Balance Magazine Nov-Dec 2012

balance

WIN

A VIRGIN BALLOON FLIGHT PAGE 65

Your diabetes lifestyle magazine • November – December 2012

SIGNS & SYMPTOMS

ALL NEW

NHS

Diabetes UK’s kids’ campaign

What the changes mean

PLUS

Beat SAD; get five-a-day savvy; calculate your new HbA1c; & what to expect at your dietitian appointment

GOOD THINGS...

Hearty meals from Hugh FearnleyWhittingstall

Type 1 pilots get ready for take off

“My Type 2

“

SKY HIGH

shock Benny talks diabetes and destiny

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PACK

SOME

INSURANCE SERVICES

PEACE OF MIND...

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Your team are very professional, organised, nothing is “ too much trouble…and you don’t have any annoying ‘on hold’ music either! From start to finish it was exceptional and I’ll be calling again the next time I need insurance!

Mrs Porter, Worcestershire

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Diabetes UK Insurance Services is a trading name of Heath Lambert Limited which is authorised and regulated by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 1199129 England & Wales. www.gallagherheath.com Gallagher Benefits Consulting Limited is authorised and regulated by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 0772217 England & Wales. www.gallaghereb.com Funeral plan is provided by Dignity Pre Arrangement Limited. A company registered in England No.: 1862158. VAT registered No.: 486 6081 14. 4 King Edwards Court, King Edwards Square, Sutton Coldfield, West Midlands B73 6AP Telephone No.: 0121 354 1557. Fax No.: 0121 355 8081. Part of Dignity plc. A British company. Registered with the Funeral Planning Authority.

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Key Retirement Solutions is authorised and regulated by the Financial Services Authority.

All benefits payable are subject to BHSF Limited policy terms: Copies available on request. BHSF Limited is authorised and regulated by the Financial Services Authority.

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contents November – December 2012 • no 249

balance

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

by Diabetes UK, the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes.

10 Parkway, London NW1 7AA 020 7424 1000 balance@diabetes.org.uk www.diabetes.org.uk/balance EDITOR Angela Coffey DEPUTY EDITOR Sabeha Syed DESIGNER John Clarkson EDITORIAL SECRETARY Melanie Aldridge CONTRIBUTOR Sheila Seabrook AD MANAGER Claire Barber, 020 7878 2319 claire.barber@tenalps.com COVER IMAGE Piers Allardyce ABC APPLICATION APPROVED 18/04/2012 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 2012 A charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136).

regulars 4 6

THIS IS DIABETES UK NEWS

features

24 STAR GAZING

With recent news that pilots with diabetes can fly professionally, we meet Karl Beetson, whose dreams may just come true

Diabetes round-up

16 OPINION & LETTERS 20 RESEARCH MATTERS 50 RECIPES Three... is the magic number Hugh Fearnley-Whittingstall creates good, hearty dishes

29 ALL CHANGE?

After much debate, the NHS in England is set to change in April. So what’s next – and what exactly will change?

54 BITE-SIZED For foodies

56 WALK

Walk the movies

58 TRAVEL

Driving Miss Daisy, a 1934 Austin Seven, to Spain and back

60 FUNDRAISING FOCUS

Celebrating your achievements and upcoming events

64 FUN & GAMES

Win £100 John Lewis vouchers and a Virgin Balloon Flight

66 DIFFERENT TYPES rthur Smith and A Mari Wilson tell it like it is

life&health

32 FUTURE PAST

B enny Bonsu, 31, was shocked to be diagnosed with Type 2 earlier this year during a hectic time in her career. But she tells us how she’s determined to make her condition a positive part of her future

37 FUNDING OUR FUTURE

41 HEALTH NOTES

Can you count on your five a day? Spot the signs of Seasonal Affective Disorder; stretch it out for a flexible future; calculate your new HbA1c; and the honeymoon period explained

45 ASK THE EXPERTS

Parents’ special DLA refusal; disconnecting your pump; & dealing with life-changing events

47 SPOTLIGHT ON...

Your dietitian appointment

48 BASIC CARE

12 days of Christmas: The balance guide to the festive period won’t spoil your fun, but it will help keep your diabetes in check

As Diabetes UK prepares to launch its Children and Young People’s campaign, Dr Richard Elliott looks at how the charity is helping to future proof tomorrow’s generation

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

A YEAR OF PROGRESS

CARE

I

Diabetes UK’s Careline provides confidential support and information to all people affected by diabetes. Call 0845 120 2960, Monday to Friday, 9am–5pm. Careline accepts TypeTalk calls and has an interpreting service.

Please check the cost of calls to 0845 numbers with your phone provider. Write to: Diabetes UK Careline, 10 Parkway, London NW1 7AA for a response within 21 days. Email careline@diabetes.org.uk for a response within 10 working days. Careline cannot provide individual medical advice.

t’s probably a bit early to be looking back at 2012, Money is tight but what a year. So perhaps we can be forgiven and we thank for collapsing in a metaphorical heap and becoming reflective. everyone who What has the year held? Well, a lot of effort – has donated helped by many individuals and voluntary groups across the four nations – to really get diabetes up the agenda, both for the public and the decision-makers. We’ve been pretty successful in that many more people are aware of diabetes and its complications, though our research shows that most members of the public are a bit hazy about the risk factors for diabetes, and the signs and symptoms.

We hope to be able to turn that around with a major push next year.

And decision-makers in all four countries of the UK are having to take diabetes more seriously as numbers of people and their families affected with the condition soar and NHS costs rise. Our research was seminal into the costs of diabetes, with 10 per cent of the NHS budget spend on diabetes and, alas, too much of that dealing with avoidable complications.

Our new brand helped get the messages across. There was some weeping with the demise of the pink hummingbird, but even folks who doubted are telling us the new brand is more positive and working.

I must admit when I saw 2,600 runners in blue Diabetes UK vests, complete with blue ‘crazy hair’, crossing the Tyne Bridge during the Bupa Great North Run, it didn’t half look great!

CONNECT Diabetes UK’s Peer Support network connects people living with diabetes, to share information, experience and support. Call 0843 353 8600 on Wednesday: 12pm–3pm; Friday: 9am–12pm; or Sunday: 7pm–10pm. You can also exchange emails – for details, visit www.diabetes.org.uk/peer-support.

CAMPAIGN

Campaigns

Diabetes Voices is the charity’s network for people who want to influence diabetes care. From quick and easy online actions to campaigning to improve services in your area – there will be some way for you to help. Sign up today at www.diabetes.org.uk/diabetesvoices.

Our campaigns have come thick and furious. Ensuring more than 1 million people with diabetes had a copy of the 15 Healthcare Essentials that everyone should get every year was a big effort, working with healthcare professionals, volunteers and voluntary groups. There are big differences geographically whether people receive all 15 or not and we’re now campaigning to persuade health services in those parts of the UK to up their game. Diabetes Voices, the frontline of Diabetes UK volunteers, have helped spread these messages within their local health service. Sign up if you aren’t a Voice yet (see right).

A big thank you to everyone who helped.

This issue of balance launches our kids’ campaign (page 12) with a push to get people to recognise the signs and symptoms of Type 1 diabetes so that far fewer children end up being diagnosed in a state of collapse at A&E. Our Careline services were extended and we started up the Peer Support (Buddy) network (see right). Our ‘yoof’ are currently helping us design services for younger people. And we’re designing an online information and support course for people with Type 2 diabetes.

Money is tight and we thank everyone who has donated. Every little helps to enable us to care, connect and campaign for people with diabetes and those at high risk.

Baroness Young, Chief Executive, Diabetes UK

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JOIN Diabetes UK 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 six times a year. To join, call 0800 138 5605 or, for details, call Supporter Services on 0845 123 2399.

CONNECT ONLINE

www.diabetes.org.uk www.diabetessupport.co.uk www.facebook.com/diabetesuk http://twitter.com/diabetesuk

balance November – December 2012

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Advertorial

Before breakfast

Pattern Guide

The importance of Pattern Management

The key to reducing the risk of short and long-term complications associated with diabetes is to minimise high and low blood sugar levels.

However, for nearly three million British people living with diabetes, this can be a daily challenge1. Different ways of thinking, combined with technological advances, can help ease this burden for diabetics.

What are your views on hypos and how best to effectively manage them?

Severe hypoglycaemia is distressing, dangerous and can have a profound effect on the individual’s home and working life, including their ability to drive. People with diabetes should be educated on how to treat episodes of hypoglycaemia, knowing to always carry fast acting carbohydrate and to contact their diabetes team if recurrent hypoglycaemia develops.

What is pattern management and how can it benefit the person with diabetes?

Pattern management is the observation of blood glucose patterns and altering treatment regimens or lifestyle factors accordingly. It is tempting for people with diabetes to ‘chase’ blood glucose levels.

Overcorrection with insulin can lead to hypoglycaemia and poor glycaemic control. Identifying patterns and taking appropriate action can help improve glycaemic control.

What are your thoughts on OneTouch® Verio® IQ? OneTouch® Verio® IQ looks good, is light so easy to carry and has a rechargeable battery. High or low patterns can be viewed prompting the person with diabetes to review insulin dose, food choices and activity and make the necessary changes to avoid hypo or hyperglycaemia in the future.

IMPACT OF DIABETES As you know, if the appropriate management of diabetes is not adhered to, the increased risk of problems associated with hypoglycaemia and hyperglycaemia can be acute and enduring.

Hypoglycaemia (low blood sugar) can result in severe impairment of cognitive function including reduced concentration and motor co-ordination and in some cases can lead to seizures, coma, and even death2,3. Furthermore, repeated hyperglycemia (high blood sugar) can lead to a number of longterm complications. With the associated dangers as they are, it is a pressing and worrying statistic that two-thirds of individuals do not achieve their target HbA1c level4,5.

DRIVING CHANGE It’s not easy balancing an already busy life while considering the daily management of diabetes. However, new rules from the DVLA mean its mismanagement can now have an even greater impact on your social as well as physical life. If someone has two or more episodes of hypoglycaemia requiring assistance in a year, they must tell the DVLA and are advised not to drive6.

Health care professionals are now obligated to inform the DVLA, and you are expected by law to notify your insurance company if you have diabetes, no matter how it is treated7.

DECODING DIABETES MANAGEMENT With the fast development of diabetes therapies and advances in medical management, it is difficult to keep up with what may be the best management strategy for you. This leads many people feeling overwhelmed and hesitant, so when single blood glucose levels are out of the desired range it is tempting to react immediately, which may then lead to over correction with insulin and subsequent hypoglycaemia.

PATTERN MANAGEMENT – EMPOWERING THE PATIENT Pattern management provides diabetics with real time information helping you and your healthcare professionals identify a potential problem before it occurs. It is a systematic approach that picks up patterns in blood glucose readings to determine whether changes in treatment or lifestyle are needed to optimise glucose control8.

Although pattern management is a vital approach to diabetes management, only 37% of patients review their blood sugar results in a log book and only 14% of patients actually download their meter at home9.

After breakfast lunch

After lunch dinner

After dinner overnight

overnight After dinner

NRETTAP WOL

An expert’s view Q&A with Diabetes Nurse consultant Maureen Wallymahmed (Aintree University NHS Trust)

LOW PATTERN

TACKLING HYPOGLYCAEMIA

dinner

It is therefore clear that patients need a way to After lunch Patternof Guide simplify the process pattern management while lunch maximising the potential benefits. This is why After breakfast LifeScan have introduced OneTouch® Verio® IQ.

Before breakfast

ONETOUCH® VERIO® IQ– PUTTING PATTERNS INTO PRACTICE With OneTouch® Verio® IQ and PatternAlert™ Technology, every time you test, it looks for patterns of high and low blood sugar and alerts you when it finds one – right on screen.

What Diabetes patients think • 9 out of 10 patients thought OneTouch® Verio® IQ was better or much better than their previous meter • 80% said that the system helps you have better conversations with your HCP • Out of all patients who received a high or low blood glucose pattern message, 100% found it useful or very useful System Trial Questionnaire9

The OneTouch® Verio® Pattern Guide works alongside OneTouch® Verio® IQ to uncover root causes and suggest steps to bring results back into target range. This allows you to take the actions necessary to control your own diabetes in a simple, accurate and effective way, letting you enjoy everyday life without complication.

To find out more, scan the QR code.

OneTouch® Verio® IQ – Put it to the test On insulin treatment?

OneTouch® Verio® IQ may be suitable for your needs.

Call OneTouch® Customer Care to order your FREE* trial: 0800 279 4142 (UK) quoting code AE252 Or visit www.LifeScan.co.uk/bal Receive personalised meter training and on-going support from OneTouch® Customer Care: 0800 279 4142 Lines open 8.30am-6pm Mon-Fri, 9am-1pm Sat

Diabetes UK website: http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/ accessed on 21 March 2012. 2A. H. Barnett, S. Craddock, M. Fisher et al. Key considerations around the risks and consequences of hypoglycaemia in people with type 2 diabetes. Int J Clin Pract 2009: 1742-1241. 3S.A. Amiel, T. Dixon, R. Mannt and K. Jameson. Hypoglycaemia in Type 2 diabetes. Diabetic Medicine 2007: 1464-5491. 4Saydah SH, et al. JAMA 2004; 291:335–342. 5Liebl A, et al. Diabetologia 2002; 45:S23–S28. 6Diabetes UK website: http://www.diabetes.org.uk/Documents/Professionals/News,%20updates,%20prizes%20and%20alerts/Driving-diabetes-professional-guidance0212.pdf accessed on 24 April 2012. 7Diabetes co.uk, Driving with diabetes, http://www.diabetes.co.uk/driving-with-diabetes.html [accessed] 21.06.12. 8Pearson J. Bergenstal R. Fine-Tuning Control: Pattern Management Versus Supplementation. Diabetes Spectrum Vol. 14 No 2. 2001. 9LifeScan data on file.

1

*TERMS AND CONDITIONS: Offer open to those who are on insulin and making their own insulin dosing decisions (e.g. Multiple Daily Injections of insulin), aged 16 or over and resident in the UK, including users of meters other than OneTouch® meters. Applicants who currently use a OneTouch® meter must have had their meter for 12 months or more and not received a free OneTouch® upgrade during this period. Offer closing date 31st March 2013. Those eligible to participate in the free meter trial will be offered a OneTouch® Verio®IQ Blood Glucose Monitoring System, 25 test strips and a questionnaire about their experience of using the OneTouch® Verio®IQ to complete and return in the reply paid envelope provided. Only one free OneTouch® Verio®IQ trial per person.

Meters are subject to availability. This offer is limited to a maximum of 4,000 free OneTouch® Verio®IQ meters. Allow 28 days for delivery. LifeScan, LifeScan Logo, OneTouch® and OneTouch® Verio®IQ are trademarks of LifeScan Inc. © 2012 LifeScan, Ortho-Clinical Diagnostics. AW 100 477A. 12-154

news Thousands miss out on vital NHS Health Check The failure to properly implement the NHS Health Check programme has resulted in thousands of people with Type 2 diabetes in England missing out on being diagnosed, according to Diabetes UK’s report, Let’s Get It Right.

Published in September, the report highlights how about 9,500 people with undiagnosed Type 2 diabetes could have been diagnosed in 2011/12 if the programme had been properly implemented.

The NHS Health Check programme, launched four years ago by the Department of Health in England, has the potential to detect people with Type 2 diabetes and to identify those at high risk.

The report has highlighted that while the NHS Health Check is supposed to be given to all people aged 40–74, in practice it has become a postcode lottery. During the last financial year, less than half (40 per cent) of people who could have benefited from an

NHS Health Check, which tests people for risk of Type 2 diabetes, heart disease, stroke and kidney failure, actually had one.

Diabetes UK used the launch of the report to call for the Government to ensure the NHS Health Check is properly implemented and to demand a public awareness campaign so that people in the target age group know they are entitled to a check and understand how important it can be for future health.

Barbara Young, Chief Executive of Diabetes UK, said: “The failure to deliver the NHS Health Check has potentially dire consequences for the state of diabetes care.

It is vital that people with Type 2 diabetes 9,400 people aged 40–74 are thought to have missed out on an NHS Health Check are diagnosed as early as possible to reduce their risk of developing complications.

“The NHS Health Check is also important for making people aware they are at high Diabetes UK is urging people aged risk and helping them get the information 40–74 who have not had an NHS Health and support to encourage lifestyle changes Check to contact their GP to ask for one. i www.nhs.uk/Planners/NHSHealthCheck to help prevent it.”

PAEDIATRIC DIABETES FUNDING DOUBTS Despite meeting mandatory standards, many paediatric diabetes units are struggling to secure the extra funding that has been made available by the introduction of the Best Practice Tariff last April, NHS Diabetes has warned.

The Best Practice Tariff for Paediatric Diabetes sets out 13 areas of care that must be met for teams to qualify for greater financing.

Local services unable to achieve these standards will be supported to improve. However, they face having their funding withdrawn if they are still unable to reach the required level by April 2013.

However, many paediatric diabetes teams report that the commissioning groups responsible for paying the

6

Tariff are looking for loopholes not to do so, or are claiming that they do not have the necessary funding available.

Gavin Terry, Diabetes UK Policy Manager, said, “It is very disappointing that many paediatric

diabetes units are struggling to secure the extra funding made available by the new Best Practice Tariff, despite meeting its standards.

“The Best Practice Tariff for paediatric diabetes, and the opportunities it presents for the improvement in care in this highly specialised area, will have a huge benefit for children living with diabetes.

“Providing high-quality care is crucial to manage children’s diabetes well and reduce the risk of developing complications now and later in life.

We fully support the development work that NHS Diabetes are carrying out in supporting services to meet the standards set out in the Tariff’s 13 areas of care.”

balance November – December 2012

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balance rounds up all the latest diabetes news

Diabetes UK is delighted to welcome Sir Peter Dixon as its new Chairman. He has been appointed following a formal interview process and will take up the position on 1 January 2013.

Sir Peter (below left) has previously fulfilled a range of senior public sector roles, including Council Member and Trustee for the NHS Confederation and Chairman of University College London Hospitals NHS Foundation Trust. He has also been a board member in registered social landlords for over 25 years, and was Chairman of the Housing Corporation. He was knighted for services to housing in 2009.

He will take over from Professor Sir George Alberti (right), the internationally renowned diabetes expert who has been Chair of Diabetes UK since 2009.

Julian Baust, Vice-Chair of Diabetes UK, said, “Peter’s wealth of experience in senior public sector roles and in-depth knowledge of the NHS will be a huge asset and I look forward to working closely with him.

“On behalf of the charity, I would like to thank Professor Sir George Alberti for his work as Chair over the last four years. His knowledge and judgement have been invaluable and we are extremely grateful for everything he has done.”

Sir Peter said, “Diabetes UK is widely respected for its work on behalf of people with diabetes. I am delighted and humbled to be asked to become Chairman. I look forward to working with the rest of the Board, the staff and volunteers to address the challenge of diabetes.

ID 24008-UK/V02/2011-06

New Chairman appointed

Thank goodness there’s a needle that only pricks when it’s supposed to.

Patented universal click® technology Fits all major brands of injection pen

Hypurin Porcine cartridges The Medicines and Healthcare products Regulatory Agency has issued a drug alert for Hypurin Porcine Isophane insulin cartridges due to a packaging error. The issue occurred when a carton for cartridges of short-acting Hypurin Porcine Neutral Insulin 100IU/ml got into the production line for the intermediate-acting Hypurin Porcine Isophane Insulin 100 IU/ml.

This could mean the effect of your insulin wears off earlier.

Manufacturer Wockhardt UK Ltd believes it is highly unlikely that there are any packs in the supply chain, but people are being asked to check their cartons. If you are prescribed this insulin please check carefully that it is not Hypurin Porcine Neutral insulin. The affected carton bears the batch number PL40147. If you have any concerns check with your doctor or pharmacist.

