Balance Magazine July August 2012 by John Clarkson

balance

FREE SUPPLEMENT

let’s get physical

Your diabetes lifestyle magazine • July – August 2012

DRIVING & DVLA

Stealth sugar

Less confusion, more clarity

The sickly sweet truth

INCA TRAIL

NEW TO TYPE 2?

Machu Picchu on a pump

Take control for a happier, healthier you

PLUS

LOST & FOUND

Uncovering the extraordinary life of Dr RD Lawrence

Go green Britain’s best seasonal dishes

Targeted Type 1 research; Bydureon; health apps; coastal walks; puzzles & giveaways

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contents July – August 2012 • no 247

balance

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

Kate Flagg DESIGNER

John Clarkson EDITORIAL SECRETARY

Melanie Aldridge CONTRIBUTORS

Sheila Seabrook, Sabeha Syed, Anna Pattenden AD MANAGER

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

Pindar plc 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

features

life&health

4 This is Diabetes UK 6 News Diabetes round-up 14 Columnists 16 Your views 20 Research matters 48 Recipes Go green with these seasonal British beauties 52 Bite-sized For foodies 54 Travel Angie Mason explains why the Inca Trail is worth the hype – and the odd hypo 58 Walk Brush away the cobwebs with these coastal walks 60 Fundraising focus Celebrating your achievements and a look at upcoming events 64 Fun & games Win a Morphy Richards Hand Blender and make the most of a hotel offer 66 Different types Arthur Smith and Mari Wilson tell it like it is

22 Lost & found Jane Lawrence describes what she found when uncovering her father-inlaw’s fascinating life story 26 Hitting the target Dr Richard Elliott looks at Diabetes UK’s targeted research on improving self-management for teenagers with Type 1 30 Rich rewards for teen trials A group of teenagers has been testing the much-anticipated artificial pancreas. Tim Gillett and his 13-year-old son, Louis, tell us more 32 Type 2 & you Tried and tested tips for getting to grips with self-management – guaranteed to make you feel healthier and happier 36 A steer in the right direction The DVLA’s driving licence application form has confused many people with diabetes recently. But it’s getting clearer...

39 Health notes The hidden sugars lurking in your food; how to handle the heat; what to do when you lose your appetite; recycling your old blood glucose meter; & the free NHS checks you shouldn’t miss out on 43 Ask the experts Rules and regulations at the Olympic Games; free bus passes; diagnosis confusion; & teeth whitening 45 Spotlight on... Bydureon – a new once-weekly treatment for Type 2 diabetes 46 Basic care App happy: 10 of the most useful health apps – download them today!

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

A TALE OF TWO MINISTRIES

atient power has worked in Scotland, where we saw Diabetes UK volunteers and others demonstrate about poor access to insulin The strength of pumps for children with Type 1 diabetes. more and more Some health boards had even suspended their Diabetes Voices waiting lists for pumps and others were rationing them unacceptably. As a result of the pressure speaking about from people with diabetes, in February, Scottish their needs locally Health Secretary Nicola Sturgeon announced substantial additional funds for pumps. A real and nationally tribute to patient (and family) power. will eventually Hoping for a repeat of that success, 70 of win through our new Diabetes Voices volunteers came to Westminster in May to ensure that their MPs listened to the concerns that people with diabetes have about the quality of their care. Using Diabetes UK’s information on how the 15 healthcare essentials (the checks and services that all people with diabetes are entitled to) are being delivered in their constituency, the volunteers headed to the House of Commons on 15 May to meet their MP and to lobby for better standards of care. MPs were very receptive; they appreciated hearing about the issues direct from constituents who have diabetes, and several undertook to contact the minister. We followed the contacts up with coverage in local newspapers. Several of the MPs lobbied were also members of the Public Accounts Committee, the watchdog that holds the government to account for its use of public funds. Early in June, the committee held a parliamentary hearing to quiz senior Department of Health officials on a report that had been highly critical of the value for money of the NHS diabetes services. The NHS spends 10 per cent of its budget on diabetes – 80 per cent of that is taken up with dealing with complications like blindness, stroke, amputation and kidney failure. Many of these can be avoided with early diagnosis, education for people to manage their condition and effective provision of the essential checks that people with diabetes should receive each year. The issue is not about insufficient money, it’s about it being spent more effectively. The hearing gave us the unedifying experience of listening to the bosses of the Department of Health and the NHS arguing that diabetes could not be named as an NHS priority! The 3.8 million people with diabetes deserve better. The strength of more and more Diabetes Voices speaking about their needs locally and nationally will eventually win through, like it did in Scotland. And you, too, can add your voice to get a better deal for people with diabetes. Baroness Young, Chief Executive, Diabetes UK i To become a Diabetes Voice, see ‘Campaign’, right. • See page 6 for more on the MP lobby. • Download a 15 healthcare essentials checklist at www.diabetes.org.uk/15-essentials.

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.

CARE

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.

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

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.

Connect online

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

balance July – August 2012

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WHAT DID YOUR METER TELL YOU TODAY?

Meet OneTouch® Verio®IQ. The meter with Verio® PatternAlert™ Technology.

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*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 Dec 2012. 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 099-111A. 12-077

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news STATE OF THE

Voicing concern Diabetes healthcare in England has reached a ‘state of crisis’, where millions of people with the condition are not getting the basic minimum care they need, according to a Diabetes UK report. State of the Nation 2012, published on 14 May, revealed that in some areas of the country the vast majority of people do not receive the regular checks and services recommended by the National Institute for Health and Clinical Excellence (NICE). It goes on to highlight that this has added to the increase in diabetes-related complications, such as stroke, heart attack and amputation. These complications account for approximately 80 per cent of NHS spending on diabetes – and are one of the main reasons why treating the condition accounts for 10 per cent of the entire NHS budget. To tackle these issues, more than 60 Diabetes Voices volunteers travelled to the House of Commons on 15 May to demand that everyone with diabetes has the right to access the basic, but essential, checks outlined in the government’s own guidelines. More than half of the

NATION 2012 ENGLAND

campaigners met with their MP, asking them to raise their concerns with Paul Burstow, the minister responsible for diabetes care. The Diabetes Voices also attended workshops and gained tips on effective campaigning before hearing Mr Burstow outline the Department of Health’s commitment to the effective management of long-term conditions, including diabetes. The government is due to publish a long-term conditions outcomes strategy by the end of the year, and will set out an ‘implementation plan’ to enable services to work together to improve the lives of people with diabetes. i Download State of the Nation 2012 at www.diabetes.org.uk/sotn2012. • To find out more about campaigning and how to email your

Bryan and Joan Vanderpeer and Sarah-Jayne Davis – just three of the Voices making themselves heard

MP, visit www.diabetes.org.uk/get_involved/ campaigning. • Diabetes UK’s 15 healthcare essentials: www.diabetes.org.uk/15-essentials. • For information on becoming a Diabetes Voice, visit www.diabetes.org.uk/diabetesvoices.

A question of health To add further weight to Diabetes UK’s findings in State of the Nation 2012, a report published at the end of May by the National Audit Office (NAO) on diabetes healthcare for adults in England and Wales also found that the poor level of care is resulting in avoidable diabetes complications and deaths. It focused on the need for early intervention, better risk assessment and screening for people with Type 2 diabetes, and better awareness of symptoms for Type 1 in England and Wales.

As a result of the report, The Public Accounts Committee (PAC), a group of MPs appointed by the House of Commons to examine public expenditure, quizzed senior Department of Health (DH) officials about the state of adult diabetes care. Margaret Hodge MP, Chair of the PAC, said: “It is one of the most depressing reports I have read as chair of this committee.” She added: “What shocks us is that it’s an area where it’s so obvious what needs to be done.”

