trip and went by coach on a week’s music tour to Italy.

I’ve seen a change in Eliot, probably as a consequence of the D of E weekend, where the guide made his group responsible for reminding Eliot to test frequently.

At first embarrassed, Eliot soon acknowledged that actually it seemed to clear the air. On the same expedition he took responsibility for administering antihistamine eye drops to two friends suffering badly with hay fever. Lesson one: people want to look after each other and be looked after.

Following the D of E expedition, I assured the teachers on the history trip that they should have no qualms about ‘checking in’ with Eliot openly and regularly. It can’t be unrelated that when he forgot to take insulin at breakfast one morning, he let one of them know straight away. Of course he knew how to recover – but a year ago he would have kept the brief crisis to himself. Lesson two: it helps to communicate, and not to hide.

The Italy music trip was more complex: many hours from Englishspeaking expertise, in high heat, with no knowledge of Italian, there were too many things that could go badly wrong, too many unknowns.

26 balance

Lesson two: it helps to communicate, and not to hide

It turned out that Eliot’s friend, T, also Type 1, wanted to go as well.

A compromise was struck: I would chaperone and try hard to stay out of their way.

There were numerous ‘Type 1 moments’ in the week: T’s Lucozade falling out of his pocket on a gigantic water slide – which had to be shut down while they looked for it; Eliot unwittingly performing an entire concert while hypo; Eliot waking one morning to find his pump on the floor; and me shaking an exhausted T from a heavy sleep on the bus in the middle of the night, slightly panicked about when he last tested… Oh dear.

Both boys dealt with the vagaries of diabetes in an unfamiliar situation with real integrity. We stayed in communication through conversation or texts, and both came to me with any comment or concern. This openness made the whole tour manageable: I could keep my distance, and they could live their lives.

Predictably, the only disaster was completely unpredictable: on the way back to the UK, the insulin stored in the coach refrigerator actually froze.

Having been just fine the whole way there. Fortunately, we were home.

Lesson three: resign yourself to the unexpected and unplanned.

What matters is what you do next. i Patricia is an author and a senior lecturer in Creative Writing at the University of Kent. Visit her blog: www.wavingdrowning.wordpress.com.

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A means to an end Andrew Fenner Not a good precedent, perhaps, but anyway: as I get older (I’ve just turned 62), I find myself thinking increasingly about how I plan to spend the rest of my life as far as I can.

Ideally, this will involve travelling, exploring and going ‘beyond the horizon’. Things I emphatically don’t want to do are: painting, gardening, ‘pottering’, ballroom dancing, line dancing, exercise classes or sitting around in some home for the elderly watching daytime TV. There is a difference between living and merely not being dead.

Diabetes is a disease of numbers: like driving a car, or flying a plane, it’s about watching the dashboard or ‘flying right’. To extend the analogy, though, that car or plane is, presumably, going somewhere – if it wasn’t, the dials and gauges would be motionless, and irrelevant.

Controlling diabetes is a means to an end (living), not an end in itself. I want to control my diabetes, not be controlled by it or rebel against it.

I sometimes suspect there’s a kind of ‘polling circuit’ in us, which goes round every so often and asks, ‘Are we feeling good?

Do we feel like there’s a point to life?’ If the answer is ‘yes’, we are more likely to carry on; if ‘no’, that’s when problems could arise. i Andrew has Type 2 diabetes.

Happy talk Sue Marshall I recently had the opportunity to sit in a room and chat with five other people with Type 1 diabetes – all of us were on pumps. It was a very interesting and stimulating conversation. We’d been asked by the hospital we attend to answer various questions and give feedback on our diabetes clinic to help them shape services for the future.

I once knew a girl in London who was from New Zealand and she said it was odd that people would always tell her if they came across another ‘Kiwi’. ‘Why would I like them just because they come from the same place I do?’ she would ask.

Talking with other people with diabetes, I remembered this, and thought that more than sharing a nationality, what we share is an experience. OK, so we each have our own diabetes that is specific to us, but we ‘talk the same language’ when it comes to our condition. We each had taken time out of our jobs and daily lives to help and support our clinic.

It’s great to think that (a) we were being asked for our feedback at all, and (b) that

our experience could make a difference to others as well as ourselves. Other than a few gripes (very few), I’m pleased to report that we were very happy with the services provided, but more to the point we were all extremely happy with the way the staff at the clinic treated us.

Yes, we had some ideas for improvements, but more practical ideas than actual complaints. All of us participating understood that the healthcare professionals are under pressure too.

We may have the condition and it can be a bore going to clinic – it can be stressful, it can involve a bit of a wait sometimes – but this is not a short-term relationship. Once diagnosed, you have a long-term relationship with your diabetes healthcare team. It’s a partnership and takes effort from both sides – and a lot of patience. Support your local surgery, clinic or hospital (whichever you attend) as much as you can. You’re going to be with them a long time, so put your shoulder to the wheel, don’t throw in the towel. i Sue, a journalist and writer with Type 1, set up www.desang.net, a website for people with diabetes.

Something for the weekend Richard Barber fears train disruptions a bit more than most Living by the seaside and working in London is something that I love and hate at the same time. I love the buzz during the week, but at the same time I can’t wait to get back to the south coast when it gets to 5pm. A major player in all of this is the two-hour – each way – commute. It’s not for the faint-hearted (as anyone who commutes into London knows), and rising stress levels can have a knock-on effect on my blood sugar levels. Far too often does a hot tube journey coincide with missing vital hypo signs. Even worse is being stuck on a train and slowly running out of dextrose. Luckily, I can count on one hand how many times I’ve had low blood sugar levels and, getting confused, subconsciously decided to take the wrong train to my final destination. And nothing beats the end-of-journey sense of freedom when I get home. So, why do I do it? Having a job I really enjoy is enough to get me out of bed in the morning. i Richard has had Type 1 diabetes since he was 15. issue four 2011 balance 27

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feature

Let’s

KICk-OFF

with the

FACTS

Education courses on Type 1 diabetes for children and young people are few and far between.

Dr Eleanor Kennedy reports on two new courses tackling carb counting, insulin adjustment, family communication, and much more

A

diagnosis of Type 1 diabetes is tough at any age, but those diagnosed at an early age have traditionally faced an added disadvantage: there has been very little available to them by way of educational programmes to help them make the difficult transition from adolescence to adulthood.

Fortunately, several researchers around the UK have spotted this gap and have started working on innovative projects to see what works with this age group and, just as importantly, what doesn’t. As you would expect, Diabetes UK has been funding some of this important research.

KICking off with carb counting First under the spotlight is KICk-OFF (Kids In Control Of Food). Based on the successful DAFNE (Dose Adjustment For Normal Eating) course designed for adults with Type 1, which gives them the necessary skills to

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feature The maths involved in calculating carbohydrate values can be really tricky, so we're working on new ideas to help young people manage that part of the course in different ways Dr Kath Price, Consultant Paediatrician at Sheffield Children’s Hospital

estimate the carbohydrate content of each meal and calculate the correct dose of insulin, KICk-OFF was tailored specifically for young people aged 11–16.

“We wanted to construct an intensive course to teach children about their diabetes and compare this to standard diabetes education,” explains Dr Kath Price, Consultant Paediatrician at Sheffield Children’s Hospital, who led the study.

“This would allow us to see the effect of the course on diabetes control, changes in quality of life, hypoglycaemia rates and so on.”

Dr Price and her team received funding from Diabetes UK to write a completely new education package from scratch, using some of DAFNE’s guiding principles, such as carbohydrate counting and insulin dose adjustment, as a foundation on which to build a programme suitable for a younger audience. The idea was to deliver it like a school lesson, giving young people something to help them manage their diabetes when in school, out with friends or doing sport, and during times of illness.

The team was also keen for it to be a fun way of learning. All in all quite a challenge, but they rose to it and pulled it off.

Much of the first year was spent setting up the project, which involved everything from getting ethics approval to run the study from the North Sheffield Ethics Committee, through producing and printing all of the teaching materials, to finding more than 500 kids aged 11–16 willing to take part.

By the time the second year rolled around, all participants had been recruited and the KICk-OFF course started in venues across the UK, including Cardiff, Inverness, Oxford, Chesterfield, Hartlepool, Manchester, Scarborough, Nottingham and more. As one

of the worst winters in recent memory blanketed the UK, the three educator teams, each made up of a nurse and a dietitian trained in the KICk-OFF method, valiantly trudged off through the snow and ice to deliver a total of 31 courses.

“Each course was delivered with at least one member of the local diabetes paediatric team also present, in order to make sure that the children taking part knew who to turn to when they had questions after the course had finished. This continuing support is crucial if KICk-OFF is to be a success,” explains Dr Price.

Divide and deliver

Children and teens on the KICk-OFF course learn about carb counting in a fun environment

So that the educator teams could deliver the course with the greatest ease, the participants were divided into two age bands: 11–13 and 14–16, with a maximum of eight in each group. For greatest impact, each course took place over five consecutive days. Dr Price was delighted by the outcomes: “The groups were so enthusiastic. Virtually all of them stayed the course.”

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feature

Parents acknowledge that they generally expect their teenager to accept an enormous responsibility at a relatively tender age Dr Helen Murphy, Senior Research Associate at the University of Cambridge’s Metabolic Research Laboratories

»

But what about the results? “Well, the information we collected at the start of the courses, and at six and 12 months after they finished, is more or less all in and will be analysed soon,” Dr Price continues. “So, until that’s done, we won’t know how effective or not KICk-OFF has been. It’s always difficult for people to keep doing in real life what they’ve learned on courses, but it will be fascinating to see if there have been any improvements in blood glucose control in this group. However, a drop in HbA1c is not the be all and end all here, so we’re also gathering information on other factors, such as the number of hypos that the children and young people in the group experience, and the effect on their overall quality of life.”

As with all research, the results that Dr Price’s group will be reporting over the next two years won’t be the end of the story.

“One of the most obvious things we found when delivering the KICk-OFF courses was that the maths involved in calculating carbohydrate values and insulin doses is really tricky, and a real struggle for some people. So, we’re working on new ideas Heads down as the to help young people manage that part KICk-OFF lessons of the course in different ways. Tweaking get under way this one aspect should help to make it more friendly overall.”

Hallam University to develop a training course to help paediatric healthcare professionals become better teachers.

Although first used solely to train KICk-OFF staff, this course will now be available nationally, initially to paediatric diabetes healthcare professionals and, the hope is, eventually to any healthcare professional working with children.

“We’re delighted,” says Dr Price. “However, we still have a lot of work to do. First, we’ve had interest from groups overseas, so it would be good to see if and how KICk-OFF can be translated across borders. And, of course, it was set up for children and young people on multiple daily injections of insulin, but with so many now on insulin pumps, we’d like to develop it for this group too. Also, with Type 1 diabetes now much more common in very young children, what about educational courses for the under-11s and the parents of toddlers?

These are all areas we want to explore in the next few years.”

Get your FACTS right Of course, there’s more to improving life for children and young people with Type 1 than

Education, education, education Educationalists from the University of Sheffield observed some of the courses to make sure that the approach was consistent and the teaching methods appropriate for the age groups. Their feedback has been very positive and has helped the team to refine KICk-OFF even further. Also, Dr Price’s team has worked with experts in teacher training at Sheffield

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simply equating food and lifestyle with insulin dosage. Family communication around diabetes management also plays a vital part, because young people with Type 1 tend to enjoy better blood glucose control if they share responsibility for practical aspects of their care with family members.