6-15 News.indd 7

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7 18/10/2012 20:53

news

THEY SAY, WE SAY

Diabetes risk for nocturnal teens?

Teenagers playing computer games all night and listening to music could be at an increased risk of Type 2 diabetes, declared the Daily Mail and Daily Express in October. But is there any substance to these claims?

SPEED READING A Scottish racing driver has Diabetes UK firmly in his sights. For Craig Brunton, a racing driver with Type 1 diabetes, the charity is never far from his thoughts as he races around his home circuit at Knockhill – as he races around his home circuit at Knockhill – reaching speeds of up to 150mph.

That’s because the because the 24-year-old, who lives in Glasgow, has the Diabetes UK logo on his racing helmet visor to help raise awareness of the charity.

Craig (above), who was diagnosed in 2001, is the only racing driver with Type 1 diabetes to have won the

Motor Sports Association (MSA) sanctioned Scottish Formula Ford 1600 Championship, when he clinched the title back in 2010.

Although still racing, Craig now dedicates a lot of his time to developing other drivers – a move that has paid off as he has just coached and mentored fellow team mate, Ally Dow, to the 2012 championship win.

But racing isn’t just Craig’s hobby, it’s also his job – he works for the family business driving people around Knockhill Racing Circuit in F1-style passenger cars.

Higher risks for Type 1 People with Type 1 diabetes are more likely to have cardiovascular disease, such as heart attacks and strokes, a study conducted in Scotland has shown.

Controlling blood glucose, blood pressure, and cholesterol can help reduce these risks.

The study, by researchers from the University of Dundee, was based on information from Scottish national databases representing over 20,000 patients and covered the period from 2005 to 2008. The study found that people with Type 1 diabetes had a two- to three-times greater risk of heart attacks, strokes or premature death than the general population.

This study does show that in recent years the relative risks for cardiovascular

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disease and premature death have been reduced for people with Type 1 diabetes. However, there is room for improvement, according to the study [published in PLOS Medicine].

Dr Iain Frame, Director of Research at Diabetes UK, said: “People need the right education and support from their healthcare professionals to help prevent problems such as strokes, heart attacks, and ultimately early death. Everyone with diabetes should receive a minimum level of care, outlined in our 15 Healthcare Essentials, to monitor their condition and their risk of developing complications. This should be supported with advice and guidance on how to control blood glucose levels control.” i www.diabetes.org.uk/15-essentials

DIABETES UK SAYS These stories were based on a study, carried out by researchers from the University of Pittsburgh and the University of California, which looked at sleep length and insulin resistance in American teenagers. People with insulin resistance (a condition where cells aren’t able to respond normally to the hormone insulin by absorbing glucose, leading to higher levels of glucose in the blood) are at increased risk of developing Type 2 diabetes.

The study, published in the journal Sleep, found that teens who had less sleep had higher levels of insulin resistance. However, based just on this evidence, it’s impossible to make a direct link between the two. Other factors, such as genetics or diet, may also be influencing the link.

Also, as the study measured sleep and insulin resistance over the same time period, it is not possible to say whether lack of sleep could be causing insulin resistance or whether insulin resistance could be affecting sleep patterns.

The Mail and Express coverage suggested that teens were up all night playing video games or listening to music, but the study did not assess why some teens got less sleep. It could just as easily be hard-working teenagers staying up to do their homework.

Studies that follow teens over time will be needed to determine whether sleep duration will affect their risk of Type 2 diabetes.

balance November – December 2012

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18/10/2012 20:53

Something to shout about Since the launch of Diabetes Voices in October 2011, over 1,200 people across the UK have signed up to campaign for better care and services. From online surveys, to lobbying MPs in Parliament, hundreds of Diabetes Voices have taken action to make a difference over the past year. With so many opportunities to get involved, Diabetes Voices have been kept very busy. Here’s how the numbers stack up:

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200 people

In May, Diabetes Voices volunteers attended the Big Lobby at Westminster, where they asked their MP to support our campaign for a national implementation plan for diabetes.

have taken part in Diabetes Voices training to brush up their campaigning and influencing skills.

2 Diabetes Voices joined the

DVLA working group, looking at the new revised application form for people with diabetes.

4

1,000

In Scotland, over people supported the insulin pump campaign by signing an online petition.

In April, Diabetes Voices attended a meeting of the All-Party Group on Diabetes in the Stormont Assembly.

ID 20019-UK/V01/2012-02

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There were all-party Parliamentary group meetings that Diabetes Voices campaigners were invited to, where they spoke about their experiences of living with diabetes.

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1

In Wales, Diabetes Voice assumed an important role as a patient representative on the Welsh Government’s National Specialist Advisory Group on Diabetes.

The 4.5 mm mylife™ Clickfine®

1,000

Over people took part in an e-campaign to put diabetes at the top of the government agenda.

pen needle – perfect for children and slim adults

40 Diabetes Voices attended a

Parliamentary Question Time event in London, attended by Paul Burstow (the then Minister of State for Care Services).

Customer Care: 0800 092 6787 More information on www.mylife-diabetescare.co.uk

i Sign up today at www.diabetes.org.uk/diabetesvoices

6-15 News.indd 9

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18/10/2012 20:53

World

news Diabetes Day

14 November

The right education for all

Protecting our future Diabetes:

The World Diabetes Day 2012 campaign, organised by the protect our future International Diabetes Federation, marks the fourth year of the five-year focus on diabetes education and prevention. It will have a special focus on children and young people as the driving force for promoting these messages, that is hoped will inspire and engage local communities to recognise the importance of early awareness of the risks and dangers of diabetes.

The campaign will also link the urgent need for action to the protection of the health of future generations. Particular focus will be placed on highlighting the importance of education – for healthcare professionals, people with diabetes and those at risk – in reducing the impact of diabetes throughout the world. i www.idf.org/worlddiabetesday w w w. w o r l d d i a b e t e s d a y. o rg

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Activates automatically when injection completed.

Now available VAT Free for only £19.99 (+postage) with discount code ‘Balance1’ Order online: www.insulcheck.com or call us on 0203 608 2002

10 balance 6-15 News.indd 10

Ethnic differences in Type 2 risk revealed A study by researchers from Imperial College London has revealed, for the first time, the full extent of ethnic differences in the risk of developing Type 2 diabetes. Published in Diabetes Care, the new research findings show that approximately half of all South Asian, Black African and African-Caribbean people in the UK will develop Type 2 diabetes by the age of 80, compared to only one in five people of European descent.

The study revealed that by age 80, twice as many British South Asian, Black African and African Caribbean men and women had developed diabetes compared with Europeans of the same age. The researchers also found that Black Africans, African-Caribbeans and White Europeans tend to be diagnosed at around the same age (66 to 67 years of age), whereas South Asian men were five years younger on average when diabetes was diagnosed.

The study also revealed that higher body fat levels (especially around the waist) and resistance to insulin explained the increased risk of Type 2 diabetes in South Asian and African Caribbean women. However, this explained only part of the risk in South Asian and African Caribbean men, suggesting that other risk factors, which are as yet unknown, may also

play a part. The new information comes from the Southall and Brent Revisited (SABRE) study, a large-scale population-based investigation which has followed 4,200 middle-aged Londoners of European, South Asian and African Caribbean descent for more than 20 years. The SABRE study that produced these findings was funded by the Wellcome Trust and British Heart Foundation and the preliminary research was funded by the Medical Research Council, British Heart Foundation and Diabetes UK. Iain Frame, Director of Research at Diabetes UK, said: “In-depth studies like this are useful because they help us to visualise the long-term picture of diabetes. We will continue to fund and monitor studies that examine the complex interaction of genes and other factors and their influence on the risk of developing Type 2 diabetes. We look forward to seeing further evidence to determine where support and change is needed.”

November – December 2012 18/10/2012 20:53

Pilots get all clear for take off

PATCHP & PUM

{

In August, The Civil Aviation Authority (CAA) announced that qualified pilots and air traffic controllers with diabetes treated with insulin and other medications can carry out full operational duties, including flying commercial aircraft.

Licensed pilots and air traffic controllers, who have diabetes, will need to demonstrate good overall control of the condition before gaining medical qualifications to fly. Pilots with diabetes have been able to fly recreationally since 2002, but the new policy allows full flying privileges once medical requirements are met. The CAA plans to issue guidance information to pilots and air traffic controllers, setting out the new procedures. This includes the application of operational restrictions and in-flight testing regimes.

The decision has been welcomed by Diabetes UK, JDRF and the group Pilots With Diabetes. Barbara Young, Chief Executive of Diabetes UK, said: “The CAA has rightly acknowledged that advances in the management of diabetes along with the appropriate level of testing and monitoring ensure that safety standards are maintained.

“The decision will be of huge benefit to the many qualified pilots and air traffic controllers who until now have not been able to fully participate in their chosen field.” i Turn to page 24, to read the balance interview with Karl Beetson, founder member of Pilots with Diabetes, who has campaigned for pilots with diabetes.

{

700,000

extra people will have diabetes (mainly Type 2) in Britain by 2020, according to new Diabetes UK analysis.

Source: Data from the Yorkshire & Humber Public Health Observatory.

At last, a continuous and safe insulin treatment with no tubing!

Discreet and with no tubing Alternative pod placement options for more flexibility Intuitive and easy to use Automated and safe cannula insertion Integrated blood glucose meter

Your experience counts

Parents and carers of children with diabetes are being asked to complete a ‘Patient Experience Questionnaire’ at their diabetes clinic. The Royal College of Paediatrics and Child Health (RCPCH) will record responses on a secure database, and will help to produce reports for clinicians to help assess and improve services. You will also be able to see the results of all the clinics in the country and compare them to yours.

Simply ask for a form next time you are at clinic.

The questionnaire (available until the end of 2012) is anonymous and members of your child’s healthcare team won’t be able to see your responses. i www.rcpch.ac.uk/npda

6-15 News.indd 11

Customer Care 0800 092 6787 www.mylife-diabetescare.co.uk Ypsomed Ltd. Blackwood Hall Business Park North Duffield, Selby North Yorkshire-UK YO8 5DD

18/10/2012 20:53

news special

The Children and Young Person’s Campaign Diabetes UK is launching its Children and Young Person’s Campaign on World Diabetes Day (14 November), Libby Dowling, Clinical Advisor at Diabetes UK, explains What’s it about?

We want to improve diabetes care and outcomes for all children with the condition.

Children with diabetes, their parents and the healthcare professionals who look after them have told us about the issues they face and have raised a number of problems that all need addressing. While there are some children receiving great care in all aspects of managing their diabetes, unfortunately this isn’t the case for all.

We hear of children being seriously ill in diabetic ketoacidosis (DKA) before they are diagnosed with Type 1 diabetes, of children not achieving recommended blood glucose targets and not getting all the health checks they need, putting them at risk of complications later on in their adult life, of not getting the support they need in school, and not having a planned transition to adult care, meaning that they stop coming to the clinic. This needs to change.

29,000

children have diabetes in the UK

25%

of children aren’t diagnosed until they are in DKA, and this goes up to 35% in the under-5s

Only 4%

of children and young people have all the recommended care processes recorded

More than 85%

of children and young people over 12 have blood glucose levels higher than recommended targets

What will you do?

This is an ongoing campaign.

We’ll start by raising awareness of the symptoms of Type 1 diabetes, and in 2013 we’ll address the need for highquality care and support for all children with diabetes. In 2014 we will highlight the need for children with diabetes to

12 balance 6-15 News.indd 12

receive the right support in school, and in 2015 we will focus on transition.

We’ll highlight all of these issues throughout the duration of the campaign – it won’t be a case of dropping one for the next.

Tell us more about the first phase We want parents, carers and everyone looking after or working with children and young people to know the main signs and symptoms of Type 1 (needing the toilet more often, being extremely thirsty and tired, and losing weight).

If a child has any of these symptoms, we want parents and carers to visit a doctor straight away and insist on a test for Type 1 diabetes there and then. Being diagnosed quickly avoids children and young people becoming seriously ill with DKA. Currently, one in four children aren’t diagnosed with Type 1 until they’re in DKA. For those under 5, it’s one in three.

Every healthcare professional (HCP) – especially GPs, practice nurses, health visitors and pharmacists – needs to be aware of the signs and symptoms, too, and to understand the risk and devastating impact of DKA. If a child shows symptoms of Type 1, we want the HCP to arrange a finger-prick blood test immediately. If the result indicates diabetes, we want the

Spotting the early signs of diabetes, such as extreme thirst, is vital to avoid DKA child to be referred to a specialist paediatric diabetes team the same day so they can be treated without delay.

We also want HCPs to help raise awareness of symptoms by displaying our posters.

Behind the scenes, we want policy makers and commissioners of healthcare services to ensure the right protocols are in place to diagnose Type 1 diabetes in children as quickly as possible. We also want effective policies implemented to make sure that every paediatric unit is recording and monitoring how and when Type 1 is diagnosed in children and young people.

Who did you consult with?

We held focus groups for children, attended a networking day to hear from parents, as well as conferences to get input from doctors, nurses, dietitians and psychologists who look after children with diabetes.

We also got lots of feedback by interacting with people via social networking sites.

HOW YOU CAN HELP

Look out for the campaign from World Diabetes Day, 14 November, when you’ll be able to order free posters and flyers via www.diabetes.org.uk/onlineshop or 0800 585 088.

Find out more about the signs and symptoms of Type 1 diabetes by visiting www.diabetes.org.uk/symptoms.

November – December 2012 18/10/2012 20:53

44373 B

Chloe said...

...she wanted life with diabetes to be more spontaneous.

We listened.

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Go to BOOTS stores or www.boots.com for your iBGStar, today.

For further information go to www.diabetesmatters.co.uk or call Freephone 08000 35 25 25 iBGStar® does not include the iPhone or the iPod touch. iPhone and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries. *iBGStar® Diabetes Manager App is available on the App Store. ** Terms and Conditions apply

6-15 News.indd 13 44373 BGM iBGStar Patient Ad Balance 212x267 AW2.indd 1

GBIE.BGS.11.12.13

Date of preparation: January 2012

18/10/2012 20:53 16/01/2012 10:23

news

In brief...

ANIMAL

MAGIC

Thirty families enjoyed a fun-filled day out at the zoo, thanks to Diabetes UK volunteers in Devon. Children with diabetes, their siblings and parents were treated to a trip to Paignton Zoo, Devon, following donations from the Plymouth Diabetes UK Voluntary Group and the Queen Victoria Masonic Lodge in Plymouth.

Diabetes UK Plymouth Voluntary Group Chair, David Cudlip, said that the group was delighted to support the event for local families in August. “Our members

WINNER TAKES ALL

understand the challenges of diabetes. We are keen to give all those on the trip a memorable day out, and provide families with the opportunity to gain support and advice from each other.”

The families (above) were selected by Plymouth Hospitals NHS Trust staff.

Becky Smith, consultant paediatrician, said: “For young people being

diagnosed with diabetes is something that poses daily challenges and affects even the simplest of activities.

This is something our young people face with remarkable courage and skill. The paediatric diabetes service at Derriford Hospital has found running organised activities for young people with diabetes and their families is hugely beneficial.”

PRODUCT WATCH Sue Marshall, who has Type 1 diabetes and set up www.desang.net, shares her favourite diabetes kit...

Contour NEXT USB meter The innovative Contour NEXT USB meter from Bayer has numerous benefits. Review your logbook and blood test trends, carbs and insulin on the meter (on the colour screen), or download and share them with your healthcare professional. It stores up to 2,000 test values, you can reapply more blood to the same test strip if needed, and it plugs into your computer (see website for system requirements), so you can see results in charts or tables and pick up on patterns quickly. i Prices start from £29.99; www.bayercontourusb.co.uk;

Funkypumpers When Sabrina Dawe’s 13-month-old son was diagnosed with Type 1 diabetes and was put on an insulin pump, she found that a pump bag was essential to help improve the odds on keeping the pump safely attached and accessible. Sabrina set up a website, funkypumpers, and offers a range of bags

14 balance 6-15 News.indd 14

from her website.

All the bags are suitable for all commonly used insulin pumps in the UK and can carry CGM and PDA devices. i Prices start from £19.99; www.funkypumpers.com; 0845 009 4014

Forget Me Not reminders It is not electronic and requires no batteries or charging, but the ‘forget me not’ reminder is a simple, but effective, way to manage insulin injection regimes.

This simple, affordable reminder tool can help avert the unwanted implications of whether a person has taken their insulin or not. i Priced at £6 (free p&p); www. forgetmenotreminder.com

You could be our next jackpot winner of £12,500 in Diabetes UK’s Christmas Eve Prize Draw. Call 0800 515 376 to order tickets, which cost £1 each with all proceeds going towards the charity’s vital work.

The Draw takes place on 24 December 2012.

FORUM IS FOUR

Diabetes UK’s support forum is four years old on 14 November – World Diabetes Day. Diabetes Support has almost 8,000 members and is a fantastic place to get advice and to help others, too, with their questions about diabetes. It’s free to sign up and everyone is welcome to join in.

Talking to other people about your diabetes can really help you better manage your condition. i www.diabetessupport.co.uk

HAPPY SHOPPER?

You should find a free copy of the Winter 2012 Catalogue in this issue of balance, packed with gift ideas and a wide range of Christmas cards, with all profits coming to Diabetes UK. But if you haven’t received your catalogue, or would like extra copies, call Diabetes UK on 0800 585 088, quoting code 9000AW.

November – December 2012 18/10/2012 20:53

44374 B

Sally said... ...she wanted life with diabetes to be more straightforward.

We listened.

Hypo and hyper alerts

No coding

Easy-to-read backlit display

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Now you can simply take charge of your life with diabetes with this easy-to-use, accurate and fully supported new BGStar® blood glucose meter.

• Free batteries • Free control solution • Meter replacement for life* With the new BGStar, SANOFI DIABETES gives you more options for life with diabetes.

Ask your healthcare professional for your BGStar, today.

For further information go to www.diabetesmatters.co.uk or call Freephone 08000 35 25 25 *Terms and Conditions apply

6-15 News.indd 15 Patient Ad Balance 212x267 AW2.indd 1 44374 BGM BGStar

GBIE.BGS.11.12.12

Date of preparation: January 2012

18/10/2012 16/01/2012 20:53 10:29

opinion

balance

5

SUPER SUPPERS FOR YOU TO TRY PAGE 50

Your diabetes lifestyle magazine • September – October 2012

Back on track

LAYING DOWN THE LAW

Getting fit at 60

Police officer’s Type 1 struggle

FACING

UP TO

FAT

How to read between the lines

EXERCISE IN RESEARCH Behind the scenes on a Type 2 trial

Photo: Alan Lewis

feature

PLUS

Contraception; 15 Healthcare Essentials update; guide to Edinburgh; Nordic walking; giveaways & more

STAR LETTER

Bike able Breaking the cycle

I’m a National Standards cycle instructor with Type 1 and, after reading the article on Malachy O’Doherty (‘Breaking the cycle’, September–October 2012 balance), I thought this may be helpful. In London some free (or almost free) cycle training is available. This training delivers Bikeability, which is the Department for Transport’s national standard training.

It covers all levels of riding on road. The scheme is designed to either get people riding or to increase their confidence and skills on road.

Training is delivered nationally through local authorities. Details on booking the London training can be found at Transport for London’s www.tfl. gov.uk/tfl/roadusers/cycling/requestcycle-training.aspx and more on Bikeability: www.dft.gov.uk/bikeability.