Responding for the DH, Dr Rowan Hillson MBE, National Director for Diabetes, recognised the scale of the challenge, noting that the number of people living with diabetes has doubled in recent years. Sir David Nicholson, Chief Executive of the English NHS, acknowledged the need to ‘ramp up’ the approach to improve performance on diabetes care and said that the DH will set out its priorities later this year. i For more on the PAC hearing, visit www.diabetes.org.uk/PAC-hearing.

balance July – August 2012

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21/06/2012 20:03

Setting Wales alight As the Olympic torch reached Wales, Diabetes UK supporters Melanie Stephenson, 24, and Hannah Jarrett, 14, had their turn to run with it in honour of their hard work for the charity. On 25 May, Melanie (above) lit the cauldron in Cardiff, and the next day Hannah (below) ran a leg of the relay through Margam. Both Melanie and Hannah have Type 1 diabetes and have put in a lot of time and effort to raise money and awareness of Diabetes UK’s Cymru work. Melanie, who has competed internationally for Wales as a sprinter in the 100m and 200m, has supported Diabetes UK at events and in the media. Hannah, who’s had diabetes for four years, writes a blog on the Diabetes UK Cymru website and has raised more than £2,500. “It’s a day I’ll never forget,” said Melanie. “My run was an opportunity to show other people with diabetes what we can achieve.” i You can read Hannah’s blog at www.diabetes.org.uk/hannah-blog.

Enjoy precision.

High-precision blood glucose monitoring, easy to use: High Deﬁnition Signal Processing for maximum precision and accuracy Autocoding and Autostart

Everyone’s talking about...

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Type 1 aware video Together with JDRF UK, Diabetes UK has produced a video to raise awareness of the symptoms of Type 1 diabetes and to make sure that people can spot the symptoms early on. The aim is to get 1 million views by World Diabetes Day (14 November) – and you can help make this happen. Please share the video with your family, friends and schools to help make as many people as possible Type 1 aware. i Watch the video at www.diabetes.org.uk/type1aware.

The only meter with a side loading strip! Promotes better strip handling for safe and hygienic use Protection during lancet replacement

Get your free meter! Call 0800 092 6787 More information on www.mylife-diabetescare.co.uk Ypsomed Ltd. // Blackwood Hall Business Park North Dufﬁeld, Selby // North Yorkshire, YO8 5DD PH: 0844 856 7820 // www.ypsomed.co.uk

21/06/2012 20:03

news

Call for more hospital training

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Nearly one in three hospital patients with prescription errors and medication diabetes is affected by errors, which can management errors, and some result in dangerously high or low blood patients experienced both in hospital. glucose levels, according to Audit lead clinician the recent National Diabetes Dr Gerry Rayman said: Inpatient Audit (NaDIA), “Although it is pleasing conducted in partnership to see there have been with Diabetes UK. improvements in medication The audit examined bedside errors since the last audit, data for 12,800 patients and training for all hospital inpatients had 6,600 patient questionnaires, doctors and ward nurses at least one covering subjects including to improve diabetes control error in their medication errors and patient should be mandatory. hospital harm during a week in There is no excuse for treatment. October 2011. It involved diabetic ketoacidosis (DKA) 11,900 patients in 212 English to develop in hospital. This hospitals and 900 patients in occurs when glucose levels 18 Welsh hospitals. are consistently high and The audit found that 3,700 inpatients its occurrence is negligent and should with diabetes experienced at least one never happen.” error in their treatment in hospital in one i Find out about what care to expect in hospital: seven-day period. Medication mistakes www.diabetes.org.uk/care-in-hospital • For more were recorded under two types – on DKA, visit www.diabetes.org.uk/dka.

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3,700

Case highlights inpatient concerns The death of a man with diabetes in a Welsh hospital four years ago is shining the spotlight on inpatient care for people with the condition, in the wake of a critical Ombudsman’s report. David Joseph died in 2009, days after a stay in Bronglais Hospital, David Joseph’s widow and daughters, with Mark Williams Aberystwyth. MP (left) and Dai Williams, Director of Diabetes UK Cymru Wales Ombudsman Peter Tyndall found that the care of Mr Joseph ‘fell well below a reasonable standard’ and that the hospital’s failings – specifically not treating a ‘hypo’ for over three hours – had a ‘causal effect’ on his subsequent heart attack and deterioration. Mr Tyndall’s report also found there had been a deliberate attempt to cover up the lack of blood glucose monitoring. Mr Joseph’s family members have been supported in their bid to get important answers to key questions about the case by Diabetes UK Cymru, who organised a meeting with Assembly Health Minister Lesley Griffiths on 30 May. The family has donated the £1,700 compensation offered by Hywel Dda Health Board to Diabetes UK to back its campaigning work to improve inpatient care for people with the condition.

THEY SAY, WE SAY

Pregnancy diets Newspapers picked up on a study into dieting during pregnancy in May. The Independent claimed ‘Dieting is good for you’, while the Daily Mail insisted ‘piling on the pounds during pregnancy’ increases the risk of complications. So what’s the real story?

DIABETES UK SAYS Researchers at Queen Mary, University of London have shown that dieting during pregnancy has no adverse effects on the birth weight of newborn babies and is the most effective way for obese or overweight women to reduce the weight gain that can lead to complications such as gestational diabetes. ‘Eating for two’ and piling on excess weight during pregnancy is discouraged by doctors, since it increases the risk of complications, such as gestational diabetes and high blood pressure. However, many women worry that dieting could harm their unborn child and doctors are often cautious about advising on ways to manage weight. This research studied the effect of diet, exercise, or a combination of the two on the amount of weight that women gained during their pregnancies and whether the mother or child experienced complications. All three methods reduced weight gain but dieting had the greatest impact. It also seemed to reduce the risk of complications and did not affect birth weights. Not all pregnant women need to follow calorie-controlled diets to manage their weight, but such diets could help some pregnant women who are obese or overweight.

CORRECTION

The GSF Syrup segment in ‘Product watch’ (News, May–June 2012 balance), is not a tablet, as reported. As the name suggests, it is a syrup. Apologies for any confusion caused.

balance July – August 2012

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WHAT A WEEK! DIABETES WEEK (10–16 JUNE)

Enjoy comfort.

Diabetes UK’s Chief Executive steps up with Lee Latchford-Evans

556

3,867

Tweet, tweet There was a real buzz on social networking site Twitter, where celebrity supporters including Philip Schofield, Melanie C and Amelia Lily all showed their support. Hashtag #diabetesweek was used 3,867 times, reaching hundreds of thousands of people. Diabetes UK’s Facebook page was also in on the action when the charity’s clinical advisors took part in live chats to answer questions.

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ID 20019-UK/V01/2012-02

Officially amazing Diabetes UK became Guinness World Record holders for the ‘most waist circumference measurements taken in eight hours’. Armed with tape measures, Diabetes UK staff and volunteers descended on London’s Southbank on 12 June with one goal in sight – to measure as many waists as possible. The record-breaking team smashed their target and measured 556 in total. Diabetes UK Chief Executive, Barbara Young, who started the record attempt with Steps star Lee Latchford-Evans (pictured), said: “Having a large waist size is one of the main risk factors associated with Type 2 diabetes. It’s brilliant to be able to set a Guinness World Record that highlights this.”

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Type 1 aware We also saw the launch of a video highlighting the symptoms of Type 1. During Diabetes Week it had 18,879 views. See page 7.