Dr Helen Murphy, Senior Research Associate at the University of Cambridge’s Metabolic Research Laboratories, has been working with similar age groups, examining the links between family communication, quality of life and blood glucose control.

“While we had some pilot study data from our Families, Adolescents and Children’s Teamwork (FACTS) study to suggest that there was a link, we really needed to do a much bigger study to evaluate this more scientifically,” says Dr Murphy.

Thanks to a Diabetes UK Care and Treatment Grant, a large study was set up and run in 10 centres across the East and West Midlands, and Southern England. It involved 300 participants aged 11–16, half of them randomly selected to attend the family communication programme, and the other half to their usual clinical care.

The study was designed not just to look for a drop in HbA1c but also, like KICk-OFF, to gather important information on quality of life, hypoglycaemia and how families share responsibility for diabetes management.

Dr Murphy explains why this kind of intervention is so important. “During adolescence, young people take increasing responsibility for their diabetes selfmanagement, while experiencing very rapid physical and psychological changes.

In early adolescence, parents are often responsible for supervising their child’s diabetes management. But, by the end of this period, much, if not all, of this responsibility has transferred to the adolescent. For both parties, this transition can be particularly challenging. Parents acknowledge that they generally expect their teenager to accept an enormous

Both programmes teach children and teens skills to help them better manage their diabetes

responsibility at a relatively tender age.

And, of course, we all know that constant nagging just makes things worse.”

More FACTS The extension to Dr Murphy’s original FACTS study – called, unsurprisingly, the FACTS-2 study – was run over six months, with families meeting the team once a month for 90 minutes. As well as recording HbA1c, severe hypos and hospital admissions, the group devised a number of innovative communications tools and techniques.

Some of the greatest impact came from role play and drama scenarios in which, for example, the teenager who says nothing and the parent who says everything swapped roles in order to understand each other’s viewpoint more clearly.

“It was important for us to get the balance right,” says Dr Murphy. “Our educators were trained and monitored to ensure that they spoke for less than 40 per cent of any given session. This gave the families plenty of opportunity to talk and learn how to communicate more effectively. Importantly, this approach proved very popular. As with KICk-OFF, we experienced very low dropout levels and the anecdotal feedback has been fantastic.”

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feature

Joint working

Teens on the FACTS-2 study communicate how they feel about their diabetes. Above: ‘my train has derailed and mum and my diabetes team need a crane to get me back on track’. Below: sad about blood tests

One interesting crossover between the two studies has been in the area of skills training. Just as some of the KICk-OFF participants had difficulty calculating the carbohydrate content of meals, the parents and children in FACTS-2 who had to count carbohydrate often arrived at very different results. “This means that there are obvious gaps in skills training, not just for the children and young people but for their families too, so more research is needed here,” says Dr Murphy.

Dr Price agrees: “We often look at these types of studies as one-off events, but it’s looking more and more as though we need to get programmes like KICk-OFF and FACTS-2 working together so that patients and families get the most effective help we can offer. We need to stop focusing on a ‘one size fits all’ course, and find new ways of educating

those people who need it on a more frequent basis.”

The results of KICk-OFF and FACTS-2 are still pending, but Dr Iain Frame, Director of Research at Diabetes UK, is optimistic about the future. “Adolescence is a particularly challenging time for everyone but having to take on board your own management of Type 1 diabetes complicates life hugely. What’s important about these studies, and why Diabetes UK has funded them, is that we know that beliefs and behaviours formed during adolescence often persist into early adulthood.

If we can help people with Type 1 diabetes get this right at the outset, the results will be better for everyone in the long run.” i KICk-OFF: www.kick-off.org.uk/team.php • For more on FACTS-2, email Helen Murphy at hm386@medschl.cam.ac.uk or visit www.mrl.ims.cam. ac.uk. • If you would like to get involved in diabetes research, visit www.diabetes.org.uk/research.

Play the Diabetes UK lottery and win great cash prizes every week

Jackpot £1,000 Play £1 for a chance to win Call the Diabetes UK Weekly Lottery hotline on 01628 822271 and quote ‘Balance’

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For terms and conditions and more information visit www.diabetes.org.uk/weeklylottery

The charity for people with diabetes A charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). © Diabetes UK 2011

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cod

Give us a break T

he idea of holiday camps for children with diabetes was conceived before the Second World War, in the early years of the British Diabetic Association (as Diabetes UK was then known). The success of the first, small-scale events proved there was a scheme worth developing, but the war delayed progress. Happily, in 1952 Diabetes UK’s Care Support Events were restarted – this time on a national basis. Nearly 60 years later, they remain one of the charity’s most valued services.

Diabetes UK’s Care Events team organises a variety of breaks for children and families with diabetes (see box, page 35) – and this year alone at least 600 people will have attended one. Fun and educational, the events provide opportunities to meet and share experiences with others living with diabetes, and ultimately learn how to better manage the condition.

34 balance

Photos: Dave Lews © Diabetes UK

Diabetes UK has been organising much-needed holidays for children with diabetes for more than 70 years. Kate Flagg finds out more

Give the kids a break Fiona Concaig, a volunteer for Diabetes UK’s Research team, sold the idea of a Children’s Support Holiday to her 12-year-old daughter, Eilis, who’s had Type 1 since she was 6.

“I assured Eilis that she wouldn’t be with ‘little kids’ and she thought it sounded fun,” says Fiona. “She was keen to experience the activities and the inclusiveness that comes with everyone having diabetes.”

In August, Eilis attended a week-long children’s holiday in Cumbria with 39 other kids aged 11–15. She loved it, and it’s easy to see why. Activities included canoeing, indoor climbing, mountain biking, ghyll scrambling and horse riding. There was also a day at Blackpool Pleasure Beach.

All Care Support Events are staffed by volunteers, including people with diabetes – many of whom attended a support event themselves when young.

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Photos: Dave Lews © Diabetes UK

Come rain or shine (left to right): summer showers don’t dampen the fun in Northampton; teens take aim in the Weymouth sunshine; and the kids take time out to learn more about diabetes in Altrincham Doctors, nurses and dietitians supervise each child’s diabetes management and lead the informal lessons, while qualified instructors run all the activities.

“To know that Eilis was having a great time and her diabetes was being well managed was a rare privilege,” says Fiona.

Along with the majority of those who attend Care Support Events, Eilis enjoyed meeting new people with diabetes the most: “I learnt I was not the only person out there who has to put up with having Type 1 diabetes and all the stuff that goes with it,” she says. “I just get on with it more now.”

Fiona has noticed this change in her daughter too: “Eilis has always been confident in her ability to manage her diabetes, but she hasn’t always been diligent. Her attitude towards her diabetes has improved a great deal as a result of her going on the holiday.” Unsurprisingly, Fiona can’t recommend the events enough, and it seems Eilis feels the same. Eager to go again next year, her advice for other children considering a holiday is: “Don’t think about it too much, just go. You’ll have a great time!”

issues associated with diabetes, such as treatment of hypos, ketones, sick-day rules, healthy eating and understanding food labels. They are able to raise their concerns with healthcare professionals while their children enjoy fun activities, make new friends, have a trip out and learn more about their diabetes – or, if they’re under 4, are looked after in the on-site crèche.

“The weekend was amazing and so well organised by Tim Westwell, who has a daughter with Type 1,” says Kelly. “At last we could talk to other parents and

»

Diabetes UK’s Care Support Events Family Support Weekends These events are a great way for parents of children with diabetes to share experiences and find peer support, while their children enjoy fun activities and informal learning sessions.

Price: £125 per person aged 14 or over; £75 per child (aged 13 or under). Includes hotel accommodation, food, snacks, activities and trips.

Support for the whole family

Children’s Support Holidays and Weekends

Kelly and Keith Avila, from Maidstone, have attended three Diabetes UK Family Support Weekends over the years, as their 10-year-old daughter, Gwen, has Type 1.

So, what inspired them to sign up? “Gwen now has a fantastic paediatric diabetes specialist nurse (PDSN) – Jenny Endean – but when she was diagnosed with Type 1 at 11 months old, there was no PDSN or local support group,” says Kelly, who went on to set up the Maidstone Area Parents’ Support Group in 2006.

“We really wanted to meet other families in the same situation, so we went on our first weekend when Gwen was 21 months old.”

During Family Support Weekends, parents attend relaxed discussion groups that cover a wide range of

These fun-packed breaks for children and young people with diabetes take place during the school summer holidays. There are week-long, five-day and weekend breaks specifically designed for each age group: 7–10, 11–15 and 16–18 years.

Price: Week-long holiday: £360; five-day holiday: £280; weekend: £95. Includes all activities, accommodation, trips, food and snacks.

Funding – you may be able to obtain funding to attend one of Diabetes UK’s Care Support Events through your local Diabetes UK voluntary group or hospital. A bursary is available for those requiring financial assistance; contact Diabetes UK’s Care Events team (see end information, page 37). issue four 2011 balance 35

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Group talk: the kids can’t praise the events enough

»

relate to what they were going through. We felt more confident in our ability to manage Gwen’s diabetes, knowing that we weren’t alone.”

The family went on another two weekends after that – when Gwen was old enough to benefit from them too. “We were amazed when Gwen started doing her own injections during our second weekend – aged just 4,” recalls Kelly, proudly.

At the end of their third weekend, Kelly promised that one day she would “give something back”. She stuck to her word, and for the past two years she has been volunteering at both the Ashford and Telford Family Support Weekends, helping out in the crèche.

“Having had depression on and off for the last 10 years, it does me the world of good to get away and help other families in the same situation,” says Kelly.

Dedicated volunteers The success of these events owes a lot to the staff who offer their time and expertise voluntarily.

Carol Metcalfe, a PDSN based in Telford, first volunteered at a Family Support Weekend in 1994 and has attended at least two events every year since – one year she went on eight! Her husband, Russell, a psychiatric nurse, has volunteered with Carol from

What the parents say...

“The whole weekend was amazing and I hope to go back.

I’d recommend a Diabetes UK Family Support Weekend.”

“My daughter really enjoyed meeting other kids. It was humbling that so many people volunteer – they really care.”

“For our children it was a fantastic, fun-packed weekend, and for us as parents it was a place to ‘not be alone’.”

36 balance

her second year onwards; and their 19-year-old daughter, Bryony, has been helping out at support events since she was 16. It must be in the genes.

“I volunteer as the senior nurse for the Family Support Weekends, and I’ve done the odd Children’s Support Weekend too,” says Carol. “I think all DSNs, medical students, dietitians and anyone with an interest in diabetes should attend a Care Support Event. Seeing people living with diabetes day to day teaches you more than you could ever learn from a textbook or 20-minute patient session.

“I’ve learnt a lot about the emotional side of living with diabetes, and I can do my job of supporting families a lot better because of this.”

During the weekends, Carol runs group discussions and a 1–1 surgery with parents. “The discussions cover what the parents want to know,” says Carol. “We’re quite frank if we talk about diabetic complications, but we’re never negative and everyone leaves knowing more than they did before.

“Afterwards, I feel as if every drop of information has been squeezed out of me,” laughs Carol, “but you only get out what you put in. I love volunteering. The best part is seeing the families grow in confidence and take on board good advice, not just from healthcare professionals but from other families too.