Left: Malachi O’Doherty felt transformed after he lost 2st 5lb (15kg) in six months after rediscovering his love of cycling and taking to the rural roads of Northern Ireland. Below: Malachi before he got back in the saddle

Two of a kind Twins Vicki and Kate on their different Type 1 control

01 Cover realAC2.indd 1

15/08/2012 16:20

Unfit, overweight and diagnosed with Type 2 diabetes, writer, Malachi O’Doherty, knew journalist and broadcaster, something had to give.

Approaching 60, he didn’t in a fast car; instead he try to relive his youth tells balance how he turned back the clock to his 30s his bike and revisiting many by getting on of his cycling-route haunts in Northern Ireland…

What was your lifestyle like before your Type 2 diagnosis?

I had just accepted that gradual fattening and putting on weight was a normal part of ageing. I was lazy and used the car a lot even for short trips. But, even before I was diagnosed I’d started to make some changes. I was conscious that I was unfit and I was trying to walk a lot more. I hadn’t been up enough mountains and I hadn’t been out on my bike for over a decade.

26 balance

You have a twin brother, Roger, who seemed fitter than you. Why did you think he was healthier?

He maintained his health through his love of hill walking. The summer before I was diagnosed, we walked up Knocklayde Mountain.

We took a ridiculously circuitous route that ended in a steep climb. He made it to the top but I had to give up.

September – October 2012

Did you suspect it might be diabetes before your diagnosis?

There is no known history of diabetes in my family, but then there may be huge numbers of people who have it and don’t know.

I wasn’t aware of specific diabetes symptoms, but I had been living with erratic discomfort in my stomach area for years, worrying about gallstones and possible ulcers.

In the end it all amounted to being fat and nothing working

26-27 Malachi.indd 26

Robin Smith, via email

feature

15 HEALTHCARE

All eyes on your care:

ESSENTIALS

You’re fired

a follow-up

I was concerned to hear the difficulty Dave Sowerby has faced trying to get onto a DAfNE course ‘All eyes 36 71% on your care: a followup’ (September–October 2012 balance). In order to qualify for DAfNE, I had to switch hospitals because my original didn’t offer the course. Mr Sowerby is likewise within his rights to ‘sack’ his existing hospital and to ask his GP to refer him for treatment at a hospital in the North West that offers the course.

campaign, It is nearly a year since Diabetes UK launched its 15 Healthcare Essentials have access outlining the checks or services that every person with diabetes should see how it to... We focused on the care experiences of some of our readers, to they receive? varied. A year on, have there been any changes to the annual checks

* Source: National Diabetes Audit

But I’ve been told Still empowered to take control access to a patient education course. funding is being prioritised to Type 2 patients, so Dose Dave Sowerby, 37, from Adjustment for Normal Eating (DAFNE) or an equivalent Lancashire, has had Type 1 since he was 3. When he spoke to balance is not available to me.

I also attended the Diabetes UK Big Event and last year about the care he was participated in the 15 Healthcare Essentials seminar. receiving from his healthcare It highlighted that I wasn’t quite as knowledgeable about team, he rated it as excellent. it as I thought, and will arm me with information about He also said that he felt empowered to discuss any what I need to be checking at my next appointment. aspects of his ongoing diabetes care with them. continual a on is I’d say my management “I was referred back to the diabetes clinic with an improvement curve, though I feel the lack of DAFNE HbA1c of 87mmol/mol (10.1 per cent), and although (or equivalent) is hindering me in achieving the levels I was initially wary, before the appointment I made of control I think could be possible. The involvement of a decision to sort myself out, which I did with the so many other people with diabetes around the country support of my wife, Laura.

– and the world – has definitely been a support for me Around that time, I got in touch with other people in improving my control and giving me the confidence with diabetes through online forums, such as www. for the care I should be getting.” diabetes-support.org.uk and www.shootuporputup.co.uk to push and was encouraged by like-minded people to approach Different circumstances, my appointment as a discussion, rather than a judgment. different care – again!

When I last spoke to balance, I said that I enjoyed the Natalie, 32, from Buckingham, was relationship I have with my diabetes healthcare team, diagnosed with Type 2 diabetes in as I felt able to debate what I was being told and reach a November 2007. Upon diagnosis, solution that we agreed on, rather than feeling told off. she felt that she was handed her This still stands, and my healthcare team supports me medication and told to get on with very well with the facilities they have, but they it. She was forced to learn everything about are restricted in resources and funding. diabetes herself, only seeing a diabetes At the moment, I am not accessing any specialist nurse a few times, and never the extra services through my healthcare same one. She never team. In fact, had her legs, feet or I used the 15 the number of weight checked, and Healthcare primary care trusts was never offered where less than Essentials emotional support. of people with half of people of people with information to Twelve years on, all diabetes received with diabetes diabetes only contact my MP that changed when she all their checks in received all their received all their and chair of the became pregnant with one PCT* necessary checks* checks in one PCT* primary care twins and she rated trust to request

11%

»

»

September – October balance

28-31 15 essentials AC1.indd 29

29

16/08/2012 10:30

Feet first

The idea that patients with foot ulcers should be referred to a specialist within 24 hours (as reported in ‘News’, September–October 2012 balance), is the easy bit, and this happened in my case. The problem is how long it takes to actually see a specialist, and this is where Diabetes UK should concentrate its efforts by insisting that this should be a few days.

Having waited to see a specialist, one has to wait for the test, results, another wait for a meeting to discuss the results, a further wait to see the doctor who will take action, visit them for that test, pre-admission interview and tests, and then wait for a bed!

In my case all this has taken nearly six months, with dressings three times a week at my surgery, visits to the footcare clinic every two weeks, similarly visits to a podiatrist. I’m retired, but wonder how anyone in employment would be able to hold down a job in a similar situation.

I have always had first-class treatment from the doctors and nurses and others, and they seem to be as frustrated by the system as I am.

15/08/2012 19:14

BLF Hammond, Wimborne

Editor’s note: Diabetes UK is working towards ensuring that the NICE quality standards for diabetes in adults are met. This includes a standard which states Giacomo Benedetto, via email that people with diabetes with a

foot problem requiring urgent medical attention are referred to and treated by a multidisciplinary footcare team within 24 hours.

This is why the charity has been highlighting the need for multidisciplinary footcare teams, which are available to provide assessment and appropriate treatment within 24 hours of referral. For more on Putting Feet First, visit www.diabetes.org.uk/ Putting-feet-first.

I’ve been diabetic for over 40 years and I receive excellent footcare, run on a daily basis at the Royal Cornwall Hospital Truro. It’s run by an excellent team of podiatrists.

I have had neuropathy (nerve damage) in both feet for many years.

I developed Charcot’s foot in 1994 and have had various problems related to this condition. I’ve had surgery to realign my foot and the podiartry team have looked after it very well – so much that I still, after ll this time have a complete foot and all five toes! I personally could not have received better footcare. Praise were praise is dueand long may the foot clinic at the Royal Cornwall Hospital Truro continue its wonderful work!

Laverne Caddy, Truro

Support service

I’m 89 and have had Type 2 since 1987. I’ve spent a large part of the last year in and out of hospitals with various ailments, which has caused

WRITE TO US balance, Diabetes UK, 10 Parkway, London NW1 7AA EMAIL 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.

16 balance

November – December 2012

16-19 Your Views.indd 16

18/10/2012 20:21

opinion

life&health

Blogs, tweets & posts www.facebook.com/diabetesuk twitter.com/diabetesuk “13 years of being diabetic this month... about 20,000 injections to date... I’m extremely lucky to lead a normal life... no negativity and all positivity gets you everywhere.”

Emma Davey-Sinclair, via the Diabetes UK Facebook page #@DiabetesUK really enjoyed the run today, looking forward to next year – excellent massage at Diabetes tent.” #greatnorthrun Paul Russell reveals that the Bupa Great North Run was well worth it, via Twitter I want to experience these events as a visitor not a visitor with diabetes. So whilst I am comforted by the existence of a good hospital around the corner... it’s nice to know it’s there but I don’t want to see inside. And on all my holidays, I never have.

Helen May on the finer things in life in blog ‘Taking a city break’, http://blogs.diabetes.org.uk.

COLUMNIST Richard Lane OBE

True inspiration I was privileged to present the Inspire Awards at the Northern & Yorkshire Volunteering Conference at the beginning of October (together with Sue Browell, Trustee and Caroline Moore, Diabetes UK’s Director of Planning and Support Services), and also at the London Region’s Conference (with Simon O’Neill, Diabetes UK’s Director of Health Intelligence and Professional Liaison). I speak for us all when I say

Spotlight on...

Necrobiosis While the severity of the lesions may it is be unaffected by diabetes control, glucose advisable to pay attention to blood levels to avoid any problems of secondary 44 for infection within the lesion. See page a guide to blood glucose targets.

What is it?

(NLD) Necrobiosis Lipoidica Diabeticorum is a chronic skin condition that occurs when collagen breaks down, deposits of fat build up and the blood vessel and walls thicken. It can progress slowly for a scar the skin. It might not bother you times. while but it can then flare up at other

Is it dangerous?

the Although NLD is not life-threatening, an emotional trauma of dealing with such unsightly condition often has the most damaging effect. NLD is not infectious.

What causes it?

cause Researchers don’t know the exact of NLD. However, some studies indicate a possible connection between NLD and damage to the small blood vessels, 2 as a result of both Type 1 and Type diabetes, but it can also affect people without the condition.

Who does it affect?

NLD is extremely rare. It is reported to affect only 0.3 per cent of all people with diabetes, usually appearing some years after diabetes has been diagnosed.

It can occur at any age, but most commonly starts between the ages of 30 and 40. It is three times more it common in women than men and can happen no matter how well diabetes is controlled.

What are the symptoms?

NLD appears as a rash initially, most commonly on the lower legs, but some people might notice it on their face, torso, scalp or arms.

In the beginning, the rash might appear reddish-brown with fairly well-defined borders. Over time, the lesions might grow larger, turning shiny and red, sometimes developing a yellow centre. Eventually, the lesion develops into a purplish depression in the skin.

What to do during a flare-up

and Many people with NLD (both men women) find that camouflaging the condition, using specialised make-up, is one way of living with it. The make-up four is extremely effective, can last up to days, is waterproof and also contains sunscreen. Colour matching and skilful application is important for camouflaging is to be successful and professional help available. The charity Changing Faces teaches people how to apply specialist Can it be treated? cover creams to improve the appearance As long as the lesions of the rash don’t of affected areas. This service is provided break open, NLD doesn’t usually require free of charge (but donations are to rest treatment. Your GP might ask you GP welcomed) on referral from your your legs occasionally and protect them or consultant, while camouflage creams from injury to reduce the risk of ulceration. on prescription. available are stockings support A padded dressing, elastic If a lump, persistent scab or ulcer or shin guards can help with this. develops in an area of NLD, consult During a flare-up, some people find your GP as soon as possible. and relief using a topical steroid cream i www.changingfaces.org.uk covering the area with a sterile dressing.

Others find that steroid injections help.

Do you have necrobiosis? How do Trauma to the affected area might you manage it? Email your tips cause ulcers to form and these need to balance@diabetes.org.uk or write treatment. If this is the case seek help to us at balance, Diabetes UK, from your healthcare team.

10 Parkway, London NW1 7AA. Some researchers have found that treating the area with ultraviolet light can control NLD during flare-ups.

Camouflaging the condition, using specialised make-up, is extremely effective

but Sometimes, NLD itches and hurts, other many people report no symptoms than the rash.

47 September – October 2012 balance 15/08/2012 19:41

46-47 SpotlightAC.indd 47

hypos. Now I’m receiving a service called ‘Telesupport’, which may help others. At 8am, 12noon, 4pm and 11pm a machine reminds me to take a blood glucose reading, which is then transferred to the clinic via telephone link. If my level is higher than 12mmol/l or lower than 5mmol/l the clinic ascertains if I’m well and if I can explain why the readings are high or low. I have nothing but praise for the care and guidance and reassurance that it offers.

Mrs Marion Rayfield, York

Skin deep

At last! Necrobiosis (NLD): a name for this strange, alarming condition (‘Spotlight on... Necrobiosis’, September–October 2012 balance).

I say alarming, although the only time it troubles me is when I take a long walk in the sunshine. Then the heat seems to go through my trousers and causes the vivid red shiny rash at the back of my legs that we are inspired by the winners’ incredible achievements, which were over and above the call of duty in their regions. However, the many other volunteers who were nominated, and indeed the many who were not, also deserve our sincere thanks and respect for what they have done for Diabetes UK and for those affected by diabetes.

There were overall winners, too: Christine Guy in Northern & Yorkshire, who was given the Margaret Hunter Award, and Michael and Shirley Mitchell who won the Sue Braeger Award. Both Margaret, who works tirelessly as Chair of the

below the knee, ending at my ‘sock line’. This lasts about a week. The interesting thing was that it seemed to have a border on my ‘sock line’, with a small purplish indentation at the back of my leg.

I’ve had Type 1 diabetes for 33 years and this first occurred 10 years ago. Occasionally it itches,and I treat it with a lotion containing manuka honey from a health food shop. Thank you for this enlightening article.

Richard Carley, via email

I’ve had NLD for the past five years.

It started as a small red spot on my right shin; I thought nothing of it until it started to spread and it appeared to become shiny and flaky.

I was referred to a dermatologist who prescribed a steroid cream for when it became flaky. I don’t have any pain, but I’m self-conscious. I went to a Red Cross camouflage assistant who told me how to apply cover creams, but, they don’t last

»

Diabetes UK Gateshead Voluntary Group, and Sue, who was Chair of the Havering Family Group but sadly died last year, have contributed so much and the winners of the awards named after them have continued the work that both of them are so well loved for.

I’ll be presenting more Inspire Awards – it’s a really humbling experience. I’m truly inspired by the extraordinary work that all of these wonderful people and Groups have achieved. What an example to us all. i Richard is President of Diabetes UK and has Type 1.

November – December 2012 balance 17 16-19 Your Views.indd 17

18/10/2012 20:21

opinion

I love my... than 24 hours and it’s hard » more to match my skin tone.

I’d love to speak to others with this condition. Have they had a skin graft? Do they use cover creams? Do they accept they have it? Do they feel the same way as I do?

Jayne Hughes, Chester

started small, they have now all run into each other and are quite unsightly! Forget wearing pretty dresses & wear trousers! I love my baths and relax in E45 Bath Oil which keeps my skin soft!

Clayre Hall, via email

I have this on my legs – four quite bad patches on one shin and, on the other. I have a large one on the side of my other leg, with more beginning to show. I’ve recently started using Bio-Oil and find it helps a little – even Kayra Fernandez, via email more so for my confidence.

I have suffered from NLD since 1994.

I live in Gibraltar and I have been treated in a hyperbaric chamber.

After 20+ sessions my skin is much better, I even grow hair and now, if I bang my shins, it doesn’t ulcerate.

Charlotte Tuplin, Lincolnshire

I’ve had Type 1 diabetes for 18 years and have had NLD on both legs for about 15 of those years.

I was treated with steroid injections in 2007. It dramatically reduced the redness of the scars and has made a huge difference to my confidence. The process is uncomfortable and I was sedated with medication as I needed injections around each scar, but I’d say it was worth it.

What’s your date?

My daughter was diagnosed on 11/11/11. I even think it was about 11pm! It’s a date that will be etched on my memory forever, together with the pain and emotional trauma that has followed, and a date which as my daughter grows older will no doubt find easier to commit to memory.

May I take this opportunity to thank the wonderful team at North Staffs Abbie Mercer, via email Hospital, Stoke-on-Trent, who help my daughter, and us a family, manage I have had necrobiosis for about her diabetes.

20 years and, although they Joanne Powell, via email COLUMNIST Patricia Debney

remained who he ‘always was’. He’s still my strong, funny, gifted, empathetic and sound young man. (With a pinch of salt: this is his mother speaking!)

I can see that perhaps having November marks four years since Eliot’s diabetes made him more of himself: he diagnosis. As soon as the leaves begin is fiercely alert to issues of social justice; to fall, and a certain damp grey creeps he rejects superficiality, weighs up risk, in, the utter devastation of those first and has little patience with those who days is close to the surface: one of loss, don’t seem to know or accept who he is. and of being lost. Completely.

His friendships are based on trust.

Many of my early fears have proven We cannot gauge the developmental unfounded. He’s not ‘medicalised’. impact of having diabetes. Certainly He’s not ‘alienated’, or ‘different’. It in the early days, I didn’t want to hear took a while but he recovered and has about any impact; ‘what doesn’t kill

A new era

18 balance

Is there someone you couldn’t do without? Tell us about them – email balance @diabetes.org.uk or post to the usual balance address (see page 16) marked ‘I love my…’

I’d like to thank three invaluable people in my life.

My respect and appreciation goes to the skill and dedication of my truly excellent eye surgeon, Mr Radford.

He has shown real support, patience and provided advice. He is an invaluable eye consultant. I feel very lucky and privileged to have benefited from his commitment and work. And thanks also to the work of his amazing surgical team and all at Ward 1 at the Royal Preston Hospital.

I’d also like to acknowledge my wonderful diabetes nurse, Sister Lindsay Davies. For many years she has given me support and care of my diabetes and shows a real commitment to my wellbeing.

She is invaluable, and very kind and understanding.

Last, but not least, I’d like to send all my love to my precious Mum, Sylvia. I am so proud of her courage through illness. She’s a very special Mum. Katrina Place, via email

you makes you stronger’ seemed an absurdly clichéd grasp at straws. What I really wanted was for Eliot to remain unscathed in every way. I wanted diabetes to leave no trace.

And yet the truth is that everything we do and feel changes us, makes us who we are; our only choice in the matter is to evolve or stagnate. The truth is, I learned this from my son. i Patricia is an author and senior lecturer in Creative Writing at University of Kent. Her son, Eliot, 15, has Type 1. www.wavingdrowning. wordpress.com. @PatriciaDebney

November – December 2012

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opinion

COLUMNIST Andy Kliman

Chatroom I have scleroderma (a connective tissue disorder) and diabetes, and I’ve recently started on insulin.

I’ve had a few problems since and I’m looking for fellow sufferers of both conditions to share tips and advice. I have difficulty writing and would rather keep in touch by phone, so please include your number when replying.

Please reply to Mrs O’Loughlin, c/o balance chatroom.

Send your reply or your own advert to: balance chatroom, Diabetes UK, 10 Parkway, London NW1 7AA. After balance has forwarded on replies, correspondence is made directly between individuals. i You can also connect with others online – see page 4 for details.

Date of diagnosis? That’s easy, it was my 22nd birthday!

The numbers game

Tim Edmonds, via email

I was diagnosed on the day the Twin Towers came down. Not a day any of us would easily forget.

Janet Shepherd, Scarborough

Breakfast blues

I wonder how many other people with diabetes spend a frustrating amount of time searching along supermarket shelves looking for breakfast cereals? Most, including those targeted at children, are loaded with sugar! I was disappointed recently when my favourite low-sugar cereal, Nestlè Force Flakes, disappeared. I contacted Nestlè, who said they had halted manufacture due to low sales, but hoped to resume production in 2013. This is good news.

Dr Martin Hadlington, via email

Me & my balance balance tried – and failed – to get tickets to the Olympics and Paralympics, so we were delighted when we saw we’d made it there after all. Thanks to Russell Stephens, who took his trusty copy to the Olympic Park and got snapped with us at the Orbit. Russell tells us he had a great day at the Paralympics – and the sun was shining, too!

And balance reached new heights when Diabetes UK’s Director of Human Resources Deirdre Saliba (left) took the mag all the way to the top of Kilimanjaro on a fundraising trek.

You can still support her by visiting www. virginmoneygiving.com/DeirdreSaliba.