7,318

Make the connection Diabetes UK sent out 7,318 Diabetes Week supporter packs, and thousands more people ordered materials. Whether it was putting up posters or filling coinboxes, many people made a connection. i www.diabetes.org.uk/diabetesweek

Customer Care: 0800 092 6787 More information on www.mylife-diabetescare.co.uk Ypsomed Ltd. // Blackwood Hall Business Park North Duffield, Selby // North Yorkshire, YO8 5DD PH: 0844 856 7820 // www.ypsomed.co.uk

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news

Family days in Wales Diabetes UK Cymru has teamed up with children’s self-care workshop specialists Getting Sorted, to provide fun-packed interactive events that focus not just on the impact of Type 1 diabetes on the young person affected but on the family as a whole. There are two events costing £10 per family: Plas Menai National Watersports Centre near Bangor on 21 July and Cardiff City Football Stadium on 28 July. i For a registration pack or more information, email wales@diabetes. org.uk or call 029 2066 8276.

The family days in Wales are educational and great fun!

In brief...

let’s get physical

LET’S GET PHYSICAL

The balance guide to diabetes and

physical activity 2012

To celebrate this year’s summer of sport, let’s get physical, a special supplement covering the basics of getting active with diabetes, is included with this issue of balance. i If you haven’t received your copy of let’s get physical, or would like extras (free+p&p), call Diabetes UK Supporter Services on 0845 123 2399 or visit www.diabetes.org.uk/shop. Lets Get Physical JC THUR.indd

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TUNE IN

Also included with this issue is the Department of Health’s Games4Life activity questionnaire. It’s simple to fill in and when you return it you’ll receive a tailored activity pack to get you up off the sofa, away from watching the sports and getting physical yourself! i You can also fill in the Games4Life questionnaire online at www.nhs.uk/games4life to receive a tailored activity pack.

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hours of sport will be shown on TV this summer Source: Games4Life

HELP US CELEBRATE

balance is celebrating its 250th issue in January and we’d like you to help. Have you featured in an issue from way back when and have a great story to tell? Or have you read an article that has inspired you to make a difference to your life? Let us know – you may even find yourself in our birthday issue! i Write in at the usual address (see page 3) or email balance@diabetes.org.uk with the subject header ‘250’.

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July – August 2012 21/06/2012 20:04

HIGH TEA Two long-serving Diabetes UK volunteers had tea with the Queen at a Royal Garden Party held at Buckingham Palace on 22 May, in recognition of their support of Diabetes UK. For the past 22 years, Nigel Jenner, from Marden in Kent, has generously given up his time working on Children’s Support Holidays, running the London Marathon twice and as a member of Diabetes UK’s Council for People Living with Diabetes. He attended the party with his partner, Michelle, (both pictured above) and said afterwards: “I was honoured to be invited, particularly in this Diamond Jubilee Year. I had a truly memorable day.” Another volunteer with more than two decades of dedication to Diabetes UK is Christine Staff, treasurer of the Weston-super-Mare voluntary group. Christine (left) joined the group after being diagnosed with Type 2 diabetes and found she was unable to find any information about the condition. Christine attended with her guest diabetes specialist nurse Ann Barrett (right), who is Chair of the group. “I was thrilled to go for tea with the Queen. I couldn’t wait to attend!” said Christine.

PATCHP & PUM

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CLEVER CHEK ALERT BBI Healthcare’s Clever Chek blood glucose meter may give false readings if an incorrect amount of blood is applied to the strip, according to an alert issued by the Medicines and Healthcare products Regulatory Authority. There is potential for falsely low blood glucose results if the test strips are under-filled, and falsely high results if over-filled. This could result in inappropriate insulin administration. The alert has been widely distributed to healthcare professionals, so if you are using this meter you are advised to discuss possible alternatives with them.

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

21/06/2012 20:04

news

newinsulcheck.pdf

There will be opportunities to connect with others and share experiences, so whether you have Type 1 or Type 2 diabetes, are the parent of a child with diabetes or a carer/friend to someone with diabetes, this event is for you. There is a free on-site creche for children under 6 and a range of ageappropriate activities for children and teenagers aged 6–16. Registration is £15 for adult members, £20 for non-members and family/ group rates are available.

02/04/2012

08:41

DIABeT eS

1in70

THe

BIG

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people have undiagnosed Type 2 diabetes

SATURDAY 14 JUlY 2012, 10Am – 5pm, RooTeS BUIlDING, UNIveRSITY of WARW Join us for our first national Ick, coveNTRY event for everyone seminars, workshops and

affected by diabetes. Choose from 20 interactive activities covering all aspects of diabetes and diabetes care.

for programme inform ation: www.diabete s.org.uk/thebigeven To book tel: 020 7324 t 4330 or visit www.d iabetes.org.uk/theb igevent Find us on: www.facebook.com/di

abetesuk

www.twitter.com/diabe tesuk

A charity registered in England and Wales (215199) and in Scotland (SC039136). © Diabetes UK 2012 Big_Event_A4 Poster.indd

1 14/05/2012 12:18

i Register online at www.diabetes.org.uk/thebigevent or call 020 7424 1000.

You can encourage people to take an online risk assessment at www.diabetes.org.uk/riskscore or to visit a Healthy Lifestyle Roadshow, launched by Diabetes UK and Bupa. See www.diabetes.org. uk/roadshow for dates.

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There’s still time to register for Diabetes: The Big Event, which is aimed at everyone affected by diabetes. Taking place on 14 July at the University of Warwick, Coventry, it promises to be an action-packed day of interactive seminars and workshops, including an exhibition covering all aspects of diabetes and diabetes care. There is a range of activities, including a relaxation zone, where you can experience a pampering massage, take part in gentle chair exercises or an energetic Zumba session.

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IT’S BIG – AND IT’S NEARLY HERE...

Product watch Sue Marshall, who has Type 1 diabetes and set up Desang (www.desang.net), shares her favourite diabetes kit...

Accu-Chek Mobile

InsulCheck helps reduce double and missed injections with safety and certainty.

CMY

Large easy to read display, simply clips onto your pen to show time since last injection. Fits most re-usable and disposable insulin pens. Enhances pen grip. Activates automatically when injection completed. Stock now readily available - order online: www.insulcheck.com Or call us at 0203 608 2002

Balance Readers: enter discount code ‘Balance1’ to avail of a 20% discount when ordering. Valid to 31st August 2012

12 balance 6-13 News AC.indd 12

This boasts strip-free testing – individual strips have been replaced by a cassette with a reactive strip, which only needs to be replaced after every 50 tests. There is a built-in FastClix finger pricker (can be detached), which uses a drum of six lancets that retract after use. The screen displays results in ways that are easy to understand. i www.accu-chek.co.uk, 0800 701 000; costs from £35 or speak to your diabetes healthcare team for more details.

Desang kitbags Designed for carrying one or two insulin pens plus blood-testing kit (lancing device, tub of strips and meter). Ideal for getting your kit through airport security by keeping everything in one place. i Prices start from £19.99; www.desang.net; 0870 300 2063.

Hypowallet Contains a tube of chewable orange GlucoTabs (4g carbs per tablet), a shot of GlucoJuice (15g carbs per shot), as well as two tubes of GlucoGel (10g carbs per shot). There’s also a treatment guide card, providing an at-a-glance reference, and an emergency contact card with emergency first aid instruction. i Costs around £9.99; www.hyposite.co.uk/hypowallet; 0845 677 3349.

July – August 2012 21/06/2012 20:04

44373 B

Chloe said...