It’s very rewarding seeing the kids become more accepting of their diabetes.”

Carol is well known for recruiting people for Diabetes UK’s Care Support Events – children, families

Top: Getting used to alternative injection sites under the watchful eye of Libby Dowling, Clinical Advisor at Diabetes UK. Below: PDSN Sean Pettet helps kids get to grips with blood testing at the Ashford Family Support Weekend

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...and from the children and volunteers. She knows they’ll have a good time.

“One patient, a typical 14-year-old boy, came back from the Cumbria holiday recently; he hadn’t wanted to go at all but came into his appointment saying, ‘That was the best holiday I’ve ever had!’ He admitted that, for the first time, he’s been thinking about his diabetes and doing more blood tests. It was fantastic.”

Any final words of encouragement for parents who might be thinking about going on a Family Support Weekend? “It’s not about ‘group hugs’ and mushy stuff, so don’t worry,” says Carol. “It’s all very laid back, but you’ll learn a great deal.” And to those who are considering signing-up their kids for a Children’s Support Holiday, her advice is simple: “Try not to worry – they’ll have a fantastic time.” i Details of 2012 Care Support Events will be published online in December at www.diabetes.org.uk/careevents and in a leaflet sent out with balance issue 1 2012. • For further details or to find out how you can volunteer, call the Care Events team on 020 7424 1000, email careevents@diabetes.org.uk or visit www.diabetes.org.uk/careevents.

“I loved the fact that I could talk about my diabetes and people understood.”

“They made me feel accepted and not alone.”

“I’m better at reading hypos now and know when I’m low.”

2011 events The Children’s Support Holiday season is now over for this year, but there are still fun weekends to be had: Family Support Weekends 23–25 September 2011 at Altrincham, Cheshire 11–13 November 2011 at Inverness, Scotland Children’s Support Weekends 21–23 October 2011 at Windmill Hill, East Sussex i Contact the Care Events team for details or to book your place (see end information, left).

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38 balance

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Found in translation With health services under financial strain, the need to translate research findings quickly into medical practice gets ever greater. Dr Eleanor Kennedy reports on promising advances in Type 1 diabetes

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T

ype 1 diabetes develops because of an autoimmune disorder: the body’s immune system attacks and destroys the insulinproducing beta cells, leaving the body unable to produce insulin. This causes increased blood glucose levels, which can, in turn, cause serious damage to all organs in the body.

Because Type 1 is autoimmune in nature and researchers understand what the immune system is targeting, a cure has always been spoken about in terms of ‘when, not if’. But with the health service under increasing financial stress, there is a pressing need for so-called ‘translational research’ – research that translates quickly into medical practice for those people who need it; in this case, people with Type 1.

So what’s in the pipeline, and what is Diabetes UK funding to help plug the gaps in medical knowledge?

From islets to stem cells The advances in medical research in Type 1 over the last few years have given genuine hope to those living with the condition. Many believe the trigger for these advances was the pioneering work of James Shapiro and his colleagues in Edmonton, Canada, who, in 2000, published details of highly successful improvements to the islet transplantation procedure.

Islets, the clusters of cells that make insulin, can be collected from a donor pancreas and transplanted into someone with Type 1. This can restore the person’s blood glucose to near-normal levels and completely prevent hypos (hypoglycaemia/low blood glucose).

“Even with the best possible results in Edmonton, 50 per cent of people are back on insulin five years after their islet transplant” While islet transplantation has revolutionised the lives of hundreds of people around the globe, much can yet be done to improve the results of the procedure. Professor James Shaw at Newcastle University explains that while it clearly works, the means of isolating islets for transplantation needs to be improved, as does the process of finding suitable patients.

Prof Shaw is trying to assess overall satisfaction levels enjoyed by people who have had the surgery

40 balance

and the impact on their quality of life, in addition to collecting detailed information on their medical outcomes. Following in-depth interviews with islet patients, new questionnaires have been developed. These are being completed before and after transplantation in all UK centres. The goal is to provide a clearer picture of all the overall risks and benefits of islet transplantation and determine who is most likely to benefit from the procedure.

Longer lasting A little further down the pipeline is other research that aims to get a better understanding of how islets can be made to last longer after transplant. Over time, many transplanted islets die, leaving people in need of another transplant or having to go back onto insulin.

Even with the best possible results in Edmonton, 50 per cent of people are back on insulin five years after their islet transplant.

One vital indicator that islets have survived is their ability to make new blood vessels after transplant.

Normally, islets have an extensive blood supply, essential for their work in the pancreas. Importantly, it is now known that the insulin-secreting beta cells can influence the function of the cells lining the surrounding blood vessels, and vice versa.

Dr Claire Clarkin at King’s College, London, was awarded a Diabetes Foundation–Diabetes UK Joint Training Fellowship to conduct further research into islets. “Once islet cells are isolated,” she explains, “they very quickly lose their capacity to encourage blood vessels to grow into them. As a result, once they are transplanted, their chances of survival can be low.

We’ve been trying to prevent this happening by stimulating the islet cells with chemical growth factors to see if we can help sustain the formation of new blood vessels, so that, once they’re transplanted, the islet cells get the vital blood supply they need.”

Professor Peter Jones, Dr Clarkin’s co-supervisor, adds: “Although this work is being done mainly in mouse islets, because they share so many similarities with human islets, we’re looking at the actions of the same growth factors in human islets. The ultimate aim is to improve the efficiency of clinical islet transplantation, so this project is a great example of translational research that really does take the research from the bench to the bedside.”

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From stem cells to islets Meanwhile, as research continues apace to find ways of improving existing processes using transplanted islets, another tantalising possibility hangs ever present in the air: producing a seemingly endless supply of insulin-producing islets from stem cells.

Recent research has shown that stem cells found in the pancreas may have enormous potential to be turned into cells that secrete insulin. A PhD studentship, under the guidance of Prof Shaw in Newcastle, is using fluorescence technology to ‘tag’ stem cells obtained from pancreases donated for medical research, then tracking them to see whether they have the potential to develop into insulinproducing cells. If they do, this exciting line of research could eventually lead to a new and sustainable source of beta cells for people with Type 1.

But is all this too good to be true? Dr Astrid Hauge-Evans, holder of a prestigious Diabetes UK RD Lawrence Fellowship, believes things may not be quite as simple as they sound: “Islets aren’t just made up of insulin-secreting beta cells. They’re formed of quite complex ‘communities’ that include several other cell types crucial in islet biology. The key to islet function is how these communities of cells communicate with each other.”

Although our understanding of how individual beta cells behave has advanced hugely over the years, we still know little about how they communicate with each other and with other cells found in the islet. Therefore, using state-of-the-art techniques to identify those genes and molecules that are important to communication between cells, Dr Hauge-Evans is focusing on how such interactions regulate insulin secretion and survival. “Having a limitless supply of beta cells produced from stem cells is only part of the answer,” she adds. “We need to piece together the 3D structure of islets to work out what else we need in order to produce functioning islets in a test tube.”

Professor Peter Jones, Dr Hauge-Evans’ supervisor, believes that this type of research has the ability to answer questions not just for Type 1 diabetes, but for Type 2 also. “A better understanding of the interactions between beta cells and the other cell types in islets will benefit those with Type 1, as it will help address issues surrounding the lack of donor tissue available for transplantation. But, since Type 2

can ultimately result in a loss of functional beta cells, this work may allow us to identify new molecules, and use drugs to modify their actions to help maintain or increase numbers of beta cells and, crucially, improve their function in Type 2 also.”

“Another tantalising possibility hangs ever present in the air: producing a seemingly endless supply of insulin-producing islets from stem cells” The immune system on trial Closer to the route of the problem, we find those researchers striving to identify what, precisely, goes wrong with the immune system that it starts the whole process of islet destruction leading to Type 1 diabetes. Again, Diabetes UK is at the forefront of funding research in this area.

Dr Yuk-Fun Liu, one of Diabetes UK’s Clinical Training Fellows, working with Professor Mark Peakman at King’s College London, is looking to explore the possibility of creating a vaccine against Type 1, using a small fragment of proinsulin (the larger protein that the body breaks down to make insulin), which is already in clinical trial.

“We’re looking to understand how these vaccines could retrain the body’s immune system to stop attacking beta cells,” explains Dr Liu, “to establish whether we can slow or stop the process of beta cell destruction in its tracks. If successful, we might be able to salvage beta cells still capable of producing insulin at the point of diagnosis or, possibly, even beforehand, which could perhaps prevent the onset of Type 1 or at least greatly slow its progress.”

Meanwhile, at the University of Cardiff, Professor Susan Wong is doing research with animals to see how such vaccines could make the biggest impact: “We’re testing these vaccines for effectiveness and safety, so that we can find the best ways of administering them to people and finding out how well they are tolerated.”

ADDRESS-ing the issue For any of this work to flow freely down the pipeline, however, it is vital that people take part in clinical trials. Professor Des Johnston, the Director of the National Institute of Health Research Diabetes

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Hypowa

feature

Research Network (NIHR DRN), explains: “The primary goal of the NIHR DRN is to achieve benefits for people with diabetes, or at risk of developing diabetes, through excellence in clinical research.

Clearly, we need to get as many people into trials as possible, if we’re going to get new diabetes treatments onto the market.”

In ADDRESS-2, an innovative joint funding initiative between Diabetes UK and the Juvenile Diabetes Research Foundation run through the Diabetes Research Network, a system has been set up to support recruitment into early intervention and prevention trials, and other kinds of studies, for Type 1. “We’re looking to recruit people who have been diagnosed with the condition within the past six months and their siblings too”, says Prof Johnston. “The age range is wide because we know that people can be diagnosed with Type 1 at any age, so people aged 5–60 will be invited to participate. By giving some clinical data and consent to be contacted about research now and in the future, plus possibly donating a little bit of blood, you’ll be helping researchers across

England and Wales. We want to make the UK the best place in the world to do Type 1 research, so having a resource where we have all the newly diagnosed cases of the condition is a great step towards this goal.”

Cover all bases Research into Type 1 in the Diabetes UK portfolio spans every area, from basic research, right through to the recruitment of people into clinical trials.

Dr Iain Frame, Diabetes UK’s Director of Research, thinks it is important to cover all the bases: “Every research project that we fund has the potential to shed even more light on our understanding of Type 1 diabetes. We may not be sure exactly where the next big leap forward is going to come from, but we can be certain that Diabetes UK is continuing to invest wisely in the future.” i Take part in diabetes research: www.diabetes.org.uk/ involvement-in-research or www.ukdrn.org/patients.html.

• Donate to Diabetes UK research: www.diabetes.org.uk/ fundresearch. • ADDRESS-2: www.address2.org.uk (website goes live on 26 September).

Are you a keen swimmer looking for an exciting challenge?

Channel Swim Relay Summer 2012 “We are looking for individuals or groups to make up teams of six who will swim, in relay, across the English Channel from Dover to France.

Be a part of our Diabetes UK Channel Swim Relay and help raise vital funds for people with diabetes.”