Keep your photos coming to the usual address, marked ‘Me and my balance’. Every photo printed wins a Diabetes UK drawstring bag.

So, it turns out it wasn’t threeand-a-half-years of Type 2 diabetes, but instead late onset of Type 1. This has posed a number of challenges, mostly surrounding insulin.

There are two things you need to know about insulin: how much to inject and when to inject. And also how sensitive you are to it.

Three things, there are three things you need to know about insulin: how much, when and how sensitive you are. And how to carb count so you know how much to inject.

There are four important things you need to know about insulin. Including the fact that there are two different types of insulin, so five things.

The five things I have listed above are the key things you need to know about dealing with insulin. And then there are, of course, the effects of exercise, alcohol and what time of day it is as one’s sensitivity to insulin changes.

So, in total, eight things.

I probably shouldn’t mention the ‘honeymoon period’ when your pancreas splutters out some extra insulin in its death throes. But, despite all these complications, I’m actually doing pretty well. There’s a good support network on Twitter, too. i After years of treatment for Type 2 diabetes, Andy Kliman has recently been diagnosed with Type 1. Follow his blog at http://t2dkidding.blogspot.com and his Diabetes UK blog at www.diabetes.org. @andykliman uk/bloggers.

November – December 2012 balance 19 16-19 Your Views.indd 19

18/10/2012 20:21

research matters Cutting-edge results reported at conference In early October, diabetes researchers and healthcare professionals flocked to Berlin, for the 48th annual meeting of the European Association for the Study of Diabetes (EASD). Approximately 18,000 attendees came together to hear the latest updates from leading authorities on the study of diabetes from around the globe. Here are a few of the highlights

THE GENETICS OF TYPE 2

Professor Boulton presents Professor Frayling with his awards

Researchers from the UK were particularly well-represented at EASD, including Diabetes UK-funded experts like Tim Frayling, Professor of Human Genetics at the University of Exeter. Prof Frayling is internationally recognised for his studies of the genetic components of Type 2 diabetes and he opened the conference by becoming the third UK researcher in a row to receive the EASD Minkowski Prize, which rewards those who have helped to advance our knowledge of diabetes.

Prof Frayling’s team have helped translate genetic links into an improved understanding of the biological basis of diabetes. Their findings, alongside those

‘Florence’, the machine Dr Roman Hovorka from the University of Cambridge also presented at the conference. He made the case for a technological solution to the treatment of Type 1 diabetes as a cheaper and easier-todevelop alternative to biological approaches. He also gave an update on his Diabetes UK-funded project that aims to develop and test an artificial pancreas system. His latest prototype is named Florence (after Florence Nightingale) which, after a successful feasibility study based in the hospital, is currently undergoing trials in the homes of adolescents with Type 1 diabetes. Early findings in only a few

20 balance

participants hint that the prototype artificial pancreas can achieve much better blood glucose control than conventional treatment. Ultimately, Prof Hovorka thinks that the artificial pancreas is the bridge to a cure for Type 1 diabetes and could revolutionise the management of the condition within one or two decades. However, he also believes that technological and biological solutions to diabetes will need to work together in harmony if the potential of both is to be realised. i You can read about Dr Hovorka and the artificial pancreas in the July–August 2012 issue of balance.

of other groups, have produced an unprecedented leap forward in our understanding of Type 2 genetics.

In his speech, Prof Frayling went behind the sensationalist headlines of ‘personalised medicine’, ‘fat genes’ and ‘next generation sequencing’, to outline the progress in genetics made over the last five years. He argued that human genetic studies are a vital tool for understanding Type 2 diabetes and that a single genetic finding can lead to a cascade of new revelations about diabetes and the biological pathways responsible for its development.

How the Artificial Pancreas works 1 Glucose levels monitored continuously 2 Required insulin dose calculated 3 Insulin dose delivered automatically

1

3

2 Outcomes: • Better glucose control reduced risk of complications • Risk of overnight hypos reduced • Improved quality of life and peace of mind

November – December 2012

20-23 Research Matters.indd 20

18/10/2012 13:53

Type 1 and the problem of ‘immune memory’ Professor Bart Roep, of Leiden University Medical Centre in the Netherlands, spoke about his research into the immune system and its role in the attack that destroys insulin-producing cells in the pancreas and leads to Type 1 diabetes. He highlighted the issue of ‘immune memory’, whereby the immune system learns to target insulin-producing cells, remembers their characteristics over time (even after they have been destroyed) and will attack similar cells if they are introduced via an islet transplant. Accordingly, immune

Berry

tasty

memory is an enormous hurdle that stands in the way of successful immunological and transplantation therapies for Type 1. Prof Roep even described islet transplants that fail to block the body’s immune memory as equivalent to “mopping the floor while the tap is still running.” Nevertheless, Prof Roep is hopeful that the latest trials of Vitamin D3 as an immune therapy will help to boost self-regulation of the immune system and prevent immune cells from attacking the cells of the pancreas. Prof Roep is already carrying out preliminary tests of this therapy and plans to trial it in the first human patients

by January 2013.

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18/10/2012 13:54

research matters

GENIE makes diabetes discovery An international group of researchers have identified two genes that increase the risk of developing diabetes-related kidney disease. In the largest study of its kind, investigators from the ‘GENIE’ consortium recruited 4,750 patients with diabetesrelated kidney disease and almost 7,000 patients with long-standing diabetes but without kidney disease. They analysed over two million DNA markers per person and found that changes associated with two genes (named AFF3 and ERBB4) increased the risk of kidney disease. The exact role of these genes in the development of kidney disease is yet to be determined, but evidence suggests that AFF3 contributes to the formation of excess fibrous connective tissue in the kidney.

Professor Peter Maxwell of Queen’s University Belfast, one of the principal investigators on the study, said: “Currently available drugs cannot cure the kidney failure but may slow its progression.

Knowing which patients are most at risk of kidney complications will be helpful in managing their diabetes.”

Globally, diabetes-related kidney disease is now the leading cause of kidney failure requiring dialysis or kidney transplant and

is linked to greatly increased risk of heart attack and stroke. Up to now, scientists and clinicians were aware that some patients developed kidney disease but not why this happened.

GENIE (GEnetics of Nephropathy an International Effort) is a productive research group led by teams from Queen’s University Belfast, University College Dublin, The Broad Institute of MIT/Harvard University and the University of Helsinki. It was set up to perform the most comprehensive study of susceptibility to diabetes-related kidney disease to date, using the largest available collection of information about people with Type 1 diabetes with and without kidney disease. The Warren 3 and Genetics of Kidneys in Diabetes UK (GoKinD) and the ‘Golden Years’ data collection, which were both used in the study, were established with funding from Diabetes UK. Professor Catherine Godson, an investigator from University College Dublin said: “These new findings are important as they help accelerate development of new and effective therapies”. i The findings of this study were published in the journal PLoS Genetics in September and can be accessed via www.plosgenetics.org.

New Diabetes UK research for 2012–13

RESEARCH

PROJECT

DIRECTORY 2012 –13

Diabetes UK has released an updated directory listing all of the research grants funded by the charity. The directory describes 111 grants covering research on all types of diabetes and diabetes-related complications worth a total of more than £20m and taking place at research centres across the UK. Diabetes UK Chief Executive Barbara Young said: “We are delighted to share the diverse and exciting array of projects that we are funding across the UK. Everything we fund is possible thanks to the hard work of our members, donors and voluntary groups, who raise funds for research and help us to decide which studies will offer the greatest benefit to people with diabetes and deserve the charity’s support”. i Download the new directory at www.diabetes.org.uk/research-project-directory.

Research_project_2012_v7.indd 1

22 balance

20/09/2012 17:41

TAKE PART IN RESEARCH Dr Khin Swe Myint and her team at Norfolk and Norwich University Hospital are developing a survey to gather the opinions of care teams at all 156 university medical services across the UK (as featured in the September– October 2012 balance). First, they would like young adults with Type 1 diabetes and their families to read the draft survey they plan to use and provide feedback via telephone or email.

Visit www.diabetes.org.uk/UniversityChallenge.

Researchers at the University of Newcastle-upon-Tyne are looking for men and women with Type 2 diabetes, aged over 18, in the North East. They are keen to understand how people change their eating habits and the way they cook and prepare food after being diagnosed with Type 2. They also want to find out how people with diabetes continue to manage these changes over time and what difficulties they experience.

Contact Ian Boffey: 07977 119 904; i.j.boffey@ncl.ac.uk.

Researchers at Richmond Pharmacology in London are seeking people aged 18–75 with Type 1 or Type 2 diabetes and diabetes-related pain in their lower limbs.

They will be asked to join a clinical trial of ‘ABT-639’ – a new experimental drug being developed to help reduce the pain associated with diabetic neuropathy.

The researchers aim to find out whether this drug is more effective than other drugs currently available.

Contact Keith Berelowitz: 020 8664 5200; diabetes@richmondpharmacology.com (Ref: ABT_DEC 2011 Advert version number and date: C11069_eDM and web story_version 6 0_02 07 12). i For more opportunities to get involved, visit www.diabetes.org.uk/diabetes-researchtrial-opportunities.

November – December 2012

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18/10/2012 13:54

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feature

Star gazing In 2007, Type 1 diabetes robbed Karl Beetson of his dream of becoming an airline pilot. But, a landmark decision by the CAA in August could change all that, and – as Karl tells Heather Stephen – he hasn’t ruled out a career in spaceflight medicine

24 balance

F

or some people, the journey is the worst part of their holiday but, as a small boy, Karl Beetson, couldn’t wait to get on the plane.

“I always wanted to sit by the window and be shown around the cockpit,” he says. “I was inspired by the pilots and thought what an exciting job they had.”

With a career as a pilot in mind, Karl took his first flying lesson when he was 13 and flew solo for the first time on his 16th birthday. He remembers this as one of the best experiences of his life.

However, in 2007, just a month short of his 18th birthday, his dream of becoming an airline pilot came crashing down.

“My mum noticed I was drinking pints of sugary squash and I was

going to the toilet so much I was waking in the night. She took me to the GP, who did a blood test and he said I would have to go to hospital for further investigations.

“I told him I wanted to be an airline pilot but he said, ‘Well, you won’t be able to do that any more’.”

Hospital tests showed Karl’s blood glucose levels were 32.3mmol/l and he started on insulin straight away.

A call to action “As soon as I got home I went on the internet to research diabetes, but it still hadn’t sunk in that I had lost my career ambition,” explains Karl.

“It wasn’t until a few days later, when I rang the Civil Aviation Authority (CAA) and they told me that I wouldn’t be allowed to fly professionally that I finally broke

November – December 2012

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feature

I was inspired by the pilots and thought what an exciting job they had Karl contacted the pilot, Malcolm Knowles, and the men decided to try to pull together a band of people like them. There were eight pilots at the first meeting at the RAF Club in London in November 2007. Now there are 45 members from as far afield as America, Australia and South Africa.

Out of the blue

Karl, who took his first flying lesson at 13, had always dreamt of being a pilot

down in tears, as that was all I wanted to do.”

Karl was devastated by the news, but soon picked himself up and within a couple of months decided to take action to try to change the CAA’s mind. He started by lobbying his local MP, but campaigning on his own felt like an uphill battle for Karl.

However, Karl’s campaign gained pace when a chance introduction to a former pilot, in August 2007, led him to help found the campaigning group Pilots With Diabetes.

“I didn’t think there was anyone else out there who felt like me.

Then, when I went to visit my uncle in hospital he told me the chap in the bed opposite had been a pilot for British Airways until he was diagnosed with diabetes.”

The group started off by holding discussions with the CAA about changing policy and was considering a legal challenge when, in August 2012, the CAA made a surprise announcement that pilots and air traffic controllers with diabetes treated with insulin and other potentially sugarlowering medicine would finally be allowed to hold a commercial licence.

Until this historic decision, Canada was the only country to allow people with diabetes to fly professionally. But, in the UK, USA, Canada, Australia and Israel, pilots with diabetes have been allowed to fly privately for several years.

Under the new rules, pilots with insulin-treated diabetes can fly for a living, subject to CAA medical assessment and provision of medical reports proving they have good diabetes control.

While working they must inform the crew of their condition and the symptoms of low or high blood glucose levels. They have to fly with another pilot and must follow a strict in-flight testing regime and actions to be taken if test results are out of range. They also have to attend a check-up every six months.

It’s a rough estimate, but this new ruling is expected to benefit more than 250 pilots and air traffic controllers. These changes were made in the light of recent improvements in the treatment and monitoring of diabetes. Most people in the Pilots With Diabetes group plan to go for the Class 1 medical, which will allow them to fly commercially. Ironically, Karl will not be joining them just yet.

Looking to the future After finishing an aerospace engineering degree in 2009 he is

»

Doug (far right, who featured in May–June 2010 balance) and Karl with members of the Flying With Diabetes group

November – December 2012 balance 25 24-27 Pilots Feat SRS.indd 25

18/10/2012 19:44

feature researching into diabetic » now autonomic neuropathy for a Master’s degree, which he is due to complete this November (2012) and is hoping for a career as a doctor.

“When the news came out about the CAA decision I couldn’t believe it and I was in tears as I knew how much it would mean to my friends, who had been forced to give up the career they loved so much.

“But about half way through my engineering degree I became fascinated by medicine and I’m aiming to become a diabetologist or a surgeon in aviation or

Record breakers On top of his studies, Karl also works part-time as an instructor on a 737 airline simulator and in his spare time he has been technical support for three record-breaking flying projects organised by Pilots With Diabetes in the US. Over the last nine years, members of the Pilots With Diabetes group have notched up 13 flying speed records and last year co-founder Douglas Cairns made the first landing in a light aircraft on the polar ice at the North Pole.

When the news came out about the CAA decision, I couldn’t believe it and I was in tears spaceflight medicine,” says Karl.

“I am certainly ticking all the boxes.”

Karl, now 23, has always taken living with diabetes in his stride, but he finds it even easier to manage since a few recent changes.

“I used a test meter and strips until a few years ago when my parents funded a continuous glucose monitor for me. This has a fine metallic wire, which goes into the abdomen. It measures the glucose in the body and gives off an early warning sign for a hypo or hyper.”

Karl finds the monitor much more convenient than having to carry around a pot of 50 testing strips.

And since last year, he has no longer had to inject since the NHS agreed to fund an insulin pump, which is attached to the abdomen by a cannula and administers a small amount of insulin all the time, then extra by pressing some of the buttons on the pump when he eats.

“The pump is great. I think everyone should have one, but it really is a postcode lottery. I had to prove that the pump would significantly improve my quality of life and I was really lucky to get one.”

26 balance

Since Karl gained his private licence last year, he and Douglas set a new speed record in flying around Britain’s coastline in a single engine two-seat acrobatic plane.

And this September (2012) Karl was one of six pilots from the group to set a national formation record when they flew between Derby and Southampton in 1 hour, 22 minutes and 38 seconds.

Last year, the group started running Flying With Diabetes days to educate people about how safe it is to fly with diabetes and Karl was one of the speakers at the most recent, at Imperial War Museum Duxford in Cambridge.

Members of the group have raised more than £70,000 for JDRF, and £14,000 for Diabetes UK. “There are still areas, such as science, where having diabetes is considered as being a health and safety issue,” says Karl. “But everything we have achieved in the group shows that diabetes needn’t be a barrier to whatever you want to do in life. After all, if you can fly to the North Pole with diabetes you can do anything!” i Visit www.flyingwithdiabetes.com and www.pilotswithdiabetes.com to find out more about their work.

HISTORIC DATES FOR PILOTS WITH DIABETES 1996 Canada allowed pilots with Type 1 diabetes to fly planes with up to four seats privately.

1997 The USA was the first country to allow pilots with insulin-dependent diabetes to fly any plane privately.

2002 It was announced that pilots with Type 1 diabetes in the UK would be allowed to fly a private plane with a single engine during daylight hours, but could not carry passengers.

August 2012 The CAA announced that pilots and air traffic controllers with diabetes treated with insulin and other medications can carry out full operation duties, including flying commercial aircraft.

However, people with diabetes will still be unable to fly with the military.

November – December 2012

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18/10/2012 19:44

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New organisations CLINICAL COMMISSIONING GROUPS are made up of general practices and are responsible for ‘the reasonable health needs’ of people who are in their area.

They are responsible for producing the commissioning plan for health services in their area.

NHS COMMISSIONING BOARD is the most powerful of the new commissioning organisations. It will commission about £20bn of services directly, such as General Practice, and is in charge of setting up the system of clinical commissioning groups.

HEALTH AND WELLBEING BOARDS bring together groups of local commissioners, eg the clinical commissioning group, public health and social services to assess the needs of their local populations through a joint strategic needs assessment. They then produce a strategy, which acts as an overarching framework within which commissioning plans are developed for health services, social care, public health and others.

All change?

The NHS in England is going through one of the biggest reorganisations in its history, which takes effect next April. And, for many, it’s all very confusing. John Fellows, Diabetes UK’s Senior Policy Officer, tells us what to expect There’s been substantial media coverage and reports on the NHS reform, but for many people the changes are still unclear. Why? One reason is that they’re not primarily about the care that people get from the NHS, the changes are mainly about the organisations that largely work behind the scenes and set the framework for how healthcare is provided.

While most people are familiar with their local GP and hospital, people tend to be less interested in the workings of their Primary Care Trust (PCT) or a national organisation such as the National Institute for Health and Clinical Excellence (NICE).

That’s not to say people won’t have come into contact with these organisations. For example, if a person has had to go to their PCT to argue for funding of a particular treatment, if they have had to check guidance or guidelines from NICE or if they want to be involved in local healthcare decisions through Local Involvement Networks (LINks).

The new reforms are termed ‘marketbased’ because they increase the amount of competition between service providers.

The internal market (which was created in 1991) introduced the ‘purchaser/provider split’, and is one of the differences between healthcare in England and the other parts of the UK. In this, providers of healthcare (such as hospitals) gained more freedom and the ability to compete for contracts for services from purchasers of healthcare (such as PCTs).

Will we see much of a difference?

This remains to be seen. The new changes, which come into force in April 2013, rearrange the ‘purchaser’ side of healthcare. The system of PCTs will be replaced by Clinical Commissioning Groups (CCGs) and the National Commissioning Board, and these will be responsible for the money in the health service. (The organisations, which different governments have set up to advise and regulate different parts of the system are explained in the sidebars left and overleaf.)

Why is it so controversial?

There are lots of reasons but the massive difference in opinion between the political parties (and others) is about whether the

»

November – December balance 29 28-31 NHS Feat.indd 29

18/10/2012 21:11

feature will cause an improvement » reforms or a decline in the quality of care

CARE QUALITY COMMISSION has to register all providers of health and social care services according to standards of quality and safety. It responds to complaints and inspects services.

that is provided.

Another reason can be traced back to the internal market and the role and extent of competition in the English NHS. The Health and Social Care Act is so large because it was an attempt to legislate for all aspects of healthcare at the same time, with the aim of stopping future reorganisations. However, when it came to stating how far competition should go and how it should be promoted, gaining agreement on this was extremely difficult because of differences between, and within, the political parties.

Also, the NHS, along with other areas of government spending, is taking a hit. While other government departments are seeing an actual cut in their budgets, the NHS has been protected and is receiving a nominal (0.1%) rise in its budget. However, for a service that has received, on average, a four per cent annual increase, this potentially puts it under strain. The NHS has known that this funding would slow for some time, and has put in place ‘efficiency savings’ with the idea that instead of receiving more funding, services cost less through becoming more efficient, to the tune of £20bn over four years.

Will services change?

HEALTHWATCH ENGLAND will inform the NHS Commissioning Board and the Secretary of State about the views and experiences of people who use health or social care services and how standards could be improved. They will gather this information through Local HealthWatch, which replace Local Involvement Networks and Patient Advice Liaison Services.