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

We listened. Compact, stylish and discreet

iBGStar® Diabetes Manager App*

Real graphs and trends to share

Now you can share your blood glucose readings wherever you are, with iBGStar®, the first and only blood glucose meter to innovatively connect to your iPhone® or iPod touch® for seamless diabetes management on-the-go.

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

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

GBIE.BGS.11.12.13

Date of preparation: January 2012

21/06/2012 20:04 16/01/2012 10:23

columnists Marvellous May

Exam time

Richard Lane OBE

Patricia Debney (

Diabetes Week (10–16 June) was a busy and successful period for us all, but I would also like to highlight three special events that I attended in May. The ‘Big Lobby’ at the House of Commons on 15 May was a tremendous success. The objective was to persuade MPs and Peers to support a national ‘implementation plan’ to improve services for people with diabetes, which was supported by Early Day Motion 22 in the House of Commons. Many ‘Diabetes Voices’ came to lobby their MPs, and more than 50 MPs and Peers attended the Reception afterwards. We definitely made a deep impression! Then, on 27 May, there was the BUPA London 10k Run, at which I, and many other volunteers and staff, made ourselves hoarse by showing our support for

our wonderful runners (including 15 Diabetes UK staff!). The atmosphere was fantastic, despite the poor weather, and we await the final tally of funds raised with great interest. Finally, I joined Diabetes UK Chief Executive Barbara Young, senior staff and volunteers at the Re-dedication of Macleod House on 29 May, along with three members of the Macleod family. This was very poignant and meaningful. Sir Michael Hirst, a past Chairman of Trustees and a VicePresident of Diabetes UK, gave a marvellous speech, describing John Macleod’s vital involvement in the development of insulin, for which he was jointly awarded the Nobel Prize with Frederick Banting. Now do you understand why I enjoy being your President so much? i Richard Lane OBE is President of Diabetes UK and has Type 1. Follow his blog at www.diabetes. org.uk/bloggers.

@PatriciaDebney)

Eliot’s GCSE experience has been interesting – 18 exams over three weeks. Achieving good blood sugar control out of routine is always daunting – but it was vital this time. We decided to set Eliot’s pump on the less active ‘home’ pattern, to serve only our ‘tried and tested’ meals – and to roll with the punches! All went smoothly until one morning Eliot texted: he’d forgotten to take his insulin at breakfast. Eek. Despite taking insulin immediately, at school he was already 18mmol/l. Fifteen minutes before the exam, he was still 19mmol/l. The exam was two hours long, and worth 40 per cent of his GCSE. So I made a decision. I contacted the school and told them everything that might happen: his blood sugar might swing very low; he might become

unfocused or fraught, or be sick or desperate for the loo. And for the next two hours I paced the house. Later, I discovered that the invigilator had acted quickly, moving Eliot nearby. Crucially, he’d also had a quiet word, saying he knew and understood. For the first half hour, Eliot had felt sick. For the last half hour, the two bottles of water he’d had for the hyper caught up with him! But he came out of the exam OK. His blood sugar levels settled. I’d called the school without Eliot’s permission, and the risk had paid off. In fact, he said that words could not express the relief he’d felt knowing he wasn’t on his own. A lesson I for one have taken to heart. i Patricia is an author and senior lecturer in Creative Writing at the University of Kent. Her son, Eliot, 15, has Type 1. Visit her blog: www.wavingdrowning. wordpress.com.

So, in three years, what has changed? Well, I’ve lost about 8in (20cm) from my waist; I got married to my beautiful wife; I’ve learnt how to eat better and do regular exercise; I now take 10 pills a day; and I am not convinced that the condition is entirely under control.

I still eat desserts that I shouldn’t; and I still feel annoyed that I have this stupid condition. I’m not sure that last point will ever go away, but I hope it will with time. i Andy Kliman has Type 2 diabetes. Follow his blog at http://t2dkidding.blogspot.com.

Three years & counting Andy Kliman (

@andykliman)

I have just ‘celebrated’ three years of living with Type 2 diabetes. Although ‘celebrated’ might not be the most appropriate phrase and, on reflection, I know that I have had the condition for much longer.

14 balance

I remember going to see my doctor in 2008 complaining of extreme tiredness at the end of the working day. He sent me for a blood test to check my thyroid but nothing showed up. As I was overweight, I don’t know why he didn’t test for Type 2 diabetes at the same time.

July – August 2012

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21/06/2012 18:36

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Date of preparation: January 2012

21/06/2012 16/01/2012 18:36 10:29

your views

balance Your diabetes lifestyle magazine • May–June 2012

“WE PLAY THINGS DOWN”

MEN: LISTEN UP Get symptomsavvy with our revealing guide

Denis Healey’s nephew reveals his family’s Type 2 trait

SCIENCE & SOCIETY

STEEL MAGNOLIAS

Social and psychological diabetes research

Playwright Robert Harling’s touching true story

SIBERIAN STUNTS

Injecting at -40°C

WRITE TO US AT: balance, Diabetes UK, 10 Parkway, London NW1 7AA; balance@diabetes.org.uk Please state if you would like an acknowledgement. Letters may be edited and may appear on the Diabetes UK website. The views expressed on these pages are those of readers. The writer of the balance star letter wins a £50 book token thanks to our friends at Heath Lambert, which provides insurance services on behalf of Diabetes UK.

PLUS

Rotating your injection sites; gastroparesis; understanding sun creams; Euro 2012 hotspots & lovely pub walks

Vickery’s victory Top TV chef Phil shares his gluten-free treats

01 Cover 3.indd 1

STAR LETTER Tube tales

I have recently received the Alan Nabarro Medal for living with diabetes for 50 years. At times, it has been difficult. However, with the help of a wonderful wife, doctors and diabetic nurses, I have survived. My working life was spent in London, travelling via London Bridge Tube station. I recall a poster by the British Diabetic Association, as Diabetes UK was then known, warning of the complications that could occur if one did not ‘walk the straight and narrow’, which I have tried all these years to do. It paid off. Thank you.

Mr AK Harmer, Lowestoft

Editor’s note: Find out more about Diabetes UK’s medals for those who have lived with diabetes for 50, 60 and 70 years at www.diabetes.org.uk/medals.

how fantastic it is until you don’t have it! I was moved to the USA by my company. The standard of care I received from the diabetic clinic at Stoke Mandeville Hospital in the UK would astound a person living with diabetes in the USA. Consultant appointments, reminders… Dream on! In the USA you have to organise everything yourself and pay for it. I have healthcare insurance through the major multinational company I work for, but the insurance rarely covers everything and what you personally have to pay can be a lot. A supply of test strips and insulin pens for eight weeks has just cost me US$900 (£579), and I estimate that, this year, I will spend around US$6,000 (£3,862) on diabetes-related supplies and visits to doctors.

16/04/2012 16:17

definitely not alone. The condition can be extremely debilitating, but can also be effectively managed in most cases.

Samantha Cleal, via email

Don’t skimp on the sun cream

After a recent skin cancer scare, I was glad to see your article ‘How to… understand sun creams’ (May/June 2012 balance). Another point to add is that although sun creams are not required to show a use-by date, they can actually lose their effectiveness after being open for a while. So please don’t save leftover sun cream indefinitely. Buying more is a small price to pay to avoid melanoma.