To register: online: www.diabetes.org.uk/channelswim phone: 020 7427 1000 email: events.fundraising@diabetes.org.uk

42 balance

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Address Post Code • Important notice. If ordering by post and you want to add a message please print it clearly on a separate piece of paper and attach it to this order coupon when you send it in. If you are ordering more than 1 Flowercard then please also write the additional recipient details and message on a separate piece of paper Data Protection: We may from time to time make our mailing list available to carefully selected companies which may be of interest to you. If you would prefer not to receive such mailings please tick this box . Telephone orders: If you do not wish your details to be passed on to other reputable companies for marketing purposes please state this to your customer service representative. *P+P is £2.99 for orders placed for U.K. delivery. Delivery normally within 3 working days. All special offers and prices featured in this advert are valid until 30/11/11. Please note that all our products are subject to seasonal variations and if any flowers are not available, we reserve the right to substitute your order with flowers of an equal or greater value. All items will be despatched individually unless specifically requested otherwise. Please order (by 1pm) 2 days before the required delivery date for guaranteed 1st class delivery. So as to make sure your gift is NOT late, we send the cards out 2 days before the required arrival date so there is a chance the recipient may get the gifts a day early as the first class next day service is not 100% reliable. If you require the product to be guaranteed on a specific date then please call the order line or visit our website and choose special delivery service. The postage charge for special delivery is £7.99.

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Sugar Businesswoman and finalist of The Apprentice in 2008, Claire Young, 32, had a wake-up call when her mum, Cheryl, was diagnosed with Type 2 the same year. As she tells balance, it was time to lose weight and get fit How did your mum’s diagnosis affect you?

It was quite a shock, as you never think diabetes will affect your family. It was also my call to action to look after myself: I knew I was putting my health at risk by being overweight, especially as my dad had a heart attack several years ago.

Now the motivation to lose weight wasn’t just cosmetic, but being ‘papped’ on the beach looking like Nellie the Elephant spurred me on even more, and I’ve since lost more than 3st (19kg).

Above: Claire’s in charge – of her health as well as her businesses. Left: Claire with Lord Sugar

How has your diet changed?

I had no idea why I was overweight until someone explained exactly what I was eating. I didn’t realise that what I thought were healthy options, such as certain breakfast cereals and fruit bars, were actually full of sugar. I had a really good canteen at work, and, not knowing what time I’d get home, I’d often have a proper meal for lunch, followed by an amazing pudding in the afternoon. Meeting rooms would have sweets on the table, and then after work I’d go out for either a social or corporate dinner.

I’m now much more aware of what I’m eating and drinking. It’s the little things that make all the difference – I no longer eat a bread roll before my meal in a restaurant, and I’m really aware of how calorific alcohol is and limit it.

What’s your fitness regime?

I run 3–5k twice a week, go to kick-boxing class once a week, and to Zumba and step aerobics when I can.

What’s your health philosophy?

You’ve got to be realistic when trying to lose weight, and you have to be disciplined. I’ve got a real sweet tooth and I have to be organised so that when I’m travelling and working long hours, I have healthy options with me and don’t have to resort to eating junk for an energy boost.

What was it like appearing on The Apprentice and what have you been up to since?

The show taught me so much about business and how to be resilient. It was a life-changing experience that opened many doors for me. At the end of the process, I realised I didn’t want to be employed by anyone else – I wanted to start my own business. Since then, I’ve set up a number of business ventures, including

»

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feature

» School Speakers and Girls out Loud, to promote

can fit 20 minutes of exercise into their day, you just have to be super organised. It helps that my boyfriend is very sporty and motivates me even more. It’s easier to exercise when you have company – it makes it fun and not a complete drag.

entrepreneurship and enterprise to young people.

We work ‘hands on’ in schools and across multiple government organisations, helping students raise aspirations, take off the blinkers and think big!

Describe a typical day

What advice about having a healthy There isn’t one! I tend to get up at 6am and finish work lifestyle would you pass on to others? around 8pm. Today, I’ve got two interviews, a couple of meetings, a stack of paperwork to clear and a business speech to write. This evening I’m going to an event hosted by a women’s network I recently set up.

When I’m not working, I’m riding my horse Bryah – or mucking her out. I love spending time with my family and friends, and I’m also happy chilling out on the sofa with a pile of magazines and a cup of tea.

Is it hard to keep up your healthy lifestyle with such a busy schedule?

Yes! The number one excuse you hear from people with busy lives is ‘I haven’t got the time’, but everyone

Take it one step at a time. If you try to go ‘cold turkey’ and change everything all at once, it probably won’t work. Don’t buy the things that will tempt you at home, and if you do have a day off from healthy eating, just get back on it the next day.

Finally, what is Lord Sugar really like?

He’s brilliant, very funny and can spot a fib from a mile off! Lord Sugar has been a great supporter of mine and I’m very grateful for his words of wisdom. He’s been there, done that and I’ve now learnt to listen! b

Cheryl says…

“It wasn’t a shock when I was diagnosed with diabetes. Six months earlier, at the annual check-up I have because I take statins, my doctor had told me that my blood glucose level was on the upper end of normal. However, I ignored it and didn’t have a blood glucose tolerance test. If I’d known more about Type 2 at the time, I would have been tested sooner.

I treat my diabetes by diet alone, which works well. I know that Type 2 is a progressive condition, so the longer I can delay going onto medication, the better.

Since being diagnosed, I’m much more aware of what and how much I eat. People in the post-war generation have been brought up to finish what’s on their plate, but you don’t necessarily have to if you’re full. A smaller plate helps me control my portion sizes.

I follow a low-carb, low-fat diet, which means 200g of carbohydrates per day spread over three meals. If I have a snack, I make sure it has less than 10g of carbohydrate.

I began by weighing everything out to work out the carb content, but now I can estimate it by sight. I’ve lost more than 2st (12.7kg) through eating fresh, healthy food and cutting out convenience food.

I have two mottos: ‘deny diabetes and die earlier’ and ‘adapt and survive’. I don’t want to be on the kidney

46 balance

transplant list, and to lose my eyesight would be devastating.

Maintaining the weight loss is the hardest Three years on: Claire and Cheryl and most important are happy and healthy thing. As my background is in biology and psychology, and I’m a trained hypnotherapist, I have an understanding of diabetes and know the tricks to control my mind. I think many people with Type 2 feel ‘Why should I bother?’, as they may feel absolutely fine.

I would encourage people who have just been diagnosed with diabetes not to be frightened and to recognise that there’s a lot of help and information available from Diabetes UK. After the initial shock, you will learn to accept and control your diabetes.” i For support and information, call the Diabetes UK Careline on 0845 123 2399, Monday to Friday, 9am to 5pm.

• Diabetes for Beginners Type 1 (code 6015) and Type 2 (code 6014), £4+p&p each, can be ordered on 0800 585 088, or online at www.diabetes.org.uk/shop.

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44-47 Claire-KFColour.indd 46

31/08/2011 12:29

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diabetes uk

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life&health

F

Halt your hunger

eel hungry not long after eating a meal? Find yourself reaching for a snack? This can result in you eating more food than you require, which can be particularly frustrating if you are trying to manage your weight.

However, combining low glycaemic index (GI) and protein foods, as part of a healthy, balanced diet, can help you keep those hunger pangs at bay.

Low-GI carbohydrate foods (see below) are slowly absorbed during digestion, so they make you feel fuller for longer, controlling your appetite and helping you to eat less. They also help to maintain even blood glucose levels between meals, which may in turn help prevent hypos.

Low/medium GI foods • Most fruits and vegetables • Beans and lentils • Sweet and new potato •A ll-Bran, Special K, porridge • Pasta • Basmati or easy-cook rice • Granary/rye bread Protein foods • Chicken (no skin) • Lean meat • Fish • Eggs • Nuts • Soya/tofu

Resist the biscuits and manage your weight by choosing foods that will help you feel fuller for longer

It is important to recognise that there are many factors that can influence the GI rating of a food or meal. The amount of fat or protein that the food or meal contains affects the speed of absorption of the carbohydrate.

The ripeness of a fruit and how the food is cooked can also alter the GI rating, eg mashed potato will be more quickly absorbed than a new potato.

Protein foods (see below left) are also known to promote the feeling of fullness, helping to reduce hunger and aid weight loss.

Keep it healthy Remember, it is still important to make healthy food choices, such as low-fat cooking methods and lower-fat alternatives, where possible. If you feel like a snack, a piece of fruit, a yogurt or a handful of nuts are good options.

However, bear in mind that nuts are very high in calories, so consider sticking to a small handful. i See ‘Basic care’, page 56, for more tips on healthy eating.

• For further information on GI eating, visit www.diabetes.org.uk/GI.

issue four 2011 balance 51 51-53 Life and healthColour2.indd 51

31/08/2011 12:29

life&health

{75%

}

are unable to recognise hypo symptoms

Source: A recent YouGov survey of the general public

How to... get a care plan Everyone with diabetes is entitled to a care plan.

This is an agreement between you and your diabetes healthcare team to help you manage your condition day to day. A care plan helps to assess what care you need and how it will be provided, and is a record of goals, test results and future appointments. It can also be useful if you are admitted to hospital.

The care plan will be based on what you want, so when agreeing one with your diabetes healthcare team, mention anything that you feel is important to your needs. Typical examples are your: • agreed targets for blood glucose (both home tests and HbA1c), blood pressure and blood fats (LDL and HDL cholesterol and triglycerides) • medication and when to take it • food and physical activity plan • measurements such as BMI (body mass index) • important contact details • important appointments such as flu vaccination and retinal screening.

You may also have a separate section for your annual review, where results of your retinal screening, foot examination and urine test (microalbuminuria) can be written along with the next review date.

A care plan can be printed out for you to take home, or stored on your GP’s computer. If you think one could help you, speak to your diabetes healthcare team. You are entitled to a care plan review at least once a year, as part of your annual review, where you can discuss how it is working.

• If you live in Northern Ireland, care planning is different. Talk to your diabetes healthcare team. i Turn to pages 40–41 for a pull-out checklist of what other diabetes care services you should receive.

52 balance

& kids

hypos

It can be especially difficult to monitor children with diabetes, and parents and carers can be particularly worried about hypos. balance takes a closer look…

H

ypoglycaemia (or hypo) means ‘low blood glucose’, which is when blood doesn’t have enough glucose in it for the body to work properly. For people with diabetes, a hypo means a blood glucose level of less than 4mmol/l.

Why do they happen?

Sometimes there is no obvious reason, but some things can make it more likely that your child will have a hypo: • too much insulin • a delayed or missed meal or snack • not enough carbohydrate food • unplanned physical activity • if they are old enough, drinking large quantities of alcohol, or alcohol without food.

Spotting the symptoms Hypos can come on very quickly and your child will tend to develop symptoms that warn them.

The signs of a hypo vary, but typically include: • feeling shaky • hunger • anxiety • sweating • fast pulse or palpitations • going pale • irritability.

• blurred vision

issue four 2011

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s

health notes

Treating a hypo 1 Get your child to stop what they are doing – ignoring 2 3

4 5

a hypo means it will only get worse.

If there is time, do a test to make sure. If not, get them to eat first and test later.

Make sure they eat or drink something sugary, such as glucose tablets, jelly babies or a sugary (not diet) drink.

This fast-acting carbohydrate will raise their blood glucose levels quickly. The amount needed will vary from child to child. Don’t use chocolate – because of its fat content, it doesn’t work quickly enough.

Try to sit them down until they feel better.

After about 10 minutes, check their blood glucose again.

Many children will need a longer-acting carbohydrate, eg fruit, biscuit, small sandwich or their next meal if it’s due. This will prevent their blood glucose levels from dropping again.