MONITOR regulates

Diagrams based on a version by Nuffield Trust

At the centre of the reforms are two ideas.

Firstly, it is thought that putting clinicians in charge of commissioning in CCGs will allow better services to be purchased. The second is that more providers of services will create a more competitive environment, which will improve the quality of care that CCGs can purchase.

The extent to which these two things happen are likely to affect how much services change. But the extent to which they will happen is still open to debate. The reason for this is that the new regulator (Monitor) and the new purchasers (CCGs and the NHS Commissioning Board) are still setting themselves up and working out the extent of their powers.

If there are any changes to services, CCGs must involve people affected by the changes in those decisions.

30 balance

What is Diabetes UK doing?

We are monitoring the new organisations and responding to their ideas about how they should be set up. The quality of care that people receive should not be compromised by these reforms.

If you tell us what’s happening with your local service we will: • Collate information so we can see what’s happening across the UK. This helps us when we’re talking to the key decision-makers who can make a difference to the quality of local diabetes services.

• Shine a light on the very best services and identify those areas where more needs to be done to ensure people with diabetes are provided with the essential care they need and expect. i Visit www.diabetes.org.uk/Get_involved/DiabetesVoices/Take-action/speak-out/ for further information.

NHS Foundation Trusts, which are the hospitals that have gained greater freedom over their activities.

Monitor’s powers were extended by the Act and it is now the ‘sector regulator’ which means that it has the role of promoting competition in the NHS. NICE becomes the NATIONAL

INSTITUTE FOR HEALTH AND CARE EXCELLENCE and continues to assess evidence and provide a wide range of guidance such as clinical guidelines, appraisals of drugs, Quality Standards and Public Health Guidance.

November – December 2012

28-31 NHS Feat.indd 30

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feature

future past Main photo: Piers Allardyce

The past year has been memorable for Benny Bonsu, 31. Not only did she see her work – helping to deliver a memorable London 2012 Games – reach its conclusion, but she also discovered that she has Type 2 diabetes. Still coming to terms with her condition, Benny explains to Elizabeth Hughes how it has helped shape her future – back in her ancestral homeland of Ghana…

32 balance

November – December 2012

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feature

N

o one could believe it!” says Benny, from Tottenham, as she reflects on being diagnosed with Type 2 diabetes back in March of this year.

“I was only 30, so it was a shock.”

Benny – a slim, dynamic young woman – has never smoked, is teetotal and has played sport throughout her life, particularly athletics and basketball. To make matters worse, the diagnosis coincided with an incredibly busy time at work.

She was working for LOCOG, helping to organise the London 2012 Games, and the pressure was on. For four years, she had taken on a wide variety of roles – from managing budgets to buying equipment and

tournaments, acting as a courtside presenter and managing the on-court entertainment between quarters. The work left little time for cooking evening meals or even stopping for lunch.

“I loved my job, but it was hard work,” she says. “One of the London 2012 sponsors was Cadbury’s so we were surrounded by sweets in the office and often you just grabbed a packet of chocolate buttons instead of eating a proper lunch.”

High risk Family history of the condition and the fact that Benny is of Black African descent put her at higher risk of developing Type 2 diabetes early in life. Yet, when Benny’s

People perceive me as healthy because of the way I look.

Now I recommend that all my friends get checked

Main photo: Piers Allardyce

ensuring that venues were ready for both the Olympic and Paralympic Games. In the final six months of her job, Benny worked in sports presentation – producing both the Olympic and the Paralympic basketball and wheelchair basketball

As courtside presenter, work left little time for cooking or stopping for lunch

symptoms developed she didn’t consider the possibility that she would go on to be diagnosed with diabetes.

“I was losing a lot of weight, I looked like a skeleton, my hair wasn’t growing, it was really bad, but you don’t realise at the time, do you?”

Benny had been feeling weak and tired. However, she put that down to long hours in the office, until things got so bad she could no longer ignore the symptoms.

“I was falling asleep at my desk and one morning I felt so weak I couldn’t even get out of bed, so I finally went to my GP, got tested and was

Games maker: Benny managing the on-court entertainment for London 2012 diagnosed with Type 2 diabetes,” Benny explains.

“I had also been going to the toilet a lot, which was really embarrassing!

I didn’t know what was wrong, so at least when I was diagnosed I was happy to know the reason.”

Dealing with the diagnosis and its implications wasn’t easy. And six years previously, Benny’s mother Mary was diagnosed with Type 2 diabetes after suffering a brain haemorrhage, which left her in a coma for several months. Mary was in her late 40s when this occurred and, thankfully, has made a full recovery. She now manages her diabetes with medication and by eating a healthy diet.

“After my diagnosis, I was disappointed to say the least,” Benny says. “I took two days out of work. I was so unhappy to know that it was real and I had to learn to live with it.

Now I can’t be careless any more and can’t eat exactly what I want. That was the hardest thing for me.”

Support As Benny struggled with changing her lifestyle, she was lucky enough to have great support from her

»

November – December 2012 balance 33 32-35 Benny SRS AC 1.indd 33

18/10/2012 18:46

Benny’s workmates did everything they could to help her make healthy choices

friends and colleagues. She » family, moved back home so that her mum could make tasty, but healthy, evening meals and lunches for her.

Her workmates also did what they could to help Benny make good choices. They joined her in making healthy, home-cooked lunches, eating them together at least once a week.

Benny received excellent care from her local GP and health centre and is learning to manage her diabetes through a healthy diet and activity regime – she doesn’t take medication and received monthly hospital checks on her blood glucose levels. But, she feels that the impact on her daily life has been huge.

“My whole lifestyle and what I eat has changed,” she says. “I love healthy food, so as long as I have a tasty meal I don’t miss chocolate as much.

“I am not 100 per cent, I am still trying to put on some weight, but my skin is looking much better. I enjoy eating nutritious food and love taking more exercise – I feel like I’ve become like an athlete myself!”

Since her diagnosis, Benny has taken part in both a 10K race and the Bupa Great North Run to raise money for Diabetes UK Healthy Lifestyle Roadshows.

Benny finds it alarming that many people from Black and Asian backgrounds are still unaware of their increased risk of developing Type 2 diabetes over the age of 25.

When she brought up the fact that she is Type 2 with a group of professional Black women, they were shocked. “People perceive me as healthy because of the way I looked,”

34 balance

says Benny. “Now, I recommend that all my friends get checked.”

Now 31, and with her work on the Olympic and Paralympic Games at an end, Benny made an exciting career move in October back to Ghana, a country she left as a small child when her parents moved to Britain. Benny now works as a presenter on breakfast TV, and as a basketball coach for young people in Accra. And, Mary, her mother, is also considering a move back to Ghana.

To have the opportunity to come back to Ghana and a less stressful environment is great Facing the future After thinking about it for some time, Benny’s diabetes diagnosis sealed her decision to move, believing that living and working there would be less stressful than the hectic existence she had in London.

Benny was also diagnosed with sickle cell anaemia at the age of 16, for which she takes daily iron tablets, so feels that a more relaxed life in Ghana will help her to manage both conditions. “Changing my lifestyle has been very difficult, so to have the opportunity to come back to Ghana and do things I love in a less stressful environment is great.”

The move has given Benny the opportunity to change her lifestyle completely, which is better for both her health and work-life balance.

Home-made meals are still the norm there and Benny will have a cook at home to prepare food for her, so sticking to a healthy diet should be easier.

However, illness is a taboo subject in Ghana and awareness of diabetes is low, so Benny wants to try to

address both of those issues and also plans to raise awareness of diabetes because a rise in the numbers with the condition threatens Africa, too.

In early October, shortly after arriving in the country, Benny attended a health conference for women and also plans to set up a monthly dining/discussion club for professionals. In the past, she has successfully run similar events in the United States and London to give professional Black women the opportunity to gain support from their peers regarding a range of issues, such as racism and health matters.

Health is now much higher up Benny’s agenda, especially after discovering the lack of diabetes awareness, even among professional women of Black and Asian heritage.

Benny also plans to use her basketball coaching sessions with young people as a platform to raise awareness of diabetes and the importance of activity and diet.

Her advice is simple: “If you recognise any of the symptoms of diabetes, talk to your GP. And if you’re diagnosed, keep talking about it with the people who care about you. Sometimes it can get hard. But the more you talk about it and seek help the easier it is.

Being open about it is much better and also helps to educate others.” i You can encourage people to find out their risk of developing Type 2 diabetes at www. diabetes.org.uk/risk.

November – December 2012

32-35 Benny SRS AC 1.indd 34

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36-39 Research Feat 2 SRS AC.indd 36

18/10/2012 20:35

feature

s

Funding our future Childhood and adolescence can be challenging for people with diabetes and their families, and can have a significant impact on complications in later life. Dr Richard Elliott talks to researchers who are studying diabetes in young people to help make growing up with the condition easier

“If you look at a clinical trial,” she says, “as scientists we take the mean or the average result. But if you look at adolescence where there is so much difference and diversity, it is difficult to apply a mean or an average result.”

Exploring needs with ADNAT

Bridging the gap Professor Helen Cooper at the University of Chester understands the difficulties faced by young people with diabetes, as she has Type 1 herself.

“Controlling diabetes as a teenager can be extremely difficult,” she says. “Not only due to physical changes, but also because of the need to form a sense of identity and the pressure to fit in with peers and not be different.

Alongside America, the UK has one of the worst levels of diabetes control

for this age group and the question you have to ask is why? What are we doing here that, despite our best efforts, means we’re not achieving what is happening elsewhere, where they are getting much better results?”

Prof Cooper, who has worked in diabetes education research for many years, found that most approaches to diabetes education and support tend to be ‘one-sizefits-all’, without any way of assessing the individual needs of adults and children, including the different ways that people learn.

To bridge this gap, she has used £197,335 from Diabetes UK to develop and test ADNAT (the Adolescent Diabetes Needs Assessment Tool), an online questionnaire that aims to uncover the educational and support needs of people with Type 1 diabetes aged 12–18. The first of its kind in the UK, ADNAT uses 117 questions to provide a wide-ranging evaluation of knowledge, psychological and social issues and an overall self-care score of patients’ needs. It then feeds information back to both patients and healthcare professionals using a traffic-light system to show (in green)

»

November – December balance 37 36-39 Research Feat 2 SRS AC.indd 37

18/10/2012 20:35

feature

needs are being met and » where (in amber and red) where support is needed with increasing urgency.

The tool covers six areas, including the background of each child, their physical activity levels, diet and eating habits, their medication, their selfmonitoring of blood glucose and how they live with their diabetes in relation to a series of problem-based scenarios.

In this way, ADNAT helps to tailor the care provided for young people by taking account of diverse backgrounds and situations.

Prof Cooper’s team wanted ADNAT to fit the modern lives and the culture of young people with diabetes and so they have made it available online and have also adapted it for use on smart phones and tablet devices. This will not only make it cost effective, but will also make it useful for healthcare professionals, who will be able to receive feedback using the same electronic platforms.

She says: “Our research has taught us that children can often speak more directly and more honestly to a computer than they can face-to-face with a healthcare professional. We hope that ADNAT will help to overcome that barrier, providing them with a safe place to disclose information about themselves.”

Looking to the future…

Next the researchers plan to extend ADNAT and turn it into ADNET (the Adolescent Diabetes Needs-Based Education Tool). This would allow them to provide online and offline education to help meet

young people’s needs once they have been identified.

“What the children told us is that they want tools for learning that respond to their needs quickly,” she says. “So, for example, if they receive a red light in the diet area, they can click on a learning programme associated with that area to give them the support they need. We don’t all learn in the same way because our learning needs relate to how we learn, not just what we learn. It is therefore extremely important to have different ways of

development of KICk-OFF (Kids In Control Of Food), the first similar course for young people with Type 1. Initial studies revealed that the KICk-OFF course improved quality of life and confidence in managing diabetes – for both children and their parents –

Will it help kids to manage their diabetes more easily, have a better quality of life and blood glucose control? We hope it will! learning. ADNAT, alongside more conventional programs, aims to provide choice to young people” Prof Cooper and her team are now evaluating the use of ADNAT in NHS care, so that practitioners and patients have a choice regarding the way that they are educated and meeting their needs can become a standard part of care planning.

KICk-OFF enters home straight Back in 2000, Diabetes UK funded initial research into DAFNE (Dose Adjustment for Normal Eating), the successful education course that helps give adults with Type 1 diabetes the skills needed to calculate how much carbohydrate is in each meal and to inject the appropriate dose of insulin. The aim is to let people with diabetes retain effective control of their blood glucose levels while leading lives that are as normal as possible. Building on this achievement, Diabetes UK has granted £993,751 to support the

while gathering feedback so that the course curriculum could be refined.

Staying the course Dr Kath Price, a Consultant Paediatrician at Sheffield Children’s Hospital, has now entered the final year of a trial involving 480 young people at 31 locations around the UK. Approximately half attended a KICk-OFF course, while the rest continued with their usual care and education. Dr Price explains what is involved: “Groups of 11–13-year-olds and 14–16-year-olds come along and slowly, through the course of the week we hope to build up their knowledge and skills around their diabetes. The principles for KICk-OFF are the same as DAfNE, but we have completely rewritten them to address the very different learning styles of adolescents.

KICk-OFF is much more interactive and much more practical – it involves cookery and sports sessions and there is a lot of opportunity for those who take part to talk and express their beliefs and their fears about having diabetes. They also get the chance to share any difficulties they’ve had, address misconceptions and practice what

38 balance November – December October 2012 36-39 Research Feat 2 SRS AC.indd 38

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feature

they’ve learned. Every meal is a social event – at every meal they are sharing ideas and carb counting – so there’s an element of peer support to it as well.”

The future is KIcK-OFF Since we last reported on the trial (balance, issue four 2011) the researchers have been monitoring the effects of KICk-OFF on diabetes control and quality of life of children who took part (compared to children who received standard education) for the last two years. Data collection was due to end in September and

by February 2013 it will have been fully analysed by a statistician. Then researchers will know if KICk-OFF is effective and how it might be used to help young people with Type 1 diabetes.

Dr Price tells me about some of the obstacles that have been overcome and some of the challenges that remain as the research nears its conclusion: “A lot of kids were really scared about joining

Cutting Type 2 risk factors Childhood is also a period that can have a significant impact on the risk of Type 2 diabetes, especially in ethnic minorities. In the UK, the risk of Type 2 diabetes is 4–6 times higher among South Asian people and 2–3 times higher among African-Caribbean people than that among White European people. A key finding of the Child Heart And Health Study in England (CHASE), which examined risk factors for Type 2 diabetes among 5,000 children of different ethnic origins between 2004 and 2007, was that these ethnic differences in Type 2 risk were already emerging in childhood.

Now, with £76,167 from Diabetes UK, Professor Peter Whincup at St George’s, University of London, will use the information obtained during CHASE to explore the influence of diet in

from more than 2,000 children to examine how diet influences emerging Type 2 diabetes risk, including differences across ethnic groups.

“We’re trying to find out which components of the diet are the most important,” he says. “We can study that in a number of different ways, but we’re looking specifically at energy intake, the quality of children’s diets and the patterns and circumstances of eating.

Simple markers, such as whether children are regularly eating breakfast or not, what kind of meals they have at school and whether or not they are eating takeaway food may all provide important clues.”

Uncovering new evidence

Prof Whincup concludes: “Our hope is to provide information which will inform strategies for the early prevention of diabetes or to lay the ground for trials of new dietary interventions to reduce the long-term risk of diabetes. These might involve elements of dietary advice or focus on Controlling diabetes as a teenager can be difficult because of the particular nutrients in the diet. We’ll also look need to form a sense of identity and the pressure to fit in at the importance of eating patterns. For a KICk-OFF group, because talking childhood on variations in the risk of example, there has about these sorts of things can Type 2, both between individuals and been concern about make kids quite anxious. But once between different ethnic groups. the health of they got through the door, they children who stuck with it and you could see Explaining ethnic differences don’t eat that each group gelled over the Prof Whincup explains: “In our original breakfast, course of the week. A lot of them study, we were able to show that particularly formed really strong friendships and ethnic differences in diabetes risk in relation have kept in touch afterwards, and a were already apparent in children by to obesity, few parents told us that they cannot 9–10 years of age. The next question or who eat believe the changes they have seen is to identify the reasons for these a lot of in their children over the week. differences. A lot of evidence suggests takeaway “The biggest issue is whether that diet is very important in Type 2 meals they can sustain changes afterwards. diabetes, but it hasn’t been easy to – those They can go on a course and pin down exactly what the dietary are the be enthusiastic but in the long components are – and there has been sort of run, will it help them to manage very little study of the influence of diet dietary their diabetes more easily, and and nutrition in childhood on emerging patterns we have a better quality of life and Type 2 diabetes risks.” hope to give blood glucose control? We His team will use statistical analysis of evidence-based hope it will!” data on detailed dietary assessments advice on.”

November – December 2012 balance 36-39 Research Feat 2 SRS AC.indd 39

39 18/10/2012 20:36

GREAT NEWS! Diabetes UK has launched a new web shop to make your shopping experience even better. You’ll see bigger, clearer pictures, concise product information and a simplified ordering process The shop includes Diabetes UK’s branded items, Christmas cards and a wide range of products, ranging from insulin wallets, kitbags and cases, to a selection of books that will help to answer questions about diabetes and maintaining a healthy lifestyle.

Why not visit shop.diabetes.org.uk and find something you really want!

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Order these and other Diabetes UK items at shop.diabetes.org.uk or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote B158 when placing your order. (Postage is charged on some items.)

40 Shop Ad.indd 54

18/10/2012 12:50

life&health CAN YOU COUNT ON IT? Eating your five a day is the sure-fire way of making sure you include enough fruit and veg in your diet. But don’t count on food labels alone to guide you

Beans and pulses count, but only as 1 portion however much you eat 1 MEDIUM (150ML) GLASS OF UNSWEETENED, 100% FRUIT JUICE OR SMOOTHIE. THIS CAN COUNT AS 2 PORTIONS IF IT CONTAINS AT LEAST 2 VARIETIES OF A WHOLE FRUIT/VEG Fresh, dried, tinned and frozen varieties all count as part of your five a day

W

alking down supermarket aisles, it can be easy to be lulled into a false sense of security about just how healthy some of the food choices you make actually are. The labelling on some processed and packaged foods, such as ready meals, pasta sauces and soup, makes claims that the product ‘counts towards your five a day’ or makes up ‘one of your five a day’. But even though the product does contain the amount of fruit or veg it claims, it may also contain a high amount of fat, sugar and/or salt. So don’t just be guided by these claims alone, otherwise you could be misled into thinking it’s healthier than it is. Instead, take a closer look at the labels to help you decide whether or not the food you are about to buy really is a healthy choice.

salt, fat and sugar content, processed and packaged foods can help to notch up a portion of your fruit and veg. But there are

BULK UP YOUR MEALS • Add a handful of fresh berries or dried fruit to your cereal.

• Make a hearty vegetable soup for lunch.

• Not much time for dinner?

Make a quick, crunchy stir-fry (go easy on the oil).

SNACK SMART • Nibble on 1 heaped tablespoon of dried fruit as a snack.

• Try some vegetable crudités and a low-fat dip as a snack.

• Drink a glass of unsweetened 100% fruit juice/smoothie.

PERFECT YOUR PUDDINGS • Have a piece of fruit for dessert, or make a delicious fresh fruit salad • Add fruit fresh fruit to a low-fat yogurt.