Elizabeth Hopkins, via email

A testing time

I encourage you to check that your blood glucose meter is giving correct Dr Ian L Shuttler, via email readings. My wife was put on a tablet to lower her blood glucose levels, Dramatic licence Gastroparesis support only to discover that her meter was I was pleased to read in your article I was diagnosed with gastroparesis giving readings about 7mmol/l about Steel Magnolias (‘Steel going 14 years ago, up until which point higher than her blood glucose level strong’, May/June 2012 balance) that my diabetes had been well controlled. actually was. This was discovered a hypo (low blood glucose) was treated Despite various treatments, I found when, after a hypo, a paramedic took with orange juice. I have been in myself unable to eat or absorb food a reading showing 2.5mmol/l on his touch with TV channels about their and, in 2003, I was one of the first meter, while hers read 9.5mmol/l. portrayal of characters having a people in the UK to have a gastricMr H Graham, via email hypo who are given an injection neurostimulator implant (also instead of a drink or a biscuit. I known as Enterra Therapy). Making a point suppose giving someone an injection Since then, I have set up a You should have seen the look on is far more dramatic, but people website full of information about my DAFNE nurse’s face when she saw watching would obviously think gastroparesis, which has the full my needles. I was, in fact, still getting that it was the right thing to do. support of my consultant surgeon repeat prescriptions for the needles and Medtronic (the implant issued in 1982. Needless to say, I am Mrs C Williams, Swindon manufacturer). You can find it at now using the fine ultra-short needles. Editor’s note: TV programmes www.gastroparesis.org.uk. I also I read the stat in May/June 2012 may show glucagon being injected if a character is unconscious due have a Facebook support group balance (page 39) that 60 per cent to a hypo. called ‘Gastroparesis ‘R’ Us’ and a of people with diabetes have not Twitter account: @Gastroparesis2. changed their needle length since Not-so-bad NHS Gastroparesis is relatively rare, diagnosis. Shouldn’t more be done To all those who complain about and once diagnosed many people to highlight this? the NHS: you don’t know just feel isolated. But you are most Alexandra Mooring, via email

16 balance

July – August 2012

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your views

THE BIG

QUESTION B12 aware

I should like to make others aware of the link between metformin and vitamin B12 deficiency, as mentioned by Mrs Harrington in her letter ‘Vitamin vitals‘ (Your views, May/June 2012 balance). My husband, Colin, who is 74, had been taking metformin for his Type 2 diabetes for 13 years. There had been a slow change in his awareness and mobility, but I had thought that this was just the ageing process. Last year my husband was almost as active as I am, and I’m in my 60s. Then he awoke one morning with pains in his neck and knees. The following morning it seemed he had suffered a severe stroke. He was unable to open his mouth properly, his speech was very slurred and he had difficulty swallowing. When I tried to get him out of bed, he could only shuffle. His eyes were large, round and staring ahead. Our GP immediately came round and said that it seemed very much like a stroke, but the symptoms were not quite right. My husband was rushed into hospital, where he stayed for two weeks. During that time he was unaware of who people were. Then a nurse told me they had found a vitamin deficiency. His notes mentioned vitamin B12. Googling this, I found that many of the symptoms of severe deficiency matched those my husband was showing. I spoke to the doctor about these findings. She was, of course, sceptical, but Colin was given a B12 injection on the next two consecutive days. There was a marked improvement and when I visited on the third day he could speak almost normally, and had no swallowing or mobility problems. The doctor was amazed at the improvement. I would advise anyone with any worries about diagnosis to do some research and to never give up.

Evelyn Phillips, via email I also have to have vitamin B12 injections every eight weeks due to the fact that I take metformin for my Type 2 diabetes.

Anne Kellaway, Exeter

What are your top exercise tips?

Take part in team sports as you tend to forget that you are exercising!

Claire Perry, Liverpool Check sugar levels before and after to gauge how much insulin you burn during [exercise], and stop often to check. Keep squash close by too! I do four sessions a week and keep it balanced.

Amanda Jane Gray, via the balance Facebook group Build up slowly. Start out by running round the block and you’ll be surprised by how quickly you’ll build up your stamina.

Paul Newton, via email Get a Wii! My husband and I play tennis on it regularly and it’s great fun.

Ruth Thompson, via email If you go to a gym that has TVs, try timing your workout to when your favourite programme or soap is on – it’ll make time fly by!

Gillian Smith, via email

I love my...

Is there someone you couldn’t do without? Tell us about them at the usual balance address (see top left) marked ‘I love my…’

My husband, Keith, is almost 74 and was diagnosed with Type 1 diabetes aged 6. He has always loved sport and played football, cricket and badminton. He also organised, coached and refereed our local cub and scout football team, and still found time to look after our large garden and grow our vegetables. Not everything has been plain sailing. Eleven years ago Keith had a triple heart by-pass but, being the type of person he is, he was soon back to his sports. Now we are retired, we walk every day and go ballroom dancing. I really think he is a wonderful example for other people with Type 1.

Eileen O’Pray, North Ferriby

Listen to some high-energy music while working out. I listen to dance music while running because the tracks tend to be mixed in so there are no gaps.

Tom Clarke, via email

NEXT BIG

QUESTION What’s your favourite healthy treat? Email balance@diabetes.org.uk or post on the balance Facebook group wall. A selection of answers will be printed next time.

July – August 2012 balance 17 16-19 Your Views_b&w.indd 17

21/06/2012 15:21

H3838

your views It’s a small world

I was diagnosed with Type 1 diabetes in Cardiff, my home town, nearly 20 years ago, aged 18. But I studied in Sheffield at the time, and continued to live there for 21 years. During that time I was lucky enough to be looked after by the caring, brilliant Dr Caddick and Monica at the Royal Hallamshire Hospital and, latterly, by Carolyn Taylor at the pump clinic. I recently returned to Cardiff. Imagine my surprise when I found that my diabetes specialist nurse was the same Sue Warren who, 20 years ago, patiently sat with me as I trembled like a leaf when I learnt to inject myself for the first time. In this ‘game’, seeing a familiar and friendly face is so important. Thank you, Sheffield and Cardiff diabetes care – I know I can look forward to the next 20 years (and hopefully longer) with great confidence.

Luckily, my blood sugars are very stable. In future I will always ask to see the bottle first.

Ruth Haines, via email

Less sugar is more

I was surprised to see Phil Vickery’s recipes in May/June 2012 balance. They are loaded with sugar. In my family there is wheat intolerance and Type 1 and Type 2 diabetes, so I am always on the lookout for new recipes that are acceptable for all. I have just one successful cake recipe that uses both gluten-free flour and agave syrup and would welcome more.

Gill Gladman, Ashford

Editor’s note: Agave syrup is a sweetener, so can be used as a substitute for sugar. However, people with diabetes can still include sugar in their diet.

Driving woes

Your correspondent Peter Blades, who received his new driving Liz Nicholas, via email licence one week after his old one expired, should consider Beware sabotage! himself lucky (‘Red tape I was at a Christening party in frustration’, Your views, May/ a pub, trying to be very good June 2012 balance). I also have to lose some more weight – 7st Type 2, controlled by insulin, 11lb (49kg) so far! It wasn’t until and returned my completed I was on my fourth slimline form at the end of August 2011. tonic that I saw one of the I am still waiting for my new bottles and noticed that I had licence, 10 months later! been drinking ordinary tonics. S Fahy, Middlesex Each time I had stressed slimline Editor’s note: See page 36 for when ordering at the bar. more on driving.

Chatroom Hello, I have Type 2 diabetes and would like to hear from other people with Type 2 for friendship. I enjoy socialising, dancing and reading. I also love going to the cinema. Please reply to Mrs Stella Amogbokpa, 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.

18 balance

Blogs, tweets & posts www.facebook.com/diabetesuk http://twitter.com/diabetesuk Thanks NHS Ayrshire & Arran. I’ve just been approved for a pump and will start it in September. Can’t believe it has happened so quickly. Here’s hoping it helps with my dawn phenomenon.