Again, if needed, the amount will vary. Check with your paediatric team whether your child needs a follow-on snack.

The signs of a more severe hypo include difficulty concentrating, confusion and irrational behaviour.

When your child is first diagnosed with diabetes, it can be difficult to recognise a hypo, so if you’re not sure, do a blood test. Over time, you will start to recognise your child’s hypo warning signs, but bear in mind that these can change. It’s worth testing if your child shows any signs of a hypo, even if they are not their usual ones.

Severe hypos If a hypo is untreated, there is a risk that your child will become unconscious or have a fit. While this is not common, it’s important that you know what to do: • Never give them food or drink by mouth – this will cause them to choke.

• If possible, place them in the recovery position (on their side with their head tilted back).

• If you have been given a glucogen injection and have been shown how to use it, inject it as instructed.

If not, or if your child has not recovered within 10 minutes of giving the injection, phone for an ambulance.

Always tell your paediatric diabetes team if your child has a severe hypo, as their treatment may need to be altered.

Be reassured – in most cases, even if you didn’t treat the hypo, your child’s body would increase blood glucose levels naturally by releasing the glucose it has stored in the liver. This means they will eventually come round by themselves, though it may take some time.

Hypos at night Your child may not be woken by the mild symptoms of a hypo during the night, so their blood glucose levels may drop further and the hypo may become more severe.

If your child’s hypo hasn’t woken them, they may feel very tired and have a headache the next morning. If you suspect your child is having night-time hypos, do a blood test during the night. Ask your paediatric diabetes team what the best time for you to test is, as this will depend on the type of insulin your child takes. If you find your child is having hypos, talk to your paediatric diabetes team, as their insulin dose may need to be adjusted.

No matter how careful you are about remembering to test and inject, your child is bound to have some hypos.

They are a part of life with diabetes, so neither you nor your child should feel guilty if they happen. i For a comprehensive introduction to your child’s diabetes, order Diabetes UK’s Tots to Teens magazine (6042a, £4+p&p) on 0800 585 088 or visit www.diabetes.org.uk/parents. issue four 2011 balance 53

51-53 Life and healthColour2.indd 53

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life&health

Get Running: Couch to 5k (Benjohn Barnes), £1.49 What does it do? Allows you to improve your running stamina. Aims to have you running 5k (3.1 miles) in nine weeks. Initial runs are broken up into short bursts, with walking sections in between (eg 6 x 1.5-minute runs with 2-minute walks in between each run).

Pros: This app is great for people who want to get into running but don’t know where to start. You can repeat any distance until you are ready to move onto the next section.

The app provides motivational prompts and it works with your music. By the end of the programme, you should be able to run for 30 minutes without stopping.

Cons: There are possibly too many functions. This may be a positive for some people, but for those that like it simple, this app may not be for you.

Recommendation: Set yourself a clear goal and deadline by signing up for a local 5k run.

Even better, visit www.diabetes.org.uk/ running and sign up to one Diabetes UK’s fundraising runs!

54 balance

Smart way to

getfit Today’s smartphones definitely live up to their name. There are thousands of applications (apps) to download, and lots to help you get fit. Diabetes UK’s fitness guru Phil McCulloch takes a look at some of the most popular

Footsteps Pedometer (Palm Shadow Apps LLC), £0.69 What does it do? Tracks your every move, allowing you to see your step count, distance travelled and calories burnt throughout the day or for any walk or run.

Pros: This app is easy to use and works while your phone is in your pocket.

Hundred Push-ups (Softwarex Ltd), £1.49 What does it do?

Provides a six-week training plan that will have you completing 100 consecutive push-ups in one go, regardless of your current ability.

Pros: This app is excellent for helping you to develop core strength. It’s quick to set up and easy to use. The programme includes three 10-minute sessions per week, so can fit into any busy lifestyle. The app logs all of your sessions, clearly showing your progress in a range of charts. You can also sync this app to your phone calendar to provide timely reminders.

Cons: You do need to be committed to the programme. Results will come quickly but only by sticking to the plan.

There is a significant jump between weeks 3–4, which may put some people off.

Recommendation: Six weeks of push-ups may be too repetitive, so add this into a bigger training programme for variety.

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health notes

You can create music playlists, and it has a handy lock feature, so you can view your stats while exercising without interrupting the step count.

Cons: Some feedback shows that the step counts are not always completely accurate and can be interrupted when you receive a call.

Recommendation: Set yourself a challenge and see if you can reach the recommended 10,000 steps per day. If you use public transport, try getting off the bus or train a stop or two earlier to increase your step count and the amount of calories burnt.

nt .

»»»ON««« »TARGET« As everyone is different, you and your diabetes healthcare team should agree your individual blood glucose level target range.

These targets are to be used as a guide only.

» Adults with Type 1 Results will come quickly but only by sticking to the plan

Men’s Health Workout (Men’s Health), £1.49 What does it do? Takes all the best exercises from Men’s Health, the world’s largest men’s magazine. Includes pre-loaded workouts with step-by-step instructions.

Pros: If you are looking to add variety to your training sessions, this app is for you. 150 exercises are broken down into muscle groups so you can focus your sessions.

The app also provides 20 complete workouts, including no-weight workouts, so you can complete sessions any time, anywhere. You can try before you buy by downloading the ‘lite’ version for free.

Cons: Be aware of the expansion packs that are available. They repeat a lot of the exercises from the standard sessions and come at an additional cost.

Recommendation: Don’t have time for the gym? Use this app to create quick and easy sessions at home.

Don’t have a smartphone?

You don’t have to rely on the latest technology to get the most out of your chosen exercise plan. You can dust off those keep-fit DVDs, and if you are a member of a gym, an exercise specialist can set a plan for you and review it every six weeks or so. If you need a little more motivation, try getting a friend or family member to support you to reach your fitness goal – perhaps they’d even like to join you.

Another good option is to find out what’s on at your local park – this could include military fitness classes, fitness trails and free 5k parkruns (visit www.parkrun.com/events).

Many people find exercise classes more enjoyable and motivational than exercising alone. From relaxing yoga to active spinning, there’s something for everyone, so why not find out what’s on in your local area.

i Phil used apps available from the App store via iPhone or www.apple.com/ uk/itunes. The same or alternative apps are available for other smartphones – see your relevant app store for details.

Pricing correct at the time of going to print.

Aim for 4–7mmol/l before meals, and no more than 9mmol/l by two hours after meals.

» Adults with Type 2 Aim for 4–7mmol/l before meals, and no more than 8.5mmol/l by two hours after meals.

» During pregnancy Aim for 3.5–5.9mmol/l before meals, and no more than 7.8 mmol/l one hour after meals.

» Children (under

16) with Type 1 Aim for 4–8mmol/l before meals, and no more than 10mmol/l by two hours after meals.

» Children (under 16) with Type 2 Discuss individual targets with your diabetes healthcare team.

issue four 2011 balance 55 54-55 L&H AppsColour.indd 55

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life&health

Healthy eating on the go Always buy your lunch when out and about?

There are some easy things you can do to make sure it’s healthy

T

he first step to eating more healthily is knowing what’s in your food. Most supermarkets and large food and drink manufacturers now display ‘traffic light’ and/or Guideline Daily Amount (GDA) food labels on the front of their products, to help you make healthier choices.

Traffic light labelling tells you if the product has low (green), medium (amber) or high (red) amounts of fat, saturated fat, sugars, salt and calories per portion. So, the healthier the food, the more green lights it will have. Most foods will have a mixture of different-coloured lights, so try to choose products with more green and amber lights than red.

Guideline Daily Amount (GDA) labelling shows the amount of calories, sugar, fat, saturated fat and salt per portion of the product, and then expresses it as a percentage of the total amount of the nutrient that is recommended each day for a healthy, balanced diet. This is useful for helping you to decide how a particular food fits into your overall diet.

56 balance

Be aware when grabbing lunch on the go that some wraps, sandwiches and salads provide more than a third of the GDA of some nutrients.

With both food labelling systems, check the manufacturer’s idea of a portion or serving size (given in grams), as it may be different to yours.

Guideline daily amounts (GDAs) of calories and nutrients recommended for a healthy, balanced diet Calories

Sugars

Fat

Saturates

Salt

Women

2000

90g

70g

20g

6g

Men

2500

120g

95g

30g

6g

When there isn’t any nutritional information Not all manufacturers display nutritional food labels, particularly bakeries. In this case, the following top-six tips will help you to make healthier choices:

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basic care

1

Slimline sandwiches – many supermarkets offer healthier lunch ranges with low-fat spreads and dressings replacing high-fat mayonnaise, margarines and coleslaw. Healthier fillings to choose include: lean ham, chicken, turkey, fish, prawn or egg instead of fatty bacon, cheese, sausage or stuffing. Choosing grainy breads, instead of white, and sandwiches or wraps with salad will also bump up your fibre intake and help you to feel fuller for longer.

Check your salads – you may think choosing a salad is a safe bet, but many are swimming in high-fat dressings that bump up the calorie and fat content considerably. Take a look at the ingredients and remember that they are listed from the highestquantity ingredient first to the lowest-quantity ingredient last. Aim to choose salads with vinaigrette or reduced-fat dressing, or better still, none at all.

Meal-deal, no deal – try to avoid offers that encourage you to buy fattening crisps or sugary drinks with your lunch for a few pence more.

Likewise, resist the temptation to ‘supersize’, unless you know your lifestyle allows the extra calories, as most triple-decker sandwiches contain 500–600 calories, which is around a quarter of your GDA. Healthier snacks – help meet your five-a-day target by snacking on vegetable cruditiés and fruit, whether it is fresh, tinned or dried. Low-fat yogurts are also a good choice and an easy way to add bone-strengthening calcium to your diet. We all know that

2 3

4

Some sandwiches provide more than a third of the GDA of some nutrients regular crisps are high in fat, so instead choose oven-baked or lower-fat varieties, or individual packets of air-popped popcorn – though be aware they are still relatively high in fat, salt and calories.

Individual cake bars, though tempting, are full of calories, fat and sugar. Even ‘skinny’ muffins and cakes contain 300–400 calories, which is more than many chocolate bars. Individual slices of malt loaf, fruit loaf and tea cakes are a healthier alternative.

Drink well – if you’re watching your weight, remember that some ‘healthy’ smoothies contain added sugar, honey, yogurt or milk that can bump up the calories, fat and sugar content.

Even some fruit juices contain added sugar, so check the label before you buy.

Have a proper lunch break – if you’ve dashed out of work to buy your lunch, try not to run straight back to your desk to eat it. Taking the time for a proper lunch break will not only make you more aware of what you are eating and drinking (and therefore less likely to over-indulge), but also give you a chance to truly switch off and recharge your batteries. For an even healthier break, why not follow lunch with a brisk walk to work off some of those calories you enjoyed. i Turn to page 51 for tips on how to feel fuller for longer.

• ‘Know your labels’, a handy credit-card size guide, is free to download from www.diabetes.org.uk/shop.

5

6

What’s ‘high’ and ‘low’ per 100g Nutrient

High

Low

Total fat

More than 20g

3g or less

Saturated fat

More than 5g

1.5g or less

Sugars

More than 15g

5g or less

Salt

More than 1.5g

0.3g or less

Give some thought to the lunch you buy, and try to find time to eat away from your desk issue four 2011 balance 57

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58 balance

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issue four 2011

56-58 Basic careColour.indd 58

31/08/2011 13:46

spotlight on...