{

A PORTION OF FRUIT OR VEG IS 80G, THIS IS ROUGHLY EQUIVALENT TO 3 HEAPED TABLESPOONS OR • 1 MEDIUM APPLE/ BANANA/PEAR • 2 CLEMENTINES OR 3 APRICOTS • HANDFUL OF GRAPES OR BERRIES • 1 CEREAL BOWL OF SALAD

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OF PEOPLE EAT THEIR FIVE A DAY

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WHAT COUNTS AS A PORTION?

Ways to top up If eaten as part of a balanced diet with a close eye on the

Source: www.vielife.com

other – and perhaps better – ways of getting your five a day.

Preparing meals at home will give you more flexibility to make them healthier. They don’t have to be gourmet:

Buying fruit and veg in season can often be cheaper. They may even taste better, too. i Find out what’s in season at www.eatseasonably.co.uk/ what-to-eat-now and see page 54.

November – December 2012 balance 41 40-44 L&H JC 3.indd 41

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life&health

» Why is it important to eat plenty of fruit and veg?

They contain essential vitamins and minerals that are important for good health.

They also play an important role in bowel function, such as preventing constipation.

They can help to protect against stroke, heart disease, high blood pressure, some cancers.

High in fibre and low in calories, they are not only essential in our diet, but can help us maintain a healthy weight.

A flexible future We’re constantly hearing about the benefits of keeping active but what about stretching – is it really just an important part of a workout? Advanced Personal Trainer, Shenda Falvey, explains Flexibility, the measure of the maximum range of movement around a joint, is the most under-rated component of health and fitness. Muscular strength, muscular endurance, cardiovascular fitness and motor skills, get all the attention, yet there are many benefits of regular stretching.

Lack of flexibility makes the body stiff and less mobile, leading to bad posture, restriction in everyday movements and joint pain. Although stretching is commonly PECTORALIS MAJOR (CHEST) Clasp hands behind back and extend arms, squeezing shoulder blades together.

BENEFITS: Realigns shoulder girdle and reduces kyphotic posture (forward rounding of shoulders) and compression of lungs.

HAMSTRING (BACK OF UPPER THIGH) Take a small step forward, keeping the front stretching leg straight. Pivot from the waist, ensuring your back remains straight.

Rest your hands on the thigh of back bent leg.

BENEFITS: Improves posture, realigns pelvis and reduces aching of lower back.

performed at the beginning of exercise to help prepare muscles, and at the end to reduce soreness, it should also be incorporated into our daily routine.

Stretching when getting out of bed or after sitting for long periods, for example, will help ease tight muscles while improving mobility and flexibility.

So why not try out the following standing stretches? Warm up, start with feet hipwidth apart and hold for 20 seconds.

ERECTOR SPINAE (BACK) Place hands in between legs, clasping above knee. Arch back and hang head.

BENEFITS: Relieves backache, reduces stiffness of shoulders and increases mobility of spine.

QUADRICEPS (FRONT OF UPPER THIGH) Raise foot to bottom and hold by ankle, ensuring knees are aligned. Use wall for support if necessary.

BENEFITS: Improves balance and posture, realigns pelvis, reduces aching of lower back and strengthens standing leg.

42 balance November – December 2012 40-44 L&H JC 3.indd 42

18/10/2012 20:50

life&health

LIGHT

fantastic Now the clocks have turned back, it can be common to feel gloomy and to be less active. But for people with Seasonal Affective Disorder (or SAD), symptoms can be far more serious if not treated effectively

S

AD is thought to be caused by a lack of daylight and sunlight hours, which creates an imbalance of certain hormones, affecting mood, appetite and sleep. It affects seven per cent of people in the UK, though it is thought that perhaps as many as one in eight people may suffer milder symptoms of the condition. It’s also known as ‘winter depression’ as symptoms are more evident or severe during winter and disappear in spring.

Diabetes & depression Coping with diabetes and depression can be tricky. For instance, SAD can affect your appetite, choice of food and eating patterns which can all affect blood glucose levels. You may also feel exhausted and anxious about things that you wouldn’t normally, and this may put you off testing or injecting because it just feels too much to cope with. Stress can also raise your blood glucose levels or make them erratic.

It’s important to discuss this with your GP or diabetes healthcare team for further support.

Treatment A range of therapies, often in combination, such as light therapy,

cognitive behavioural AV ER AGE therapy or by taking U K D AY L I G H T certain antiJULY depressants are used 17 hours to treat SAD. Light therapy has been DECEMBER shown to be very 7 hours effective; it involves daily use of a light box from specialist A combination of the following manufacturers, which emit a high symptoms experienced over around three intensity of light (much brighter consecutive winters could signal SAD: than usual light bulbs). Some retailers • depression – feeling low, sad, weepy offer a home trial or hire scheme. and oversensitive There are also simple lifestyle • increased anxiety – feeling panicky, factors that can help to improve overwhelmed or unable to cope your symptoms of SAD: • loss of interest or pleasure in your • exercise regularly – even usual activities brief walks can help • being less physically active • eat a healthy, balanced diet • sleeping more with plenty of fruit and vegetables • fatigue – feeling tired even after sleep • get as much natural light as possible • inability to concentrate or finish tasks – try to get outside when it’s sunny • social withdrawal or daylight is at its brightest • increased ill-health • make your environments as • overeating. bright and light as possible • sit near to windows when Remember, if you have symptoms, you’re indoors speak to your GP as there are steps you • try to avoid stressful situations. i Call Diabetes UK Careline for support can take and treatments to help (see left). and information: 0845 120 2960.

• SAD Association: www.sada.org.uk

SPOT THE SIGNS

November – December 2012 balance 43 40-44 L&H JC 3.indd 43

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life&health

Old

4.0 5.0 6.0 7.0 8.0 9.0 10.0 (%)

Current 20

30

40

50

60

70

80 (mmol/mol)

How to... calculate your new HbA1c

HbA1c converter CURRENT (mmol/mol)

OLD (%)

20

4.0

31

5.0

42

6.0

48

6.5

53

7.0

58

7.5

64

8.0

75

9.0

86

10.0

It’s three years since the change began in the way HbA1c is reported, yet there’s still confusion for many people with diabetes about the new measurements. Because of this, you may even still be given your HbA1c result in percentage (%) rather than millimoles/mol (mmol/ mol) – or both!

Those who are old enough to remember when decimal currency and metric measurement took over from sterling and imperial, will know that there comes a moment when you have to stop converting back and only use the new numbers. Perhaps it is now.

If you are still given your result as a percentage, there is a way you can work out your ‘current’ mmol/mol

reading: known as ‘minus two minus two’), it can only be used for whole percentages and only holds true between 4% and 13% inclusive.

For example, if the measure is 7%, 7 minus 2 (equals 5), minus 2 (equals 3). Put these two together and it totals 53mmol/mol.

We’ve also devised a simple chart to help (left), but you can also visit www.diabetes.org.uk/ hba1c for a special converter.

Remember, don’t confuse the mmol/mol result with your blood glucose meter readings, which are in mmol/l. These have no connection with each other.

What is… the honeymoon phase?

It’s the time immediately after being diagnosed with Type 1 diabetes, when the pancreas still produces a certain amount of insulin. As the insulin comes from your own pancreas, and so is released when your blood glucose levels rise, it makes managing your diabetes easier. It also helps protect against diabetic ketoacidosis (DKA), when levels can go dangerously high.

During the honeymoon phase you only need to inject a relatively small amount of insulin to control your blood glucose levels. The phase, which happens to most people with Type 1, usually lasts between three and six months, sometimes a year or even longer. After this time, your insulin doses will increase as the amount your pancreas produces starts to decrease.

»»»ON««« »TARGET« 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 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 with your diabetes healthcare team.

» HbA1c

Below 48mmol/mol (6.5%) or 58mmol/ mol (7.5%) for those at risk of severe hypoglycaemia.

44 balance November – December 2012 40-44 L&H JC 3.indd 44

18/10/2012 20:50

Health matter on your mind?

Karen Therapist & counsellor

Deepa Dietitian

Cathy Diabetes specialist nurse

Libby Paediatric diabetes specialist nurse

Write to ‘Ask the experts’, balance, Diabetes UK, 10 Parkway, London NW1 7AA. Please note: ‘The Experts’ cannot take telephone calls

PUMP PROOF We’re going on our first holiday since my 7-year-old daughter switched to using a pump. We’re hoping to spend a long time in the pool, and, as the pump isn’t waterproof, we’ll just disconnect it. But should we limit her time in the water?

Shaleen, Kirkcaldy Libby says It’s generally OK to leave the pump off for an hour or two, so there’s no need to limit your daughter’s time in the pool, but you will need to check her blood glucose more often.

Before you go away, it’s important to get specific details of testing frequency and upper blood glucose limits from your daughter’s diabetes specialist nurse.

If her level goes above your upper threshold, reconnect the pump and give a correction. The pump can then be disconnected again.

Remember that insulin still needs to be given with all food containing carbohydrate, so be sure to re-attach it during water breaks. You may also find that periods of time off the pump don’t cause as big a problem on holiday, due to heat and increased exercise from swimming, which can both cause blood glucose levels to decrease.

You could also consider having a ‘pump holiday’ and use a pen while you’re away. If not, remember to keep the pump cool and take extra insulin and pens in case the pump breaks. Enjoy your holiday!

SHOCK TO THE SYSTEM My son, who’s 16, was diagnosed with Type 1 in June and we don’t know if we’re coming or going with his blood glucose. We moved from Scotland to the South East three weeks after diagnosis and, though his clinic is supportive, I feel isolated as we’ve lost our local friends

and support network. It’s also been hard for my son to make friends in his new school. He’s so angry about it all. Help!

William, Sandwich, Kent Karen says: Your family has been through so much change, it’s not surprising that you’re feeling isolated and disorientated. A diagnosis of Type 1 for a teenager is enough of a shock to be dealing with, without the additional stress of readjusting and settling into your new life.

Stress can raise blood glucose levels or make them more erratic and hormonal changes during the teenage years can cause insulin resistance. So, not only will teenagers experience a lot of high levels, they tend to be erratic, too.

It’s great that your son’s clinic is supportive – perhaps they can put you in touch with other local parents or teenagers. You could also consider attending a Diabetes UK Family Weekend, which are very helpful. There are even Children and Young People’s Events for different age groups, so your son may really appreciate some time away with other people his age.

There’s online support, too. i Online support: www.facebook.com or www.diabetessupport.co.uk • Diabetes UK Care Events: www.diabetes.org.uk/careevents

DLA REFUSAL My 13-year-old daughter has received Disability Living Allowance (DLA) since she was diagnosed with Type 1 diabetes four years ago. Her blood glucose levels have been fairly easy to manage, but now they’re all over the place due to puberty. She’s very sporty and competes, but she has lots of hypos and hypers. I spend my time keeping an eye on her and we’re working with her paediatric specialist nurse (PDSN) to try to manage

PARE N

TS’ SP ECIA

L

ask the experts this. But now, on reapplying for her DLA, I’m told that she’s no longer entitled to it.

It feels like I’ve been turned away now that I really need the help.

Susie, Newbury Karen says: We hear increasingly about children losing their DLA benefit once they’ve turned 12. The reason often given is that a child aged 11 and over, diagnosed with Type 1, is likely to be competent at managing their condition within 12 months.

Obviously, this isn’t the case for many children, and you can appeal.

It’s important to describe as fully as possible the nature and effects of your daughter’s condition and her individual need for care. Her circumstances will include how her condition impacts on her and why this complicates her needs.

Try to include extra evidence from her PDSN, school or sports coaches and the help she gets relating to her diabetes management. Include a diary showing the help you provide (such as prompting, checking etc), and give examples of times you get up in the night to check her levels or treat hypos. It will help the decisionmaker to get a better understanding of your daughter’s care needs. i For a guide to DLA, visit www.diabetes.org. uk/dla. For further advice, call Diabetes UK’s Advocacy Service on 020 7424 1840 or email advocacy@diabetes.org.uk.

DIABETES UK

CARELINE To speak to a trained counsellor, call 0845 120 2960, Monday to Friday, 9am to 5pm. careline@diabetes.org.uk • See page 4 for more details.

November – December 2012 balance 45 45 ATE SRS AC JC.indd 45

18/10/2012 13:56

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life&health

Spotlight on...

Your dietitian appointment Entitlement Diabetes UK recommends that everyone with diabetes should see a registered dietitian for specific advice on eating habits. This should be when you are first diagnosed, followed by regular reviews.

Registered dietitians are trained in all aspects of nutrition and health, and are part of the Health and Care Professions Council, which means they have to work within certain codes of practice, including confidentiality. All dietitians have specific diabetes knowledge and may work within a diabetes healthcare team; they’ll have been trained to translate scientific research into practical guidance to help you make appropriate lifestyle and food choices.

For some people, seeing a dietitian is right up there with a visit to the dentist because they worry they’ll be told to cut out favourite foods and Friday night takeaways. But the reality is so very different.

First appointment The dietitian will discuss your diabetes, including any insulin and medication you’re taking, as well as other medical conditions that you may have. As lifestyle has a bearing on your food choices and diabetes control, you’ll also be asked about daily life, eg your job and any exercise you like to do.

If you self-monitor your blood glucose levels, take a record of your results and around four days’ worth of detailed food records; this will help you both look for trends and the effect of foods on your blood glucose levels. It can be difficult to remember what you’ve had at the end of the day, so aim to make a note of everything you eat and drink as you go.

Jot down any activity that you do, too.

If you don’t self-monitor, a food diary will still provide essential information about your eating habits and help your discussion.

same. This, combined with your BMI, is important as it will influence the information provided by the dietitian.

Type 1 If you have Type 1 diabetes, it is likely you’ll discuss carbohydrate counting (a method of matching your insulin requirements with the amount of carbohydrate you eat and drink). It requires a great deal of effort with the support of a healthcare professional. You will need more than one appointment to learn this approach and many people attend a course, such as Dose Adjustment for Normal Eating (DAfNE).

Type 2

Dietitians aren’t there to lecture you, but to encourage you to take control and responsibility

If you have Type 2 diabetes, it’s important to be aware of carbohydrate portion sizes, so the dietitian will discuss these with you.

If you need to lose weight they will work with you to enable you to identify any dietary and lifestyle changes that need to be made.

Goals

Extra support

Dietitians are trained in counselling skills and are not there to lecture you, but to encourage you to take control and responsibility. It’s crucial to ask questions or raise any issues that you may have.

Talk about your goals, eg if you want to lose weight or you’re not sure how to eat healthily on a budget, so the dietitian can work with you to identify diet and lifestyle choices that need to be made.

If English is not your first language, it may be possible for a translator to attend, so ask in advance if this can be arranged.

Referral

You can be referred by your GP or a member of your healthcare team so, if you haven’t, make sure you ask for an appointment. You can also refer yourself depending on your local health trust.

Contact your hospital’s dietetic BMI department to find out more.

You are likely to be asked if you can be i For more on healthy eating, visit www.diabetes. weighed and have your height measured org.uk/Guide-to-diabetes/Food_and_recipes so that the dietitian can work out your body • Patient education courses: www.diabetes.org.uk/ mass index (BMI) to check if your weight Structured_Education. is in the healthy range for your height.

• You can book an appointment with a registered You will also be asked whether you are dietitian who practises privately. Visit the British losing or gaining weight or staying the Dietetic Association at www.bda.uk.com.

November – December 2012 balance 47 46-47 Spotlight.indd 47

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12

The festive season is fun but often hectic, with lots of food, drinking and parties.

The balance guide to Christmas ensures you continue to manage your diabetes without spoiling your fun

days ofChristmas

1

Food with friends?

If you’re going to a party, check beforehand if there will be food so that you don’t end up drinking on an empty stomach. If you’re not sure and you have Type 1 diabetes, have a substantial starchy snack or meal beforehand.

3

Halt your hangover

To help avoid a hangover, drink plenty of sugar-free liquids whenever possible. Also, if you have Type 1 diabetes, be careful not to mistake a hangover with hypo symptoms – check your blood glucose levels if you’re not sure. If you can’t face food or if you’re being sick, take in as much fluid as you can, including some sugary (not diet) drinks, and continue to take your diabetes medication.

48

2

Deal with drink

If the drinks are flowing and you have Type 1 diabetes, snack on something starchy (crisps or breadsticks) to avoid hypos. Stick to ‘diet’ or ‘sugar-free’ mixer drinks, eg diet tonic water and diet cola, and limit drinks with a high sugar content, eg sweet wines and most liqueurs, whichever type of diabetes you have.

4

Chill out

Christmas shopping, cooking and being busy can contribute to stress.

Don’t try to do everything on your own and plan ahead to take the pressure off. Build in some relaxation time, such as yoga, reading or listening to music.

balance November – December 2012

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18/10/2012 15:58

5

Festive food

Remember there are no ‘forbidden’ foods but traditional Christmas fare tends to be high in fat and calories, so don’t eat too much in one go. As they are occasional foods, they can be included as part of your usual meals without having to be adapted, but go easy on the high-fat and high-sugar treats, like mince pies and selection boxes.

6

All-weather workout

If you have a jam-packed social calendar and the weather’s a bit dreary, things may have slipped on the exercise front. But, no excuses, you can still get moving – whatever the weather. Try some fun, seasonal activities, such as ice skating, dancing, sales shopping (yes, that counts!) or winter walks. A brisk stroll will make all the difference and get rid of that sluggish feeling after a heavy festive meal. It will also help to use up the extra calories you have eaten and control your blood glucose levels.

8

Party lows

When you have Type 1, a hypo can sometimes be confused with being drunk, so it’s important to carry something very obvious that indicates that you have diabetes, such as an ID card, a medical necklace or a bracelet. Make sure your friends know you have diabetes and can treat a hypo. A hypo can kick in a few hours after you stop drinking, so always have a starchy snack before going to bed, especially if you had an early evening meal. Have cereal or toast, or even grab a kebab or chips on the way home.

7

Seasonal sniffles

If you come down with a cold, flu or any other illness, make sure you rest, keep taking your medication as normal and drink plenty of sugar-free fluids. If you don’t feel like eating, try to have small, frequent snacks throughout the day, eg yogurt, milk and fruit juice.

If you test your glucose levels, test four or more times a day and night (ie at least eight times in a 24-hour period) and write down the results. If you have Type 1 diabetes there is a risk that your blood glucose levels may increase too high (your blood glucose level is 15mmol/l or more or you have two per cent or more glucose in your urine) and lead to diabetic ketoacidosis (www.diabetes.org.uk/dka). For those with Type 2, if you have been experiencing very high blood glucose levels (over 40mmol/l), Hyperosmolar Hyperglycaemic State (HHS) may occur (www.diabetes.org.uk/hhs).

Contact your GP if you don’t improve or if you are concerned.

10

Block the choc You may receive some ‘diabetic’ chocolate as a Christmas present, but do remember that ‘diabetic’ foods can still affect your blood glucose levels and may cause diarrhoea. Best to have the real thing, instead.

9

Testing highs

Overindulgence, being less active and changes to your routine can all play a part in higher-than-normal blood glucose levels. Don’t worry, the odd one or two high glucose readings over Christmas should not affect your long-term diabetes control or health.

11

Scarce supplies

GP surgeries and pharmacies may have reduced opening hours over Christmas. Plan ahead to cover the holiday period and stock up on your diabetes medication and equipment. If you do run out, and your GP surgery is closed, a pharmacist can provide advice and help to arrange a supply of your repeat medication if needed.

12

Diet detox?

Detox diets after the festive season are popular, claiming to do a number of things, such as helping with weight loss, improving energy levels or boosting your immune system.

But, in reality they are often extreme and offer no real health benefit. It is better to stick to a healthy diet with plenty of fruit and vegetables, low in sugar, fat and salt, as well as staying active.