Sarah McAusland, via the Diabetes UK Facebook page I now have an uncanny ability to see when he is low or high without even checking his blood, and he knows just by the way I am looking at him that the blood checker needs to come out!

Jenny Foster reﬂects on how her connection with her son Ewan, who has Type 1, has deepened in her latest blog post ‘Connections’: www.diabetes.org.uk/bloggers

I have been Type 1 for nearly 17 years. It’s nice to see that celebs are tweeting about it and making more people aware.

Francesca Luisa tweets Philip Schoﬁeld and Diabetes UK

Me & my balance Here’s John Brian Scothern taking a wellearned break from cycling to catch up with balance at his favourite picnic site at Stoke Bardolph Lock on the River Trent. John, who has just celebrated his 80th birthday, was diagnosed with diabetes in 2008. He told balance: “Taking medication, controlling my diet and cycling – which is my medically approved form of exercise – gives me a positive outlook. I have to thank my daughter, Janet, for her care and support in helping me to remain active and happy.” Keep your photos coming to the usual address (see top of page 16), marked ‘Me and my balance’. Every photo printed wins a Diabetes UK drawstring bag.

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July – August 2012

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21/06/2012 15:21

research matters Low testosterone linked to Type 2

Type 2 diabetes is more ‘genetically driven’ in lean people than in those who are obese

LEAN GENES & TYPE 2

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an increased risk of diabetes than obese people with Type 2. In particular, they found that genetic variations near a gene called LAMA1 were linked to an increased risk of Type 2 diabetes and that these variations appeared only in lean patients. Dr John Perry, the lead author on the study, said: “This is the first time that a Type 2 diabetes gene has been found to act in this way – we do not know why it should be associated in one subgroup of patients and not another. It could point to the fact that Type 2 diabetes may not be one condition, but may represent a number of subgroups, but more work is required to prove this.” i The study was published in the journal PLoS Genetics and is available at http:// dx.plos.org/10.1371/journal.pgen.1002741.

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Obesity and a sedentary lifestyle are the most important risk factors for Type 2 diabetes; however, individuals who are not overweight can also develop Type 2. It has long been thought that this is caused by genetic rather than lifestyle factors, and, in May, an international study proved that Type 2 diabetes in lean individuals is more ‘genetically driven’ than in those who are obese. The study, led by a team at the University of Exeter, used genetic data from around 5,000 lean individuals and 13,000 obese individuals with Type 2 diabetes, and from 75,000 people without diabetes, to look for variation in common genetic markers and map their connection with Type 2. They found strong evidence that lean people with Type 2 carry a greater number of markers associated with

the year the RD Lawrence Fellowship – named after Diabetes UK’s co-founder – was established

• See right for new Fellowships and page 22 for more on Dr RD Lawrence.

20 balance

Low levels of the hormone testosterone could increase the risk of Type 2 diabetes, reported Diabetes UK-funded researchers in March. The study, conducted at the University of Edinburgh, found that mice that had their testosterone function blocked were more likely to be resistant to insulin than mice in which testosterone functioned normally. Testosterone is essential for health and wellbeing in both men and women. Men produce more of it and it promotes the development of typical male characteristics, such as increased muscle and bone mass, and the growth of body hair. This study is the first to directly show how low testosterone levels in fat tissue could be involved in the onset of Type 2 diabetes. It could also help to explain why older men are more at risk of developing Type 2 diabetes, as men’s testosterone levels fall as they age. “We know that men with low testosterone levels are more likely to become obese, and develop diabetes. However, this study shows that low testosterone is a risk factor for diabetes no matter how much a person weighs,” said Dr Kerry McInnes, lead investigator on the study. Dr Iain Frame, Diabetes UK’s Director of Research, said: “While testosteroneimpaired mice developed insulin resistance whatever diet they were given, the effect was considerably more pronounced on those fed a high-fat diet. This reinforces Diabetes UK’s advice that a healthy, balanced diet is important for everyone, and particularly for those already at high risk of developing Type 2 diabetes. “Further work is needed to translate these initial findings into clinical practice, and it is important to emphasise that results in mice may not necessarily have direct relevance for humans. But research such as this represents steps towards potential new treatments, and we are pleased to see research funded by Diabetes UK producing results that may benefit people with diabetes in the future.” i The study was published in the journal Diabetes and is available at http://diabetes.diabetesjournals. org/content/61/5/1072.abstract.

July – August 2012

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research matters

TAKE PART IN RESEARCH People with diabetes who have acute Charcot’s foot are being sought to take part in a Diabetes UK-funded clinical trial investigating whether human parathyroid hormone can heal the foot more quickly compared with standard treatment. Contact Michael Edmonds: 07713 395 156; michael. edmonds@nhs.net. University of Birmingham researchers are seeking people aged 16–60 who have been diagnosed with Type 1 diabetes within the last 12 weeks. They are hoping to find out why exercise can be particularly difficult for people with diabetes and determine if regular exercise can help to protect the insulinproducing beta cells in people with Type 1. Contact Dr Amy Kennedy: 07765 867 993; a.kennedy@bham.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 to reduce the pain associated with diabetic neuropathy. The researchers aim to find out whether this drug is more effective than others currently available. Contact Keith Berelowitz: 020 8664 5200; diabetes@richmond pharmacology.com.

NEW RESEARCH FELLOWSHIPS

Diabetes UK recently dedicated more than £1m to two new RD Lawrence Fellowships. These grants help outstanding PhD students to establish their independence in diabetes research. Here are the new Fellows and their promising projects... FELLOW Dr Reshma Ramracheya

FELLOW Dr David Hodson

She gained an in-depth understanding of islet cell biology [islets are groups of insulin-producing cells in the pancreas], with a PhD from King’s College London, a leading centre for diabetes research. Since 2005 she has worked in the lab of Professor Patrik Rorsman, an expert in diabetic medicine at the University of Oxford, and has helped to perfect techniques for measuring the release of insulin and other hormones from islet cells. Dr Ramracheya’s Fellowship will build on her existing work, advance her career as an independent diabetes researcher and could help to contribute to the development of new treatments.

He studied veterinary science before completing his PhD in reproductive biology and the biological clock at the University of Bristol. In 2008 his studies shifted to Montpellier in France, where he focused on the interaction of hormone-secreting cells in the pituitary gland. Now, with his RD Lawrence Fellowship, Dr Hodson has joined the lab of diabetes expert Professor Guy Rutter at Imperial College London, where he will use state-of-the-art imaging to study how genes associated with a greater risk of Type 2 diabetes affect the insulinproducing beta cells.

PROJECT Understanding the role of GLP-1

The release of insulin from the islets of the pancreas involves thousands of insulinproducing beta cells working together. Individual beta cells in the laboratory function differently, and this makes it difficult for scientists to study insulin production and the ways it can go wrong in diabetes. Researchers are keen to find ways of studying beta cells in the intact pancreas, where signalling from cell-tocell is preserved. This study will use state-of-the-art imaging techniques to observe and influence the function of beta cells in the pancreases of mice with Type 2 diabetes. Dr Hodson will monitor cell signalling and the release of insulin, as well as making attempts to genetically ‘remote control’ beta cells in order to boost insulin production. Hopefully, this study will provide the basis for new ways of increasing beta cell function in order to improve glucose control and help people with Type 2 diabetes.

Type 1 and Type 2 diabetes are marked by insufficient release of insulin and over-production of glucagon, a hormone that raises blood glucose by causing it to be released from stores in the liver. Glucagon-like peptide-1 (GLP-1) is a protein that is being investigated as a potential treatment for diabetes because it increases insulin production and reduces the production of glucagon. The exact mechanisms by which GLP-1 takes effect are poorly understood, but Dr Ramracheya believes that an undiscovered receptor may be involved. Using human and mouse islets in the laboratory, she will attempt to clarify these mechanisms and identify the new receptor that might be involved. Findings from this Fellowship could lead to new therapies for accurately targeting the overproduction of glucagon in both Type 1 and Type 2 diabetes.