High blood pressure What is it?

Blood pressure is a measurement of the force of blood flow inside your arteries. It is stated as two figures, eg 130/80mmHg (millimetres of mercury).

The first figure is the systolic pressure, which is measured as your heart contracts and pushes blood through your arteries. The second is the diastolic pressure, which is measured when your heart relaxes in between beats to refill with blood.

Hypertension (or high blood pressure) is when your blood pressure is consistently higher than the target level – not just a one-off high reading.

What are the recommended blood pressure targets?

The target for people with diabetes is 130/80mmHg or less (it’s 140/85mmHg or less for people without diabetes). If you have kidney problems, your diabetes healthcare team may ask you to aim for a target of 125/75mmHg.

What’s the risk for people with diabetes?

People with diabetes are at increased risk of cardiovascular disease (heart attack and stroke), nephropathy (diabetic kidney disease) and other health conditions. Having high blood pressure further adds to this risk.

It is important to have your blood pressure checked at least once a year as part of your diabetes annual review, to make sure that it is in the target range and not increasing your risk of developing diabetic complications.

How is it treated?

There are many medicines available, but people with diabetes and high blood pressure are usually given ACE inhibitors or Angiotensin receptor blockers, because they are thought to help protect the kidneys as well.

Can lifestyle changes also help?

Yes. You can help to reduce your blood pressure by: Maintaining a healthy weight – ask for help if you need to shed excess weight. You could reduce

»»

your blood pressure by up to 1mmHg for each kilogram of weight lost.

Cutting down on salt – salt makes your body retain excess water and this raises your blood pressure. Try not to exceed the recommended daily amount of 6g.

Eating more fruit and vegetables – aim for at least five portions a day.

Drinking less alcohol – alcohol contains a lot of calories that could make you gain weight and may raise your blood pressure, so stick to the recommended weekly limit of 21 units for men and 14 units for women.

»» »» »»

You could reduce your blood pressure by up to 1mmHg for each kilogram of weight lost

»»Avoiding eating too much saturated fat – this

is usually found in red meats, butter, palm oil or ghee. Look for polyunsaturated fats and monounsaturated fats. They can be found in olive oil, rapeseed oil or sunflower oil.

Stopping smoking.

Reducing your stress levels.

Aiming to do some physical activity for at least 30 minutes on five or more days of the week.

To be safe, always get advice from your doctor or nurse before you start any new physical activity.

»» »» »»

Know your numbers The Blood Pressure Association’s awareness campaign ‘Know your Numbers!’ encourages adults in the UK to know their blood pressure numbers and take the necessary action to reach and maintain a healthy blood pressure. Know your Numbers Week, the nation’s biggest blood pressure testing event, this year runs from 12 to 18 September and provides free checks for around 250,000 adults across the UK. i For more on hypertension and Know your Numbers Week, visit www.bpassoc.org.uk. • For more on diabetic complications, visit www.diabetes.org.uk/complications. issue four 2011 balance 59

59 SpotlightKFcolour.indd 59

31/08/2011 12:30

ask karen

Do you have a health matter on your mind?

If so, write to me at: Ask Karen, c/o balance, Diabetes UK, 10 Parkway, London NW1 7AA. Letters may be edited.

60 balance

ON-BOARD SAFETY CHECKS On my recent flight to Thailand, one of the cabin crew noticed my insulin pump and continuous glucose monitor (CGM) just before take-off. I was told that I could use my pump but would have to turn off my CGM for the duration of the flight. Why was my monitor considered a hazard?

Tom, London Karen says…

Safety caution around insulin pumps and CGMs on aircraft is due to wireless functionality, which may interfere with aircraft communication and navigation systems.

Pumps or CGMs with remote handsets (where the handset is not attached to the insulin pod or body) send wireless signals via Bluetooth technology, so you should contact the manufacturer to see if this can be turned off for the duration of flights.

The Civil Aviation Authority’s Advisory Health Unit recommends that people with diabetes should always contact their airline before travelling to discuss the medical devices they intend to take on board aircraft. Airlines can then assess each piece of equipment individually.

People using Medtronic equipment can request an airport card from the manufacturer that gives technical details of the equipment, specifically for airport security and cabin crew.

In most devices, the frequency of wireless signals is very low and wouldn’t actually cause a problem.

However, cabin crew need to exercise caution and, if in doubt, could ask people to remove their equipment

altogether if they can’t turn off the Bluetooth capability.

If you can’t operate your pump or CGM without Bluetooth for the duration of the flight, you may need to be prepared to remove these pieces of kit and administer insulin with an insulin pen while on board the aircraft. You would also need to test your blood glucose levels manually with a standard blood glucose meter.

Your diabetes healthcare team can provide you with any extra equipment you may need, such as an insulin pen, and help you plan your doses throughout your journey.

FIT TO DRIVE? My 72-year-old husband was recently in hospital with diabetic ketoacidosis (DKA) but insists that he’s fit enough to drive. I’m worried about his safety.

Jean, Chester Karen says…

It’s understandable that you are worried about your husband – DKA is a dangerous condition, caused by consistently high blood glucose levels, which can be fatal. However, as your husband was discharged from hospital, it’s likely that his blood glucose levels are back within a healthy range and he’s no longer feeling poorly.

According to Driver and Vehicle Licensing Agency (DVLA) guidelines, people who treat their diabetes with medication that can cause a hypo (hypoglycaemia – low blood glucose levels) must test their blood glucose levels before driving and regularly during a long drive, preferably every two hours, and this may offer you some reassurance. DVLA guidelines

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31/08/2011 13:46

People must inform the DVLA if an existing medical condition gets worse

don’t specifically mention high blood glucose levels or diabetic ketoacidosis.

However, they do state that people must inform the DVLA if an existing medical condition gets worse, or a person develops any other condition that may affect their driving ability.

Your husband’s diabetes healthcare team or doctor will be able to advise about his ability to drive safely, and whether he needs to inform the DVLA or not. i See ‘News’, page 6, for changes to DVLA driving regulations. • Download Diabetes UK’s information sheet ‘Driving and Diabetes’ from www.diabetes.org.uk/driving. • Find out more about DKA at www.diabetes.org.uk/dka.

TWO RIGHT FEET I have neuropathy (nerve damage) in my feet and want to make sure that I’m wearing the correct size shoes, but I can’t find anyone who can provide the service – do you have any recommendations?

Claire, Armagh Karen says…

There are high-street shoe stores that can provide a measuring service, but it’s best to phone ahead of your visit, to make sure that there is a qualified member of staff available to help.

Shoe sizes are merely a guide – sizes and fittings vary between styles, country of origin, manufacturer, etc, and as there isn’t standardisation of shoe sizing in the UK, the size on the fitting gauge may only be a starting point, not what you actually require.

The right footwear will help to keep your feet healthy, so try to buy shoes that are: broad fitting; have a deep and rounded toe area; are flat or low-heeled;

and are fastened by a lace or buckle to keep your heel in the back of the shoe, so your foot can’t slide forward and squash your toes.

Your podiatrist will be able to give you specific advice about the shoes most suitable for you. i Contact the Society of Shoefitters for local information on 01953 851171. A guide to shoe buying and foot care is available at www.shoefitters-uk.org.

NEEDLE-FREE FEARS I have needle phobia and have been using a needle-free SQ-Pen to administer my insulin. My nurse has said this is no longer available on prescription. I’m really worried.

Is there anything available in the UK on NHS prescription that is similar?

Mark, Sheffield Karen says…

Unfortunately, your nurse is correct; the SQ-Pen, now known as InsuJet, is not currently available on prescription.

At the time of going to press, it’s not clear whether it will be again.

However, do rest assured that there is another needle-free product available on prescription in the UK for people with needle phobia, called Injex 30. It was developed to administer liquid medications, including insulin, through the skin to the subcutaneous tissue with pressure, instead of a needle.

Your diabetes healthcare team will be able to provide you with a prescription for the injector and consumables, and your pharmacist will be able to order it for you on presentation of your prescription. i Find out more about Injex 30 at www.injex.de/en/home.

0845 120 2960 Mon–Fri 9am–5pm careline@diabetes.org.uk Careline accepts TypeTalk calls and has an interpreting service

K aren is a trained therapist and Diabetes UK Careline counsellor.

She can answer your enquiries with help from a team of healthcare professionals. But only your diabetes healthcare team, which has access to your records, can answer enquiries about your personal situation.

issue four 2011 balance 61 60-61 Ask Karen-add news page.indd 61

31/08/2011 13:46

recipes

Kids get

cooking 62 balance

Encouraging your kids to help you in the kitchen is a great way to introduce them to healthier foods. Louise Blair’s children Ollie, Freddie and Tom, and their friend Evie, had great fun with these simple yet delicious recipes

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recipes

Pinwheel tasties Makes 10 • suitable for freezing before cooking • 1 x 250g sheet ready-rolled puff pastry • 2 tbsp sundried tomato paste or pesto or tomato purée • 2 spring onions, sliced • 2 slices lean ham, torn • 50g (1¾oz) grated cheddar • handful sweetcorn kernels

1 2 3

0 Lay the pastry on a work surface and spread over the tomato paste.

0 Scatter over the remaining ingredients, then roll up tightly.

0Cut into 10 slices, then cook at 0200°C/400°F/gas mark 6 for 12–15

minutes until golden and cooked through. Cool a little, then enjoy.

If you prefer, you can use any filling you like, eg tuna and sweetcorn or salami and tomato. You could also use fresh pizza dough, rolled out thinly, in the same way as the pastry.

Per pinwheel 127 Kcal / 3g protein / 10g carbs ( 1g sugars) / 8g fat ( 3.7g saturates) / 1g salt

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issue four 2011 balance 63 62-66 Recipescolour3.indd 63

31/08/2011 13:48

Fruity lollies Serves 6 • 1 portion of fruit and veg per serving • gluten free • vegetarian Children love iced lollies, so why not try these super-easy, healthy alternatives?

If you don’t have lolly moulds, you could use yogurt pots, pushing a lolly stick into them part-way through freezing.

• Fruit of your choice, eg blueberries, strawberries, mango, kiwi, raspberries, banana, etc. The amount will depend on the size of your lolly mould. For 6 lollies, the children used 450g strawberries and 125g blueberries.

1 2

0 Blend the fruit of your choice 0 and pour into lolly moulds.

0 Freeze until solid and serve.

Perfect!

Per lolly 35Kcal / 1g protein / 8g carbs ( 7g sugars) / 0g fat ( 0g saturates) / 0g salt

•

Super noodles

•

•

•

Serves 2 • vegetarian • 2 portions of fruit and veg per serving • not suitable for freezing For the sauce • 1 tbsp red wine vinegar • 1 tbsp tomato purée • 2 tsp light soft brown sugar • dash soy sauce • juice from 220g can pineapple in natural juice • 1 tsp sunflower oil • 1 clove garlic, crushed • 2 spring onions, sliced • handful mangetout, halved • handful baby sweetcorn, halved • half red or orange pepper, sliced • pineapple from 220g can, chopped • 150g thread egg noodles or rice noodles cooked according to pack instructions

64 balance

1 2

0 Mix together all the 0 sauce ingredients.

0Heat the oil in a large, non-stick 0frying pan, then add the garlic, spring onions, mangetout, sweetcorn and pepper. Stir-fry for 2–3 minutes until just softened.