November – December 2012 balance 49 46-47 Basic Care SRS AC.indd 49

18/10/2012 15:58

recipes

3

is the

ÂŁ2.02 per serving

magic number

Hearty, wholesome food can consist of three main top-quality components, as Hugh Fearnley-Whittingstall demonstrates with these mouthwatering dishes from his new book

50 balance 50-53 Recipes.indd 50

November – December 2012 18/10/2012 15:19

Chicken, plums, soy Serves 4 • dairy free

• 8 bone-in, skin-on, free range chicken thighs (or 1 small free-range chicken, jointed into 8 pieces) • 1 tbsp sunflower oil • 1–4 red, mild to medium-hot, fleshy chillies, to taste (optional) • 4 garlic cloves, sliced • a thumb-sized piece of ginger, peeled and coarsely grated or thinly sliced (optional) • 8 plums, halved and stoned • 3 tbsp soy sauce • a small bunch of coriander leaves only, chopped (optional) • sea salt and freshly ground black pepper

1 2

Preheat the oven to 200°C/392°F/ gas mark 6.

Put the chicken thighs in a roasting tray, trickle with the oil and season well with salt and pepper. Roast for 30 minutes, turning once or twice.

Meanwhile, halve and deseed the chillies, if using, then cut each into 1cm strips. After its 30 minutes, take the chicken out of the oven and add the sliced chillies, garlic and ginger, if using, to the roasting tray. Turn the chicken again to make sure the aromatics are evenly distributed around and under the pieces. Roast for a further 10 minutes.

Tuck the plum halves around the chicken pieces and trickle over the soy. If there doesn’t seem to be much liquid in the tray, add a few tablespoons of water. Return to the oven for 10–15 minutes until the plums are soft and yielding their juices.

Baste the chicken and plums with the pan juices, then leave to rest in a warm place for 10 minutes. Finish with a scattering of chopped coriander, if you like.

Serve with noodles or plain rice.

3

4 5

6

Per serving (231g) 357Kcal – 29.7g protein – 7g

(

• •

•

carbs ( 1.4g sugars) – 23.6g fat 6g saturates) – 2.3g salt

•

21p per serving 89p per serving (homemade purée)

Barley, onion, tomato Serves 4 • 2 portions fruit & veg per serving • vegetarian • dairy free

• • • • •

2 tbsp olive, rapeseed or sunflower oil 1 large onion, finely chopped 150g pearl barley or pearled spelt, rinsed 750ml good beef or chicken stock sea salt and freshly ground black pepper

For the roasted tomato purée (you don’t have to make this; you can use 750ml good-quality passata)

• • • • •

2kg ripe tomatoes, halved 3 garlic cloves, finely chopped A few sprigs of thyme 2–3 bay leaves 2 tbsp rapeseed or olive oil

For the purée Preheat the oven to 180°C/350°F/ gas mark 4. Lay the tomato halves, cut side up, in a single layer in a large, deep baking tray. Scatter over the garlic and thyme, tuck in the bay leaves, trickle over the oil and season with salt and pepper.

Roast in the oven for about an hour, maybe a bit longer, until the tomatoes are completely soft and pulpy, and starting to crinkle and caramelise on top.

Remove and leave to cool off for half an hour or so. Then tip them

1

2 3

into a large sieve and rub through with a wooden spoon, or use a mouli. Discard the skin and pips.

Your sauce is now ready to use.

For the soup Heat the oil in a large saucepan over a medium-low heat. Add the onion and sauté for 8–10 minutes until soft.

Stir in the pearl barley or spelt, then add the stock and 750ml tomato purée or passata. Bring to a simmer and cook very gently, uncovered, until the barley or spelt is tender. Barley should take 30–40 minutes; spelt will only need 20–25 minutes.

Taste and season with salt and pepper as needed, then ladle the soup into bowls and serve.

1

2 3

Per serving (484g) 250Kcal – 6.5g

• •

protein – 42.3g carbs ( 8.7g sugars) 7.4g fat ( 0.9g saturates) – 2.7g salt –

••

Tip: Use a low-salt stock cube to lower the salt content.

November – December 2012 balance 51 50-53 Recipes.indd 51

18/10/2012 15:19

Lentils, spinach, potato Serves 4 • 1 portion fruit & veg per serving • vegetarian • dairy free • gluten free (if made with water)

• 250g split red lentils, rinsed • About 1 litre light vegetable stock or water • about 400g cold cooked potatoes • 2 tbsp sunflower oil • 2 garlic cloves, finely chopped • 1 rounded tbsp curry powder • 200–250g spinach • a good squeeze of lime or lemon juice • sea salt and freshly ground black pepper • lime or lemon wedges to serve

56p per serving

1

Noodles, chicken, greens Serves 3–4 • dairy free

• 1 small head of spring greens (about 200g), or use cabbage or kale • 2 nests of fine egg noodles, broken • 1 garlic clove, finely sliced • a dash of soy sauce (optional) • a squeeze of lime juice (optional)

you’ll need no more than 1.5 litres.

Bring to a bare simmer and cook, uncovered, for at least 3 hours, or up to 5 hours, topping up with water once or twice, if necessary. Strain the stock through a fine sieve into a bowl and leave it to cool. The stock can be For the chicken stock chilled or frozen, or you can cook your • 1 roast chicken carcass noodle dish straight away.

• 1–2 onions, roughly chopped You’ll need about 750ml stock: • 1–2 large carrots, roughly chopped bring it to a simmer. Meanwhile, • 3–4 celery stalks, roughly chopped remove the tough stems from the • ½ large leek, roughly chopped greens and roughly shred the leaves.

• a few black peppercorns Add the shredded leaves to the stock • 2 bay leaves and bring back to a simmer, then add • 1 sprig of thyme (optional) the noodles and garlic. Cook for 3–4 • a few parsley stalks (optional) minutes, stirring a few times, or until the noodles are just tender. If you For the stock, use your fingers have any reserved chicken, add this and a small, sharp knife to strip the a couple of minutes before the end chicken carcass of any remaining good of the cooking time.

Taste and season well with salt meat. Set this aside. Tear the carcass and pepper, then pour into into fairly small pieces and cram warm bowls. Finish, if you like, them, along with any skin, bones, with a dash of soy sauce and a fat, jelly or bits from the roasting squeeze of lime juice. tin, and all the stock vegetables, peppercorns and herbs, into a Per serving (307g) 67Kcal – 3.2g protein saucepan that will take them snugly.

– 10.9g carbs ( 2.3g sugars) – 1.4g Pour in enough cold water to just 0g salt fat ( 0.1g saturates) – cover everything – with a bit of luck

2

3

Put the lentils in a saucepan with 800ml veg stock or water. Bring to the boil, skim off any scum that rises to the surface, then add ½ teaspoon salt (less if the stock is already salted) and stir well. Simmer the lentils gently for about 15-20 minutes, stirring often with a whisk to help break them down, until you have a thick, coarse dahl (lentil purée). Add a little more stock or water if it looks a little too stiff. Remove from the heat.

Meanwhile, cut the potatoes into 5mm–1cm thick slices. Heat the oil

2

69p per serving

1

4

•

52 balance 50-53 Recipes.indd 52

•

• •

November – December 2012 18/10/2012 15:19

recipes in a large, non-stick frying pan over a medium heat. Add the potatoes and fry for about 10 minutes, tossing once or twice, until golden brown all over. Add the garlic and curry powder and stir to coat the potatoes well.

Lower the heat and cook for another minute or two. Then tip the potatoes into the dahl.

Keeping the heat under the frying pan (used for the potatoes) medium-low, add the spinach in handfuls, stirring over the heat as it wilts. If you’ve just washed the spinach, the water clinging to the leaves will be all that’s needed; if it’s dry, sprinkle on a little water. When the spinach is just about wilted, tip the dahl and potatoes back into the pan. Stir the whole lot gently together, trying not to break up the potatoes too much.

Add a good squeeze of lime or lemon juice, then taste the curry and add more salt and pepper if you think it needs it. Serve straight away, with lime or lemon wedges.

3

4

61p per serving

Per serving (488g) 347Kcal – 19.1g

• •

protein – 54.5g carbs ( 17.5g sugars) 7.3g fat ( 0.8g saturates) – 1g salt

•• –

WIN! There are plenty more recipes from Hugh FearnleyWhittingstall’s latest book. And we have a copy to give away to one balance reader.

All you have to do is send in your name and address on a postcard or sealed-down envelope to: balance, Three Good Things book giveaway, Diabetes UK, 10 Parkway, London NW1 7AA. Entries must be received by 23 November, when the winner will be picked at random. © Hugh Fearnley Whittingstall, 2012. Photographs © Simon Wheeler, 2012. From Three Good Things, published by Bloomsbury at a price of £25.

Apricots, tea, mascarpone Serves 6 • vegetarian • gluten free

• • • • •

250g organic dried apricots,halved 500ml hot, strong Earl Grey tea 200g mascarpone 20g icing sugar, or to taste a splash of cream (optional)

1 2

Put the dried apricots into a bowl and pour the tea over them.

Leave to soak for at least 6 hours.

Drain off the liquid that remains into a small saucepan and boil until it has reduced by about half, then pour this light syrup back over the apricots. Leave to cool, then cover and refrigerate. Leave in the fridge for several hours at least, or up to 2 Traffic light symbols

days. The apricots will become even more plump and juicy as they soak.

Beat the mascarpone with the icing sugar until smooth. If the mixture becomes unmanageably stiff, thin it down with a splash of cream or a trickle of the tea liquor.

Serve the apricots, chilled, in glass dishes, with the syrup trickled over and a dollop of sweet mascarpone on top.

3

4

Per serving (145g) 196Kcal – 4.9g

protein – 21.6g carbs 20.5g sugars) – 10.6g fat 6.5g saturates) – 0.3g salt

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bite-sized

In season

A saucy bit on the side

November The saintly spud is at its best – enjoy mashed, roasted, baked or chipped to perfection.

Crunchy and colourful, red cabbage is a winter favourite – perfect with pork or shredded in a winter salad. Pomegranates are in abundance; scatter over yogurt, cereals or mixed with lamb, fish or poultry dishes for a delicious tang.

Granola + 200ml semi-skimmed milk (60g) (374Kcal, 16.7g fat)

Festive accompaniments with a healthy twist

SWAP ’N’SAVE 64Kcal & 9.8g fat

Swiss-style muesli + 200ml semiskimmed milk (60g) (310Kcal, 6.9g fat)

Cranberry sauce

Brandy crème

Serves 8

Serves 8

• 350g (12oz) fresh cranberries • 3 tbsp port • grated rind and juice of 1 orange • intense sweetener to taste

• • • •

Place the cranberries, port, orange rind and juice into a pan. Cover and simmer for 8–10 minutes until softened and juicy. Stir through sweetener or sugar to taste. Cool and chill until required.

December Nothing captures the essence of Christmas more than the smell of chestnuts roasting on an open fire… You can mix them with another December favourite: the Brussels sprout for a traditional Christmas dinner accompaniment.

Don’t forget, too, walnuts and cranberries – succulent and delicious this time of year.

2 tbsp icing sugar 200ml extra light cream cheese 200ml light crème fraîche 2–3 tbsp brandy

Beat ingredients together.

Chill for up to 12 hours.

Serve with Christmas pud. i www.diabetes.org.uk/ Christmas_pudding

Gourmet on the go

Roast shallot & broad bean cous cous

Recipe kindly provided by www.ukshallot.com

Serves 4

+

+

97p per serving

=

Preheat oven to 190ºC/gas mark 5. Put 8 shallots, peeled and halved, in a baking tin and drizzle with 1 tbsp olive oil. Roast until tender. Put 200g cous cous in a bowl and stir in 1 tsp smoked paprika. Pour over 300ml veg stock and cover. Cook 200g broad beans in boiling water then drain, refresh with cold water and ‘pop’ out of their skins. Fluff up the cous cous and stir in the beans, rind of small lemon, 150g crumbled feta, 1 tbsp chopped mint and shallots. Per serving (262g) 274Kcal / 12.4g protein / 31.4g carbs ( 2.6g sugars) / 11.7g fat ( 5.6g sats) / 2g salt

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November – December 2012

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per ing

Grow your own Gardener Stephen Rayner prepares for his winter wonderland Finally, some breathing space after the hard (but satisfying) work of harvest time. Now we can sit back and review the successes and failures of the past season and, of course, learn from both. Even better, we can start to plan and dream about next year’s bumper harvest.

Those of you who bring on early vegetables under cloches or cold frames, will already have the ground covered and frame lights closed to conserve every scrap of warmth, ready to start sowing at the end of next January. Many of you who chose early varieties of Brussels sprouts will already have started harvesting, but even the later varieties will be ready for that festive dinner on Christmas day.

Those of you on heavy soils will need to have your digging completed before the end of December to make sure that the frost can do its work of forming a nice tilth, though it’s worth remembering that the lighter your soil the later you should dig.

Keep an eye on stored apples and pears, remove any that have gone bad, and bear in mind that mice enjoy a juicy apple every bit as much as you do.

So then, it’s back to the fireside, dig out all those tempting seed catalogues and dream. Have a merry Christmas and a prosperous gardening new year.

Porcine and Bovine insulins are still available.

Speak to your diabetes healthcare professional now to find out more.

SNOWBALL COCKTAIL (200ML) 193KCAL

=

18 MINUTES DISCO DANCING

Supporting patient choice Wockhardt UK, Ash Road North, Wrexham, LL13 9UF Tel: 01978 661261 Fax: 01978 660130 www.wockhardt.co.uk HP05/11 March 2011

54-55 bite sized JC.indd 55

3779 Hypurin Patient Ad.indd 1

18/10/2012 14:00 17/3/11 15:57:19

Walk the movies Jonathan Crocker guides us through the stunning scenery and landscapes that formed the dramatic backdrop to blockbusters from Lawrence of Arabia to Harry Potter and the Chamber of Secrets

The South West Coast Path WHERE? Lyme Regis, Undercliff, Dorset–Devon border (SY340914) AS SEEN IN This heartbreaking romantic tragedy, The French Lieutenant’s Woman (1981), based on John Fowles’ novel is set in the coastal town of Lyme Regis. Meryl Streep plays the woman jilted by a French Naval officer, and spends her time at the Cobb, staring out to sea. As the sea crashes against the stone wall, she captivates an aristocratic gentleman, Charles Smithson, played by Jeremy Irons and a tempestuous affair begins.

56 balance

BEST FOOTAGE A huge breakwater that dominates the seashore in the beautiful town of Lyme Regis, the Cobb, is one of England’s most iconic structures. It’s here that you’ll start, before taking the path marked ‘Coast Path – West’ to Seaton. This steep, winding path is tougher than it looks – no side paths, lots of steps – but you’ll be rewarded with breathtaking views over Lyme Bay. You’ll need around five hours for the 8-mile walk, which runs through the nearest thing to a British rainforest – the Undercliff, a wildly overgrown stretch of coast created by a series of landslips and one of the first of Britain’s National Nature Reserves. A lonely, isolated, suitably captivating walk. i www.lymeregis.org • www.southwestcoastpath.com

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Turn to page 64 for a chance to win a guide to the South West Coast Path

Alnwick Castle to Hulne Park WHERE? Northumberland (NU185136) AS SEEN IN Harry Potter and the Philosopher’s Stone (2001) and Harry Potter and the Chamber of Secrets (2002). The outside of Alnwick’s stunning castle is better known as Hogwarts School of Witchcraft and Wizardry in the first two Harry Potter films. BlackAdder (1983) and even The Fast Show (1995), have also been filmed here.

BEST FOOTAGE For a relaxing 3-hour walk, sure to please Harry Potter fans of any age, start on the road in front of Alnwick Castle and take a good look at Hogwarts. Now, follow the path all the way into the peaceful Hulne Park to end with a visit to the remains of the 13th-century Hulne Priory. It is also well worth stopping off at Alnwick Garden, where the garden showcases the UK’s largest cascading fountain – the Grand Cascade, which pipes out 7,260 gallons of water when in full flow. If the weather is just as wet, duck into Alnwick Garden’s giant wooden treehouse, linked by suspended walkways. i www.alnwickcastle.com

The West Highland Way WHERE? Appin, Argyll (NM920472) AS SEEN IN Monty Python and the Holy Grail (1974).

While the other castle scenes were filmed in Doune Castle, the iconic Castle Stalker appears in the final scene as the Castle of Aaargh.

French knight (John Cleese) taunts King

Arthur (Graham Chapman) from its battlements, goading him into a massive attack on the castle, which comes to a bizarre end when police arrest everyone.

BEST FOOTAGE Perched alone on a tiny island and viewed by appointment only, Castle Stalker is one of Scotland’s most photographed castles. Start at Appin and follow the old railway line that heads for Loch Laich.

Crossing a pretty wooden bridge here will give you a great close-up view of the castle, then follow the coastal path west until the road curves away from Loch Laich for the final mile to Port Appin. This is one of the most beautiful places in Scotland. Serving as a ferry point for the Isle of Lismore, the views are stunning. i www.westhighlandway.co.uk

Merthyr Mawr WHERE? Nr Bridgend, Mid Glamorgan (SS872773) AS SEEN IN Lawrence of Arabia, David Lean’s 1962 spectacular, sweeping epic about an English officer (Peter O’Toole) who becomes an Arabian freedom fighter in World War One. It was originally intended to be filmed entirely in Jordan, until Lean discovered this unique environment was once part of the largest dune systems in Europe.

BEST FOOTAGE Careful, you can easily get lost in the epic sand dunes. Remember to save your energy for the ‘big dipper’. This giant sand dune, the second highest in Europe, is what many athletes (including the Welsh rugby team) visit Merthyr Mawr specifically to run up. Starting in Candlestone car park, this 7-mile walk takes you all the way around the coast from Merthyr Mawr to finish at Southerndown.

Crossing the River Ewenny – there are 52 stepping stones – will also take you to Ogmore Castle. Be sure to fill your lungs with the salty sea air while you take in the dramatic coastal views in the second half of the walk. i www.bridgend.gov.uk A version of this article was first published in Walk, the Ramblers magazine

57 November – December 2012 balance 57 56-57 new walk.indd 57

18/10/2012 13:30

travel feature

Driving Miss Daisy Driving a modern car to any destination in mainland Europe is quite a challenge, but to make the journey in a 1934 Austin Seven is another consideration altogether.

But Pamela Hunt, who has Type 2 diabetes, didn’t let that stop her – and some friends – from making an eventful trip to Spain

58 balance

W

Pamela with Miss Daisy, her 1934 Austin Seven

hen my GP told me my blood glucose levels were 36mmol/l and that I should go straight to hospital, I was astonished. Apart from a regular need for the toilet, I felt absolutely fine.

That was 12 years ago, and while I’ve been careful with my diet, exercise regularly and have taken the prescribed tablets, the condition has progressed and I now take insulin daily. But while I pay heed to it, I won’t let diabetes rule my life.

When I retired to Pembrokeshire in 2006, I decided that I wanted to take my 1934 Austin Seven – Miss Daisy – on some nice long and challenging drives. A year later, I had planned a modest five-day, 1,000-mile trip to France with some fellow ‘Austin Seveners’. On any major trip like this, it’s not just a question of considering my own health, but also that of a historic motorcar, especially when it’s away from these shores. So I left for the

ferry with spare parts and medication tucked away and kept cool in every nook and cranny of the car’s anatomy.

Car troubles If Miss Daisy breaks down, she’ll pick the most awkward place to do so. On a trip through Snowdonia in 2005, she chose to conk out on a hairpin bend overlooking a sheer drop. Even so, my confidence in attempting longer journeys grew, and the following year I drove across Ireland and, a year later, back to France.