PROJECT Imaging insulin release in the pancreas

July – August 2012 balance 21 20-21 Research Matters COLOUR.indd 21

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feature

LOST & FOUND To celebrate the release of Dr RD Lawrence’s biography, author Jane Lawrence describes what she found – and how she felt – uncovering her father-in-law’s fascinating life story

22 balance

any people with an interest in diabetes know that Dr RD Lawrence (or RDL, as he was known) was an aspiring surgeon at King’s College Hospital (KCH), London, whose diabetes had been diagnosed by chance in 1920. This was before the discovery of insulin and, guessing that he had three years left to live at most, he decided to spend his last years in Florence, Italy. In May 1923, he was wretchedly cold, sleepy and suffering from peripheral neuropathy (nerve damage) when he received a telegram from his colleague, GA Harrison, which simply said: ‘I’ve got some insulin. Come back quick, it works.’ He returned to KCH immediately and, three years after facing that ‘inevitable’ death from diabetes, he wrote The Diabetic Life, which became a definitive handbook

for patients, doctors and nurses. Eleven years later, with the writer HG Wells, RDL founded the British Diabetic Association (BDA), now known as Diabetes UK, and became an energetic pioneer of patient empowerment. As Professor Robert Tattersall puts it, RDL ‘shaped the clinical management of diabetes in England for nearly 40 years.’ And according to the great ophthalmologist TH Whittington, who worked for more than 74 years at KCH, Lawrence was a great man because he had one great idea in his mind: ‘to do everything possible for the diabetics. He battled for them, he fought for them and that’s probably what the patients felt.’ He certainly had a strong empathy with his patients. Researching for my book Diabetes, Insulin and the Life of RD Lawrence, made me realise this and much more.

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21/06/2012 19:04

feature

Left: Doting dad… According to his family, RDL was a loving and active father, who was fascinated by his children, never ceasing to watch and to marvel at their development. He is seen here during World War II with his three sons: Rob, Adam and Dan. Below: The family RDL thought he’d never have – 17 of his 29 direct descendants. Jane (far right), spent five years researching his life. Left: RDL’s The Diabetic Life was the definitive handbook.

There was no shortage of material RDL had actually sketched an autobiography, but he’d only got as far as his childhood. Fortunately, the Lawrences are great hoarders, and RDL’s son, Adam, gave me crates and boxes full of folders, diaries, bundles, albums and scrapbooks. Visits to The National Archives in Kew were fruitful, as many relevant letters and research summaries were unearthed. And JGL Jackson (Jim), who had been the Secretary of the BDA for many years, had written a draft biography, as well as many articles on RDL for balance and the journal Diabetologia. With such a mass of information, it was more a question of marshalling the mountain of resources and shaping them for various chapters of the book. I was put in touch

I also found a wad of letters written on what looked like old-style shiny loo paper, which made for riveting reading

with Dr Mike Williams in Aberdeen, who had campaigned successfully for the placement of a plaque at RDL’s nearby birthplace. He was enormously helpful and took me to all the places familiar to RDL. We spent many hours researching RDL’s university years in the University’s Special Libraries and Archives, and he corrected early drafts of the opening chapters.

Unwrapping hidden treasures was one of the highlights of my research Quite by chance, I found a bundle of RDL’s letters to his beloved wife, Anna, in an old family chest. They weren’t only the first love letters he wrote to her, but also included a set from his first trip to Canada and America, when his good friend Charley Best took him

A PAtIEnt REMEMBERs…

Diabetes UK has launched a five-part interactive online series on Bridget Wilkins, who has had Type 1 diabetes for 60 years, and her father, Jim Nicholls (pictured), who was diagnosed aged 17. The second instalment is a recording of Jim, who passed away aged 90 in 2001, talking about his early treatment. He was diagnosed with Type 1 in 1928, seven years after the discovery of insulin. The 17 year old meticulously recorded, in a leather-bound diary, the sixweek starvation diet that was the common treatment for patients at the time and was used as an alternative to insulin. Jim recorded his experiences in his 1928 and 1930 diary entries, and recordings he made at the age of 87 about his treatment under RDL. “… I was under the care of Dr Lawrence… I was put on a certain diet, which was calibrated into how much energy I should use and also the amount of insulin required. They did one or two experiments and one of those was to leave a syringe of insulin permanently connected to a needle to my skin – under my skin – by a rubber tube. But it didn’t work because the insulin went all milky. They found out that this was due to the rubber tube that was connecting the two, but it was quite fun up there [London]...” • Find out more at www.diabetes.org. uk/Bridget-JimNicholls.

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to the laboratory where he and Dr Frederick Banting discovered insulin. He wrote: ‘I saw the old benches... I found myself rather touched, as at a shrine, for the first time in any laboratory.’ This image stayed in my mind for a long time. I also found a wad of letters written on what looked like old-style shiny loo paper. They were from his friends from Aberdeen University, who were on the front line in World War I, and made for riveting reading. They also shed light on RDL’s personality and the pivotal role he played in his circle of friends: the leader of their group, the one with wit and dynamism whose talents they respected and whose company they frequently sought.

A chance connection helped me fit the last piece of the puzzle Once I’d written the narrative of RDL’s life, described his family, education, World War I experiences, his marriage, family, involvement in architecture and education, before gently laying him to rest, the enormous gap was revealed: there was no description or appraisal

RDL had a strong empathy with his patients

He was courageous and forward thinking It was impressive that RDL continued to work with disabling neuropathy, having managed Type 1 on diet alone for more than two years before the discovery of insulin. His only complaint was that he didn’t like his neuropathy, which was then called ‘peripheral neuritis’, as ‘it interferes with work’. He also threw his wartime energies into trying to find billets for children with diabetes and, in an era of negative labelling, used the more sensitive phrase ‘these special children’ in his letters pleading for people to accept them as evacuees. It wasn’t until 1978 that the phrase ‘children with special needs’ began to be widely used in educational circles.

remarkable courage and fortitude. I only knew him during the last five years, when he’d been severely debilitated by a stroke. I was a busy young wife and mother and never fully appreciated his sheer range of talents – not just as a pioneering doctor and scientist, but as a musician, all-round sportsman and fly fisherman, and patron of the new international style of architecture. Having researched his life so closely, I wish I could have time to talk to him about what he called his ‘splendid life’.

I wish I could have time to talk to him about what he called his ‘splendid life’ of his hugely important clinical and scientific work. My younger daughter, Rebecca, was asked by a work colleague in the Treasury why she’d chosen to work on the NHS budget. She told him that her grandfather had been a doctor. He did a double-take and asked if it was RDL. His stepfather had worked at KCH in the 1960s and had organised a talk by RDL describing his life and career with diabetes. That doctor was Alex Wright. We met and within days he’d whistled up a formidable team of collaborators, and the project took on a new life.

24 balance

RDL noted that employees working in the private sector could lose their job if their employer discovered they had diabetes. Discrimination encouraged people to hide their condition and not take time off to attend clinics. So RDL arranged an evening clinic at KCH to avoid this problem.