0Add the pineapple and sauce, 0then heat through. Toss through the noodles and serve.

3

Per serving 488Kcal / 13g protein / 92g carbs ( 81g sugars) / 9g fat ( 2g saturates) / 0.7g salt

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recipes

Cranberry cookies Makes 30 • vegetarian • suitable for freezing before baking • 100g (3½oz) polyunsaturated margarine • 100g (3½oz) light soft brown sugar • 1 egg, beaten • 225g (8oz) plain flour • 50g (1¾oz) oats • 50g (1¾oz) dried cranberries or chopped dried apricots or raisins or, for a special treat, some chocolate chips

1

In a large bowl, beat together the margarine and sugar. Beat in the egg, and then stir in the remaining ingredients.

2

0Form the mixture into a dough, 0then place walnut-sized pieces on a baking sheet and press down with a fork.

0Bake at 180°C/356°F/gas mark 04 for 12–15 minutes until golden.

Cool, then serve with a glass of milk. Yummy!

3

Per cookie 78Kcal / 1g protein / 11g carbs ( 4g sugars) / 3g fat ( 1g saturates) / 0g salt

• •

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•

KIDS’ COOKERY GIVEAWAY Fancy getting your kids cooking? balance has six Eddington’s Mini Chef 11-piece cooks sets to give away, containing everything a budding chef needs!

To enter, send your name and address on a postcard or sealed-down envelope to: ‘balance mini chef giveaway’, 10 Parkway, London NW1 7AA to arrive no later than 21 October 2011. Six entries will be picked at random and the winners will be notified within 14 days. issue four 2011 balance 65 62-66 Recipescolour3.indd 65

31/08/2011 13:50

Banana and blueberry muffins Makes 18 • vegetarian • suitable for freezing Muffins are great in a lunch box or for a teatime snack. These have been made in fairy-cake cases; you could use large muffin cases, in which case you would make 12 muffins, but you will need a little extra cooking time.

• 150g (5oz) self-raising wholemeal flour • 100g (3½oz) self-raising flour • 1 tsp baking powder • 50g (1¾oz) oats • 75g (2¾oz) light soft brown sugar • 125g (4½oz) blueberries • 3 ripe bananas, mashed • 75ml (5 tbsp) sunflower oil • 1 x 284ml carton buttermilk • 1 egg, beaten

1 2

0 Stir together the two types of flour, 0 baking powder, oats and sugar, and then mix in the blueberries.

0In a separate bowl or jug, 0fork together the remaining ingredients, then quickly fold into your first bowl. Be careful not to over-work this mixture if it looks a little lumpy – this is fine as it will give a lovely light end result.

0Spoon the mixture into 18 paper 0cases in a muffin tin and bake at 180°C/356°F/gas mark 4 for about 15 minutes until golden and well risen.

0 Cool and serve or store.

3

4

Per muffin 137Kcal / 3g protein / 20g carbs ( 9g sugars) / 5g fat ( 1g saturates) / 0g salt

•

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With thanks to Pearl and Rob Neish for the use of their lovely home for this photo shoot.

66 balance

For yummy kids’ sandwich ideas, visit www.diabetes. org.uk/balance.

issue four 2011

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31/08/2011 13:51

amuse bouche

In season

September Artichoke and aubergine are healthy toppings for pizza, while plenty more vegetables are in good supply, including beetroot, broad beans, leeks, mangetout, marrow, spinach and turnips. Make the most of berries and make way for sweet, crunchy apples.

An easy way to... cut a mango »» Choose a mango that is ripe but still firm – these tend to be more yellow or red in colour. »»Hold the mango on its end, stem-side down, so that the large, flat stone runs vertically through it. »» Slice from the top of the mango down one side

of the stone, then repeat with the other side, leaving two halves and a middle section.

Take each mango half and cut the flesh into a criss-cross, then gently push it from the skin side, so that the mango segments are revealed, like a hedgehog, for you to peel from the skin.

Finally, take the middle section of the mango and use a paring knife to remove the stone and the remaining peel – waste not, want not...

»» »»

Grown your own cress • Find a suitable container,

October Butternut squash and pumpkins are delicious additions to curries; parsnips to roast dinners; and celeriac and watercress to soups.

Enjoy perfectly ripe pears, which are in abundance.

eg egg cups, egg boxes, tea cups, clean yogurt pots or whatever you have to hand.

Wet a piece of kitchen roll and squidge it into your container, sprinkle over the cress seeds and pop onto a window sill or somewhere nice and bright.

Make sure you keep the kitchen roll damp and watch the cress grow!

•

One mojito (224 calories)

=

30 mins’ fast ballroom dancing

•

Gourmet on the go

Quick corn fritters

Serves 2 • 1 portion of fruit and veg per serving • vegetarian • dairy free • not suitable for freezing

+

=

+

In a bowl, whisk together 50g self-raising flour, 1 egg, 1 x 198g can sweetcorn (drained), 2 chopped spring onions, half chopped red chilli and 2tbsp coriander. Drop spoonfuls of the mixture into a non-stick frying pan lightly brushed with olive oil. Cook for a couple of minutes on each side, then serve with a tomato salsa (either fresh or from a jar). Yum! Per serving 240Kcals / 8g protein / 40g carbs ( 6g sugars) / 6g fat ( 1g saturates) / 0.7g salt

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•

issue four 2011 balance 67 67 Amuse bouche JC.indd 67

31/08/2011 12:31

TIHA5014 Balance Magazine Ad_Layout 1 08/08/2011 15:10 Page 1

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But the best bit is nobody can see it.

SoundLens is a completely new concept in hearing help and compensates for your individual hearing loss. Everything works automatically too. There are no controls to worry about so there’s no need to keep fiddling about and adjusting settings. You can start enjoying life again as you concentrate on hearing, rather than thinking about your hearing aid.

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issue four 2011

68-71 Back BitColour.indd 68

World’s first invisible-in-the-canal hearing aid Custom designed for your ear Virtually no whistling or buzzing Works great on the phone Natural sounding ✔ Completely digital

* Invisible when worn when correctly inserted in ear canal

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68 balance

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Please post me FREE, AND WITHOUT OBLIGATION, details of the SoundLens Invisible Hearing Aid. Tick if pensioner

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31/08/2011 13:51

the back bit

•

Chatroom Get connected to others with diabetes. Reply to an ad (include the full name of the person you are replying to) or send your own ad to: balance chatroom, 10 Parkway, London NW1 7AA. After balance has forwarded on replies, correspondence is made directly between individuals.

Hi, I’m 28 years old and have had Type 1 since I was 19. I still find it hard to accept sometimes, especially as I have only met one other person with Type 1 who is under 50. I have a 2-yearold daughter and a Springer Spaniel. I love dancing and Glee. If there are any other ‘young’ diabetics out there, drop me a line.

Please reply to Chloë Conway, c/o balance chatroom.

I’m 69 and have had Type 2 for five years, treated with metformin. I’d like to hear from ladies who enjoy writing letters. I like card making, walking, gardening, reading, crosswords and sudukos.

Please reply to Mrs K A’herne.

I’m 44 and was diagnosed with Type 1 in 1981. I am looking for females in Croydon and the surrounding area, who are also diabetic, for friendship and socialising. My interests are music, holidays in the UK and abroad, and watching football and various TV programmes (but not soaps).

Please reply to Ian Smith.

I’m 68 and have Type 2 diabetes, arthritis and the occasional leg ulcer, which means I can’t walk very far.

I enjoy my pets, pot plants, correspondence, handicrafts and reading. I’d like to write to someone with diabetes who understands how miserable you can get at times.

Please reply to Maureen Songhurst.

READER OFFER Up to 35 per cent off weekend breaks Fancy a weekend away but feeling the pinch? Fear not, because thanks to our friends at IHG (InterContinental Hotels Group), balance readers can enjoy up to 35 per cent off UK weekend breaks.

The offer is available at more than 220 participating Crowne Plaza, Holiday Inn and Holiday Inn Express hotels across the UK until 31 December 2011. To take advantage of this great offer, plus some great package deals, visit www.ihg.com/roomoffer or call 0871 423 4874, quoting ‘Exclusive’. Calls to 0871 numbers cost 10p per minute when dialled from a BT landline. Terms and conditions apply – see IHG website for details.

Me & my balance

Here’s Parris Keirle, 18, taking balance out to sea while on holiday with her parents. Parris, who was diagnosed with Type 1 aged 10, tells us that thanks to her pump, she enjoyed the great selection of food on-board the ship.

Parris says: “balance is amazing, as is Diabetes UK. We always pass balance onto my 85-year-old nanny, who likes to keep informed of the interesting issues.”

WellVersed A holiday It would be nice to take a day off From being diabetic and do what I like.

Not inject insulin nor take a pill; To consume lots of sugar, forget that I’m ill.

To eat cakes and biscuits, in chocolate indulge; Not having to battle from having a bulge.

Not having to stick to the times when I eat, Or planning my portions and not have a sweet.

Not doing a blood test three times in the day, Disposing of needles in a safe, harmless way.

To dine out on pizzas and puddings galore And not find a place to inject any more.

It would be nice if I lived life like you But my doctor said this is what I mustn’t do.

I know my diabetes will not go away But can’t I forget it, just for one day?

Andrew Diamond issue four 2011 balance 69

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31/08/2011 13:51

the back bit

Imaginingdiabetes This issue’s theme: diabetes on holiday.

Martyn Revis wins with this shot of the beautiful Welsh mountains, taken when he was hiking Mt Snowdon. He’s now done the three peaks: Ben Nevis, Mt Snowdon and Scafell Pike, the last two while having Type 1 diabetes. Martyn tells balance: “I’d never tested and injected in front of such an amazing view before (see inset photo).

“I never let diabetes stop me doing what I want to do – things might take a bit more effort than usual, but that makes them all the more satisfying to accomplish."

Next issue’s theme: Autumn days.

Email a high-res image to balance@diabetes.org.uk or post photos to the usual balance address by 21 October 2011. Each winner receives a Diabetes UK scraggy bear.

I love my...

Is there someone you couldn’t do without when it comes to your diabetes? If so, tell us about them – write to the usual balance address marked ‘I love my…’ or email balance@diabetes.org.uk.

Dr Lamb at Bishop Auckland General Hospital, County Durham has been my diabetes doctor since I was diagnosed at 7 years old. He has dedicated his time to raising money to buy insulin pumps for the children in his care. He has run many marathons and attended lots of coffee mornings to reach his mammoth goal. He is on call night and day if you ever need him, and he genuinely wants to help all the kids stay healthy and manage their diabetes well. He has persuaded the primary care trust to fund the purchase of the pumps, convincing them of the great benefits they provide, and continues to canvass on our behalf. All the kids I speak to think the same as I do about Dr Lamb. I just feel so sorry for the kids in the future, when Dr Lamb retires!

Rebecca Robinson, 14, County Durham

A BALANCED LIFE – JOHN BYRNE

balance what we’ve learnt this time... there’s lots of interesting research helping young people with diabetes (p28) Diabetes UK’s kids’ and family events are life changing (p34) a phone can get you fit (p54) Lord Sugar is very funny (p46)

and coming up next time... what to do if you lose your hypo signs be alcohol-aware at Christmas veggie Christmas recipes stress and diabetes young researchers in diabetes The next balance is available from 1 November.