My diabetes hadn’t caused me any problems either, so in 2010 I decided it was time for a real challenge, a run round Spain. I’d always fancied visiting Santiago de Compostela by following the pilgrim route. So why not in Miss Daisy? I’d mentioned this to the Right Reverend Bishop of St Davids and he asked if we would carry a letter of fraternal greetings from the cathedral, itself a place of pilgrimage, to his opposite number

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18/10/2012 13:09

travel feature in Santiago de Compostela. I agreed and he offered to provide us with ‘A Seal of St David’ – used in medieval times by pilgrims to ease their path. In those days, the production of a Seal at a church or monastery would ensure a bed and some sustenance.

By now I had started to write a book about my adventures. Miss Daisy’s Diaries was being written

Fortunately, I had packed a battery charger – just in case… Next, and barely a dozen miles into Spain, first the brakes and then the brake lights failed. Then, three days in, at the Puerto Del Palo Pass crossing the Cantabrian Mountains, she overheated, then boiled and the engine died. And, given there couldn’t have been a more awkward place, she refused to start again.

Hauling the ‘Old Girl’ over the Cantabrian Mountains on a 2,000-mile trip would provide plenty of material for my book from the car’s perspective, rather than mine. So hauling the ‘Old Girl’ over the Cantabrian Mountains as part of a challenging 16-day, 2,000-mile round trip would provide me with plenty of material.

Conking out I thought it would be a good idea to invite some other intrepid motorists with vintage cars to join me. “It’ll be good fun,” I assured them.

Strangely, not many agreed and we left Portsmouth with just Miss Daisy, a 1931 Model A Ford called ‘The Lady’ and a 1938 Austin Seven Special. I didn’t show concern, as I jokingly told my friends, “Don’t worry, The Seal of St David will ease our path.” I never expected that it would, quite literally, do just that.

Miss Daisy’s first breakdown happened before we had even left the UK when her dynamo packed up.

“Well it’s only downhill from here,” said one of the others. “Get in, we’ll give you a shove. Just keep letting the clutch out as you go down, she’ll start eventually.”

I thought that most considerate of them, especially as I had a near 4,000-foot descent ahead of me to get her going again.

Signed, sealed and delivered We did make it to Santiago de Compostela as planned, eight days after leaving home, and while Miss Daisy’s health was of great concern, I also kept a watch on my diabetes.

Spanish food, while delicious, did attempt to push my blood sugars up, but I made sure that I had plenty of insulin with me in addition to my normal tablets. I did find I had to up the usual dose.

We arrived at the cathedral at the time previously agreed with the Archbishop’s office to find an enormous queue of pilgrims waiting to get in. The doors were firmly shut, as the cathedral was already full. A policeman barred us, but I produced the Seal of St David, and we were taken to meet the Archbishop with our letter… Mission accomplished.

We’d chosen to take a different route back, following the coast.

WIN! We have four signed copies of Miss Daisy’s Diaries to give away. To enter, send your name and address on a sealed-down envelope or postcard to: ‘balance Miss Daisy’s Diaries, Diabetes UK, 10 Parkway, London NW1 7AA by 23 November 2012. balance readers can buy a signed copy of the book for £7.50 (+p&p), until Christmas. Contact the author via Miss Daisy’s website (see below).

This time it was The Lady’s turn to throw up problems when her dynamo also packed up. From then on, Miss Daisy had to share her battery charger.

On our second day of our return journey, the Sat Nav decided to direct us off a roundabout and into a restricted area. A very high fence with lights and notices all over them suggested we were trespassing onto a Spanish Air Base.

It wasn’t long before we ran into the arms of a Civil Guard patrol. However, in contrast to their reputation, they kindly helped us find our way back to the main road. Mind you, I could have done without hearing them having a good old laugh at Miss Daisy’s expense as we drove away.

We made it home safe and sound and, remarkably, I haven’t been put off taking her on further challenging runs – including John O’Groats to Land’s End, which will be the subject of her next book… i Miss Daisy’s Diaries is published by Matador Books, £8.99(+p&p); www. troubador.co.uk. Available in e-book format, from £4.99. • www.missdaisydiaries.co.uk

TELL US! Have you travelled anywhere interesting or in a weird and wonderful

way? Email us at balance@diabetes.org.uk or write to the usual address (see box, above).

The cars reach their destination

58-59 TravelSRS.indd 57

November – December 2012 balance 59 18/10/2012 13:09

fundraising focus TRUE BLUE Dressed as Smurfs, Hannah Jarrett and her friend Leah Brooks, both 14, took part in the Cardiff 5K on August 25 to raise money for Diabetes UK Cymru.

They raised £100 for the charity between them. Hannah, who has Type 1, writes a blog for Diabetes UK. i http://blogs.diabetes.org.uk

Great turn-out for Bupa Great North Run More than 2,500 runners took part in September’s Bupa Great North Run on behalf of Diabetes UK. The event, which is held in Newcastle and Gateshead, is Britain’s largest half marathon, and this year saw a record number of participants. Thanks to the amazing efforts of the runners, Diabetes UK is set to raise more than £500,000 to help fund the charity’s vital work.

For many in Team Diabetes UK, the condition is close to their hearts as they know, or knew, someone affected by diabetes.

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60-61 FF SRS.indd 60

In her year as Lady Captain of Woodcote Park Golf Club, near Coulsdon, Surrey, has raised more than £8,000 for Diabetes UK in memory of her father, George Fullard, who had Type 2 diabetes. At Louise’s request, the money has been put towards funding a research project that is looking at better understanding the effects of vitamin D supplements, in addition to existing treatments, on chronic kidney disease and cardiovascular disease in people with Type 2 diabetes. Louise felt it would be a fitting tribute to her father to raise funds a specific research project during her captainship and the club’s centenary year. “My father had heart problems and diabetes, and I wanted to choose something close to my heart, as he was a member of the Club for 40 years,” explained Louise, who is pictured with Diabetes UK President Richard Lane.

Don’t diss Dave

Avoid forgotten injections and accidental double doses

60

IN LOVING MEMORY

David Appleton, from Diss, in Norfolk, has completed a 960-mile challenge cycling from Land’s End to John O’Groats in just nine days, raising £2,500 for Diabetes UK so far. David, 50, chose the charity as his wife, Sophie, has Type 1 diabetes.

He said: “Knowing the fantastic work Diabetes UK does, made me want to do it even more.”

David (above right) set off from the Cornish coast on 8 September and arrived at John O’Groats on 16 September, having cycled between eight

and 10 hours a day: “It was a brilliant experience. There were certainly a few tough moments – like riding 135 miles from Glasgow to Fort William into a 25mph headwind over Rannoch Moor. I made it in one piece!” i People can still donate at www.virginmoneygiving.com/ davidappleton/4

* valid until 30 November 2012

18/10/2012 21:01

To find out more about fundraising for Diabetes UK, call the Events Fundraising team on 020 7424 1000, email events.fundraising@diabetes.org.uk or visit www.diabetes.org.uk/fundraise

MAKING AN ICY SPLASH

DIARY 18 NOVEMBER Leicester Winter Walk Bradgate Park, Newton Linford, Leicestershire A scenic walk through the undulating terrain of the historic Bradgate Country Deer Park, home to Lady Jane Grey, queen for nine days. i 01922 614 500; midlands@diabetes. org.uk

More than 30 swimmers slid gingerly into the icy depths of Lake Bala, in Snowdonia National Park, on 23 September to take part in Diabetes UK Cymru’s annual event: to swim the largest natural body of water in Wales, while raising money for the charity.

“Yes, it was as cold as you’d think!” said Andy Brazier of Llandudno, who swam to mark the 10th anniversary of his 14-year-old son, Matthew’s, Type 1 diagnosis. “It was good to see hundreds of people cheering from the shore.”

On dry land, the Diabetes UK staff and volunteers were on hand with hot drinks, food and towels for the stalwart swimmers of the 1-mile swim, now in its third year. Locals supported the event with stalls, including a hog roast. The successful challenge is on course to raise more than £5,000.

18 NOVEMBER

3 CHEERS FOR 3 PEAKS Conquering the UK’s three highest peaks over three days is achievement enough, but September’s successful participants of the 3 Day 3 Peaks Challenge have also raised £12,500 – so far – for Diabetes UK. Ben Nevis was the first peak, followed by Scafell Pike, and making it a hat-trick with Snowdon. i Next year’s event will take place from 29 August to 1 September 2013 and applications are now being taken.

Visit www.diabetes.org.uk/3day3peaks.

OPEN HOUSE Peggy Ryle from St Leonardson-Sea has raised £300 for Diabetes UK by opening her home to friends for a day, selling books, refreshments and bric-a-brac, and holding a raffle. Peggy then held two car-boot sales. Peggy, 79, who was diagnosed with Type 1 at the age of 10, said: “I really enjoy doing all this and have been raising money for Diabetes UK since I was a teenager, hoping one day for a cure.”

TOUR DE FORCE

London Bridges Challenge Starting at Albert Bridge and finishing at Tower Bridge, this year’s challenge involves an 8-mile walk across some of London’s most iconic bridges. i www.diabetes.org. uk/bridgeschallenge VARIOUS DATES IN DECEMBER

This year’s London to Paris cycle challenge saw a 15-strong group raise £22,000 for the charity so far, by cycling approx 200 miles in three days, Diabetes UK bikers set off from Greenwich on 7 September, and cycled to Folkestone, where they boarded the Eurostar for the next leg of their challenge. Passing picturesque villages and castles on their way to the French capital, they arrived at the Eiffel Tower on 10 September. i Take part next year! www.diabetes.org.uk/londontoparis.

Santa Dash Join Diabetes UK this festive season and take part in a Santa Dash. There are a number of events taking place, so get your friends, family and colleagues into the Christmas spirit and enjoy a fun-filled day – raising funds for Diabetes UK at the same time. i www.diabetes.org. uk/festive

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fun&games

WIN!

£100

John Lewis Vouchers

PRIZE CROSSWORD To enter: Cut out the grid and send to the usual balance address

(see below) marked ‘Crossword’. The first correct entry drawn after 23 November 2012 will win £100 worth of John Lewis vouchers. Congratulations to last issue’s winner, Robert Dunk from Southampton.

1

2

3

4

5

ACROSS 1 Cure (6) 4 Loose stones (5) 9 Breastbone (7) 10 Climber’s spike (5) 11 Whiskey and vermouth cocktail (9) 12 Labour (4) 13 Prehistoric burial mound (5) 16 Flower (4) 19 Freedom fighter (9) 21 Arm bones (5) 22 Carbon allotrope (7) 23 Earthenware pot (5) 24 Plant of the parsley family (6)

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11 12 13 14

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DOWN 1 Dessert apple (6) 2 Breakfast meal (6) 3 Hardwearing fabric (5) 5 Skipper (7) 6 Housing development (6) 7 Spanish sherry (11) 8 Foolish (5) 13 Of the heart (7) 14 Ancient Greek meeting place (5) 15 Editorial article (6) 17 Distant (6) 18 Assorted (6) 20 Variegated gem (5)

GO (SOUTH) WEST

LINKLETTER

Explore more than 100 miles of historic coastline as the South West Coast Path (Exmouth to Poole) guides you from Jane Austen’s Cobb to Lulworth Cove. We have five of these books to give away. To enter, simply send your name and address on a sealed-down envelope or postcard to: ‘balance book giveaway’, Diabetes UK, 10 Parkway, London NW1 7AA by 23 November 2012.

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:

64 balance 64-65 Puzzles.indd 64

PE TA

ST

LE ER

PA TW

LA VE

IC PR

AP IS

PA RE

IS RT

TI CU

DE TE

LA PO

EN

EN

Last issue’s solution: SLIPSTREAM

24

Puzzles set by Neil Locker

SOLUTION to September/October 2012 ACROSS 4 Tisane, 7 Potato, 8 Pinafore, 9 Solo, 10 Bizet, 12 Amen, 18 Nausea, 19 Paella, 20 Step, 23 Flume, 27 Node, 28 Sprocket, 29 Rumble, 30 Ardour Name DOWN 1 Cocoa, 2 Carob, 3 Topaz, 4 Tenet, 5 Sofia, 6 Norse, 11 Ibex, 13 Malt, 14 Neat, 15 Onus, 16 Jute, Address 17 Balm, 21 Tapir, 22 Photo, 23 Fakir, 24 Ultra, Postcode 25 Enemy, 26 Adult 23

November – December 2012 18/10/2012 14:02

Last issue’s solution: SLIPSTREAM

fun&games

S U D O K U

4

Wordworkout

1 8

3 9 6 8 2 3 2 6 7 9 7 4 9 6 1 8 3 7 9 8 1 2 7 9 2

Fill the grid so that every column, row and 3x3 box contains the digits 1 to 9.

Rating Intermediate Last issue’s solution

6 2 5 3 1 9 4 8 7

4 7 1 2 8 6 5 3 9

3 8 9 5 7 4 2 1 6

9 4 6 8 3 2 7 5 1

7 3 8 6 5 1 9 2 4

5 1 2 4 9 7 8 6 3

2 9 3 1 4 5 6 7 8

1 5 4 7 6 8 3 9 2

8 6 7 9 2 3 1 4 5

How many words can you make from these 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: Baton. 20 = Average; 25 = Good; 30+ = Excellent.

Last issue’s nine-letter word: REGISTRAR

N R N E C U T O H

A BALANCED LIFE John Byrne

Christmas Competition

WIN a Virgin balloon ride for two!

Give them the gift of flight this Christmas

‘Balance’ has teamed up with Virgin Balloon Flights to offer you the chance to win this experience of a lifetime worth £310!

The adventure includes: • An unforgettable balloon flight of around an hour • 100+ locations across mainland Britain • Traditional Champagne toast (or soft drink) • Flight certificate endorsed by Sir Richard Branson To enter, send your name and address on a postcard or sealed down envelope to: ‘Balance Balloon Ride Competition’, Diabetes UK, 10 Parkway, London NW1 7AA no later than Friday 30 November. The winning entry will be picked at random. For a limited time, we’re offering 35% off national ‘7 Day Anytime Plus’ Vouchers with a FREE gift hamper for every customer.

SIMPLY call 0844 8448070 or visit virginballoonflights.co.uk and quote ‘Balance Magazine’ before December 25th!

Terms & conditions Competition prize refers to a pair of 7 Day Anytime national vouchers which have no cash value, are non-refundable and non-transferable. Offer valid until December 25th 2012 – subject to availability. Price is for one person including VAT at the applicable rate and standard postage and packing. Voucher is valid for 12 months and flying season is March to October. Free hamper off valid from 1 September 2012 while stocks last. Only one per household. Cannot be used with any other offer Passengers must be aged 7 or over and at least 4’6” in height. Children aged under 16 must be accompanied by an adult. Passengers who are pregnant or who have recently undergone major surgery are unable to fly. Offers cannot be used in conjunction with any other offer, are not transferable and cannot be exchanged for cash. Virgin Balloon Flights reserves the right to withdraw these offers or amend these conditions at any time. Customers must be UK residents and aged 18 or over. Nothing in these terms shall affect your statutory rights. Full terms and conditions at www.virginballoonflights.co.uk

November – December 2012 balance 65 64-65 Puzzles.indd 65

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EVOP52

different types

ARTHUR SMITH

MARI WILSON

West Country beauties

O

ne of the first things I was told when diagnosed with Type 1 diabetes back in 1978 was that I could never be a pilot. I became a singer instead.

Almost 35 years later, I read in the news that the Civil Aviation Authority (CAA) has announced that qualified pilots and air traffic controllers with diabetes treated with insulin and other medications can carry out full operational duties, including flying commercial aircraft. This is fantastic news! All down to certain individuals who have worked tirelessly to make this happen and enable people to realise their dreams.

To coincide with this good news, six diabetic pilots attempted to set a national formation speed record between Derby and Southampton. Taking off at 11am, they flew in a ‘D’ formation over eight towns and cities and landed at Goodwood Airport, Chichester. In the past, they’ve all had restrictions applied to flying activities or career ambitions. Well done, guys.

I can’t furnish you with the medical records of the pilots who flew me to Los Angeles this summer, but I’m sure they were fighting fit – diabetes or not. One of the highlights of my stay was spending time with Kim. I was nanny to Kim and her two sisters in Long Island, New York, when I was 18. Kim was the youngest, at just 2!

It was not long after I returned that the symptoms of my Type 1 diabetes started to show. The weird thing is that when Kim became an adult, she, too, developed Type 1 and then, later on, so did her mother, who sadly died from complications in her 60s.

So we talked about it a lot. We also spent a weekend at Walt Disney World. I’ve been there a few times now and I have to constantly keep topping up with Jelly Babies or glucose tablets as we do so much walking and it’s very hot.

Then, there’s all the screaming during the rides (not good for a singer, really). My favourite ride is Space Mountain – a thrill every second that really gives an idea of what piloting a plane (or spacecraft) must be like.

I went on another wild ride a few years ago (Mission: SPACE), where you fly to the moon – not literally, of course. I don’t know many female astronauts who hail from Neasden. I can see it now: Beehive Airlines, piloted by Mari Wilson, The Neasden Queen of Soul and Aeronautics.

I don’t know if all these scary rides have an effect on my diabetes, but it proves we can pretty much do anything anyone else can. Until next time – to infinity and beyond. i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 and coeliac disease. Her latest album, Cover Stories, is out now; www.mariwilson.co.uk.

Read our interview with Karl Beetson of Pilots With Diabetes (page 24).

Photos: Mari: Claire Lawrie; Arthur: Steve Ullathorne

W

hat is the best orange you ever ate? You don’t know? Well let me tell you about mine.

On holiday in Andalucía, in Southern Spain, I had just woken up from a brief, but deeply satisfying, siesta. Beth continued snoozing as I sauntered onto our little balcony and gazed across at the long, jagged silhouette of the Alpujarras mountains on the horizon. Then my eye was caught by an object in the foreground, sitting on a plate – more or less shouting “Eat me!” – was a large orange, no doubt recently detached from one of the nearby orange trees. The peel easily fell away beneath my thumb and within moments the first segment had started an exhilarating taste party in my mouth. It was the orangeyist of all my oranges.

I have similar stories relating to my best-ever cup of tea, my finest Diet Coke and my all-time top tomato.

The ideal confluence of man, place and foodstuff is a rare event and I am still waiting for the unbeatable pistachio nut, the greatest grape and the most sublime ice cream.

Most will never happen.

A new fruity epiphany took place, however, this last September as I was rambling along the Devon cliffs between Dartmouth and Salcombe on a glorious, warm day. Having covered 10 miles, or so, I suddenly began to wilt beneath the hot sun.

‘Maybe my blood sugar is a bit low,’ I think, and plunge my hand into my rucksack to retrieve some apple juice.

The drenched jumper tells me I have made my old mistake – I didn’t screw the top on properly. There is no apple juice.

I walk on into the burning sun but am feeling weaker.

I either have low blood sugar or am dehydrated, or both.

The nearest shop is at least a mile away. I spot a house on the brow of a hill and set off towards it, hoping to find a Samaritan with something liquid and saccharine. As I walk uphill it seems to grow no closer. Maybe I need a lie down…

And then I see them – among the green buds by the path there are a few gleaming blackberries that have ripened. I fall upon them and as I guzzle I see more that are already in their prime, and then more – they are exquisite. After gobbling several handfuls I feel stronger and my body returns to its normal (relatively) robust state – even if I am dribbling purple juice down my chin. Though I live another 1,000 years I know that I shall never enjoy blackberries as much as those sweet, West Country beauties.

You don’t have to go to top restaurants to experience the most sensational tastes, though it does help to be diabetic.

What were your favourite food moments…? i Arthur Smith is a comedian, writer and broadcaster with Type 2.

Come fly with me…

66 balance November – December 2012 66-68 A n M SRS.indd 66

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