70 balance

issue four 2011

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31/08/2011 13:51

-

The Finest

Quality and Comfort in Extra Depth Footwear: TRUE COMFORT & STYLE

Half sizes and up to 4 width fittings.

DR. COMFORT FOOTWEAR CAN HELP TO REDUCE THE ADVERSE EFFECTS OF FOOT COMPLICATIONS.

Extra width and depth in the toe box to help prevent pressure on swollen feet, bunions and hammertoes.

Fully leather lined to keep feet cool and dry.

Superior quality gel plus insert gives additional, comfort, stability & support.

- 51 Men’s & Ladies’ styles including:

FORMAL: Wing Chestnut Men’s Shoe

FORMAL: Flute Black Ladies’ Shoe

SPORT: Spirit Plus White Ladies’ Shoe

CASUAL: Patrick Chestnut Men’s Shoe

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Contact us for details of your nearest Dr. Comfort Stockist.

www.simplyfeet.co.uk issue four 2011 balance 71 31/08/2011 13:51

Monarch of the glens Roly Smith heads north of the Border to discover the fabled Lost Valley of Glen Coe

G

len Coe is without doubt the most majestic and dramatic of all Scotland’s glens – a rich mixture of brooding history, soaring rock buttresses and towering peaks, which are usually hidden from view under constantly shifting veils of mist and cloud.

Forever associated with the massacre of members of the clan Macdonald in 1692, apparently an act of treachery by their Campbell guests, Glen Coe was melodramatically dubbed by the Victorians as the ‘Glen of Weeping’.

For the traveller heading north for Fort William along the A82, Glen Coe always comes as a bit of a surprise after the lochan-spattered

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wilderness of Rannoch Moor.

The first sign that something dramatic is about to happen is the astonishing sight of the great, gullied pyramid of rock of Buachaille Etive Mòr (meaning the ‘Great Herdsman of Etive’), which stands sentinel at the entrance to Glen Coe. Our walk visits Coire Gabhail (pronounced ‘corry gale’) – also known as the ‘Lost Valley’ of Glen Coe. It is situated between the first and second Sisters of the famed Three Sisters of Glen Coe – the triple buttresses of Beinn Fhada (Long Hill), Gearr Aonach (Short Ridge) and Aonach Dubh (Black Ridge) – which thrust north from the reigning summit

of Bidean nam Bian, like the clenched knuckles of a fist.

Guidebooks claim that Coire Gabhail (which means the coire, or hollow, of capture) is where the Macdonalds hid the cattle they had stolen from their neighbours in the days when cattle-rustling was something of a croft-industry in the Highlands. Certainly the broad, green sanctuary of Coire Gabhail is well hidden from the old road, which passes through the glen below. But, as we will see, it would take a very determined rustler to drive a herd of cattle up into this mountain fastness, and equally it would be very easy to defend it with a handful of claymore-wielding warriors.

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walk this way

Where? Glen Coe is 17 miles (27km) south of Fort William on the A82. The car park is on the left side of the road, about 2 miles (3km) before the Clachaig Inn. Distance About 5 miles (8km).

Time Allow at least five hours.

Difficulty Extremely steep and rough in places, and should only be attempted by experienced hillwalkers.

Public transport CityLink runs a national coach service from Glasgow/Edinburgh to Fort William passing through Glencoe village.

For more details, visit www.citylink.co.uk.

Stagecoach runs service no. 44 from Fort William to Kinlochleven via Glencoe village.

For details, visit www.stagecoachbus.com.

Maps Ordnance Survey 1:25,000 scale Explorer no. 38, Ben Nevis and Glencoe.

Accommodation The Clachaig Inn (01855 811252; www.clachaig.com), popular with climbers, offers a good pint or dram and bunkhouse accommodation.

Loch Leven

Glencoe Aonach

A82

Lost Valley Three S iste rs Bidean nam Bian

Main image (far left): the majestic Lost Valley of Glen Coe. Above: Glen Coe deer, spectacular waterfalls, a memorial to the massacred and a map of the area

The road to Coire Gabhail It is still a tough and difficult walk to reach Coire Gabhail, and this route should only be attempted by fit and experienced hillwalkers.

Start from the large car park half way up Glen Coe at NN170569, following the obvious path down towards the river, close to the waterfall known as the ‘Meeting of Three Waters’. A series of wooden steps takes you down into the narrow, rowan-hung gorge of the Coe, which is crossed by a footbridge, and up and out of the other side.

The path winds steeply up through the rocks and heather, with fine views back across the glen to the serrated edge of Aonach Eagach (Notched Ridge) behind.

Eventually, you reach the deer fence, which is crossed by a tall ladder stile, to start the climb around the side of the impending mass of Gearr Aonach.

The path now narrows and passes through a sparse woodland of birches and rowans high on the

western bank of the Allt Coire Gabhail, which thunders below through a series of spectacular waterfalls. Take extra care here, for many people have slipped on this narrow path, which is crisscrossed by sinuous tree roots.

Keep to the path and river as close as you can, as the climb steepens towards the mouth of the coire above. This is difficult country and a sure footing is needed to negotiate the many large boulders that have fallen from the ridge of Gearr Aonach above. After crossing the infant river, and what seems a lifetime enclosed by rock and trees, you eventually emerge into the startling enclosed valley of Coire Gabhail by a huge, housesized boulder that partially blocks its entrance.

The scene that presents itself is truly breathtaking. At a height of about 1,200ft (365m), the flat, green meadow floor is enclosed by the walls of Gearr Aonach and Beinn Fhada, which sweep round to the great buttresses at the head of the

valley and the pass of Bealach Dearg, which eventually leads up to the unseen summit of Bidean nam Bian to the right. If you are really lucky, as I was on my first visit, you’ll be greeted by the magnificent sight of a golden eagle soaring effortlessly on fingered wings above the bealach (pass).

Walk up the valley as far as you wish, and then make your way back the way you came, as carefully as before, down that steep, rocky staircase, over the footbridge and back to the car park.

GIVEAWAY If you fancy exploring north of the Border for yourself, try getting your hands on one of five copies of Fort William & Glen Coe Walks (Pathfinder guide) that balance is giving away. To enter, send your name and address on a postcard or sealed-down envelope to: ‘Walk this way’, 10 Parkway, London NW1 7AA, before 21 October 2011. Five entries will be picked at random and the winners will be notified within 14 days. issue four 2011 balance 73

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If you would like to advertise on these pages, please call Claire Barber direct on 020 7878 2319

If you would like to advertise on these pages, please call Claire Barber direct on 020 7878 2319

fun&games 1

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Win £100 House of Fraser vouchers 7

ACROSS 1 Curvature of road surface (6) 4 Stratagem (6) 9 Exact copy (9) 10 Animal of raccoon family (5) 11 Persuade (4) 12 Brazilian dance (5) 14 Preside over (meeting, eg) (5) 15 Lure (5) 17 Narrow hilltop (5) 19 Acid-tasting (4) 21 Urge (5) 23 Decorated (meal) (9) 24 Sign up (6) 25 Pact (6)

8 9 10 11 12

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DOWN 1 Big Top entertainment (6) 2 Silicate mineral (4) 3 Productiveness (8) 5 Dry (4) 6 Snow storm (8) 7 Earthquake (6) 8 Flamboyance (5) 13 Oily fish (8) 14 Passageway (8) 15 Tropical fever (6) 16 Fine-quality coffee (5) 18 Accolade (6) 20 Prejudice (4) 22 Cougar (4)

SOLUTION to issue three 2011 ACROSS 1 Hepatic, 5 Pecan, 8 Nacre, 9 Parma, 10 Karma, 14 Lozenge, 16 Proof, 17 Afoot, 18 Debacle, 22 Larch, 25 Omega, 26 Ebony, 27 Pound, 28 Neptune DOWN 1 Handel, 2 Puck, 3 Trek, 4 Charles Darwin, 5 Papa, 6 Cure, 7 Neat, 11 Felon, 12 Bream, 13 Fool, 15 Offa, 19 Enzyme, 20 Pomp, 21 Beau, 22 Lard, 23 Hemp, 24 Tofu

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Name Address Postcode

PRIZE CROSSWORD To enter: Cut out the grid and send to the usual balance address (see page 3) marked ‘Crossword’. The first correct entry drawn after 21 October 2011 will win £100-worth of House of Fraser vouchers, thanks to our friends at the department store. Please don’t send any other balance or Diabetes UK correspondence with your entry. Congratulations to last issue’s winner, J Wager from Leeds.

Wordworkout

W I N Y O G K L N

How many words can you make from this box of letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word.

Names and plurals are not allowed. There is one nine-letter word in the grid. Clue: By design.

15 = Average; 20 = Good; 25 = Excellent.

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LINKLETTER

BA LI

RY LY

Find the missing letters that link each two pairs of words, as per the example.

When completed correctly, the inserted letters read in order will spell out a 10-letter word. Example:

WA PU

LE ER

SI SP

NT EN

MA PA

AS ES

ST GR

PS PY

FR CL

OS

TY ET

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Y Y

E R

T N

S S

S Y

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Balanc

B O

Arthur‘s armchair

Diab-flexibility This time, Arthur reflects on the lost art of flexibility – and how it made things so much easier…

T Do you imagine I am selling insulin on the black market?

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here used to be an ad on TV for a credit card, which described the little plastic oblong as ‘your flexible friend’ – you saw it bulging gently as a thumb and finger squeezed each end. The Access card is no more, and these days if you flex a credit card, it will not bend with the pressure but fracture or snap, so that you have to cancel it and order a new one.

It seems to have gone out of fashion in recent years, roped off into a corner by new rules and digitilisations, but I believe that for our mutual benefit we should now revive the lost art of flexibility. Or maybe we shouldn’t…

The diatribe above follows a recent run-in I had with a pharmacist over my diabetic supplies; I was going away for a few days but did not have quite enough fast-acting insulin to last me.

I really needed a pen to tide me over.

No problem. I stopped at the chemist on my way to the station, expecting to be able to put in my usual prescription, which is for five NovoRapid pens, and take one pen on tick to tide me over.

I hope you’re keeping up…

I have been going into the shop for years to get my supplies and, on the rare occasion that I need it, the pharmacist has always advanced me a pen. There was, however, a new chap behind the medicine counter, who insisted that I would have to go to the

O

doctor to get a new prescription before he could give me an emergency pen.

‘But,‘ I protested, ‘I have always done this in the past... the staff all know me...‘ But it was no good – I would have to book an appointment and hang around until the doctor signed a new prescription. This, in turn, would make me miss my train and be late for the show I was due to perform.

I got a bit shirty: ‘Look, I know you are doing it by the book but I am really in a hurry. It’s a waste of my time and the doctor’s. I mean, what do you think? Do you imagine I am selling insulin on the black market?‘ Later, after I had found a NovoPen in a jacket pocket at home, thus saving myself a trip to the surgery, I felt a bit guilty for being a little hard on the poor man – he was, as they say, only doing his job, and the regulations by which he is governed, do not, by their very nature, permit a flexible approach.

So, sorry my friend.

And now I'm off to the supermarket, this time with enough money in my pocket – last time I had only £23.66 to cover my £23.67 bill. And, as we know, in supermarkets, they cannot let you off with the penny or let you pay it next time you are in the shop.

No, no, no, not today, not in the inflexible age. i Arthur Smith is a comedian, writer and broadcaster with Type 2 diabetes.

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