WIN

I wish I could have one hour back with him Towards the end of his life, RDL endured bereavement and the indignities of ill health with

May – June 2012

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21/06/2012 18:41 19:04 29/01/2012

Hitting the target Many teenagers with Type 1 don’t meet their target blood glucose levels, so what can be done to help them achieve better control? Dr Richard Elliott explains how Diabetes UK’s Targeted Research Fund is supporting several projects aiming to find out

esearch studies have shown that children and teenagers with Type 1 diabetes often struggle to manage their condition while growing up, and that those in the UK tend to be less effective at controlling their blood glucose than elsewhere in Europe. A history of poor control as a teenager can lead to an increased risk of developing complications in later life, so it is vital that diabetes research focuses on ways of enabling better self-management for this age group. Diabetes UK’s Targeted Research Fund supports areas of research that the charity’s Science and Research Advisory Group feels are of particular importance or have been otherwise overlooked. The group – consisting of people affected by diabetes, researchers and clinicians – has this year agreed to support a range of projects aimed at identifying and overcoming barriers to improving diabetes care and/or supported self-management, and several of these focus on young people with Type 1.

App-ealing solution? Part of the problem in helping young people with Type 1 to manage their condition could be healthcare

26 balance

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consultations. Research evidence indicates that many young people feel that their appointments with healthcare professionals are insensitive to their concerns or irrelevant to their needs. “As well as managing their condition, young people with diabetes must attend healthcare appointments that can seem a bit daunting or involve clinicians who can be a bit like judgmental parents,” says Professor Jonathan Pinkney of Peninsula Medical School. “Young people are constantly being told that their blood pressure and blood glucose are not good enough and that they ought to do ‘this’ rather than ‘that’. As a healthcare professional myself, I completely accept that the whole field is pervaded by this and that it can create quite a negative experience.” In collaboration with Professor Ray Jones of Plymouth University, Prof Pinkney is using a novel electronic approach to look for

{

{85%

of young people with diabetes do not achieve the recommended targets for blood glucose levels Source: National Diabetes Audit Paediatric Report 2009–10

a solution to this problem. Since the use of computers, mobile phones and online communities (such as Facebook) is particularly high among this age group, he is hosting ‘The Diabetes App Challenge’, a competition for 16–25 year olds with diabetes to develop and submit an ‘app’ – a

I am pretty convinced that we will find out something that will help us to move care forward small software application for electronic devices – to help them take control of their healthcare appointments and get more out of them. The 10 best apps will be chosen and made available to 200 testers aged 16–22. Designers will be paid £100 to maintain the app during the study, and earn £6 for each tester who trials their app – up to

£1,200 in total. The most successful entries will be highlighted in study results and go on to inform future research in this area, while the designers are free to release their apps to the wider market if they wish to do so. “The apps should improve young people’s confidence, helping them to set the agenda in consultations and focus on the things that are important to them, rather than simply being lectured on how to improve their blood glucose control,” says Prof Pinkney. “It would be great to think that young people could access something in the palm of their hand that would really help to improve the outcomes of their consultations. Ultimately, such apps could even be a bit like a blood glucose monitor – just another little piece of equipment that could make a big difference to some people’s diabetes care.” The deadline for entries to The Diabetes App Challenge is 14 October 2012. For further details, see www.diabetesappchallenge.org.uk.

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» University challenge

identified, new and innovative ways self-management of diabetes. However, Around 43 per cent of children of tackling them can be fully explored. the work of researchers such as leaving school in the UK will go on “This research will highlight the Professor Vivien Coates reveals that to attend university. This transition areas we need to concentrate on and a significant number of those invited can be a time of stress and disruption will give us an insight into exactly to participate in diabetes education for young people and can be especially what doctors should be doing for courses choose not to attend – and this problematic for those with Type 1 their diabetes patients at university,” includes young people with Type 1. diabetes, many of whom find it Dr Myint concludes. “I am pretty “Some people may not feel particularly hard to control their convinced that we will find out comfortable about learning, or have blood glucose and engage effectively something that will help us to move literacy problems, whereas others with health services after leaving care forward.” may not feel comfortable in a group home and becoming independent environment or find it inconvenient,” of their parents. Back to school suggests Prof Coates. “Although we A targeted project led by Dr Khin Diabetes education courses – such as think that diabetes education should Swe Myint at Norfolk and Norwich DAFNE (Dose Adjustment for Normal be a priority, most people have busy Hospital will attempt to improve this Eating) – enable participants to learn lifestyles and are coping with lots of situation by identifying the obstacles about their condition, share experiences other things that come first. Some to good diabetes care during this and develop strategies for diet and have simply lived with diabetes for period. “On a lot of occasions we lifestyle modification. Most healthcare a long time and feel that it is too late receive feedback from healthcare professionals agree that such courses, for them to go on a course.” professionals and young people with which tend to be freely and locally As Prof Coates explains, the Type 1 that their diabetes care has available, are key to the effective scientific understanding of these been somewhat disrupted for a concerns is based on guesswork few years while studying away and anecdotal evidence, and so from home,” says Dr Myint. needs to be validated through “Students may still be looked additional research. That is after by their GP and diabetes Investigating ways of identifying and overcoming key why she and her colleagues at specialist team from home, barriers to improving care and self-management of the University of Ulster are using or by an entirely new team diabetes is a key part of Diabetes UK’s research strategy. online surveys and interviews at their university. However, Although the latest targeted projects focus on to hear from young people so far no research in the UK patient-centred research, future schemes might cover with Type 1 – a group that is has indicated what kinds lab-based projects, such as work on a vaccine for Type 1 particularly hard to reach with of healthcare are available diabetes or even stem cell research, where studies could diabetes education. They are at which universities. We also help to produce significant long-term benefits for attempting to identify the key know that there are problems people living with diabetes. concerns of this group and with diabetes care at university, Dr Iain Frame, Diabetes UK’s Director of Research, are beginning to develop ideas but we won’t know how we can hopes that, in future, the fund will ask questions that on how best to resolve them, improve things unless we really are even more focused: “This is a specific fund that is set perhaps by broadening the find out what the barriers are to aside to allow us to do research in a different way,” he scope, appeal and inclusivity good care.” says. “As our income grows, I hope we can expand it of current courses. In the long Dr Myint and her team will and ensure that more work in key areas is funded, while term, it is hoped that more use surveys and interviews to continuing to support the best investigator-led studies people can be encouraged to explore the perspectives of 500 and personal support schemes as we do now. attend diabetes education so university students with Type 1 “We need to hear from groups of people affected by that the overall quality of their and diabetes healthcare teams diabetes, researchers and healthcare professionals about care can be improved. at all 156 university medical what they think is important. We need to see proposals “We’re not naïve,” says Prof services across the UK. Their coming forward that we can take to our expert advisors Coates. “We know that there findings will reveal what and use to establish what is most important and what is will not be a single solution standards of care young adults less so. When I visit our voluntary groups I ask people to that will work for every person with Type 1 diabetes receive give me their ideas about what research they would like with diabetes, but we hope once they start university, and to see funded. Research towards a cure is quite rightly at to find solutions that might what healthcare professionals the top of everyone’s list, but there are other areas that overcome some of the barriers and Type 1 students themselves can also make a real difference. If what people suggest that are putting some people off.” see as the major obstacles to is strategically important for Diabetes UK, then I think i To find out more about Diabetes UK’s care and control of the condition. we should do all we can to see it gets done.” research strategy, visit www.diabetes. Once these obstacles are org.uk/research.

Finding new targets

28 balance

July – August 2012

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feature Left: Louis with Dr Roman Hovorka, who’s leading the artificial pancreas study; top right: Louis was well looked after during the trial; bottom right: Louis and his proud dad, Tim

Rich rewards for teen trials

A group of teenagers has been helping out a Cambridge team in its bid to perfect the muchanticipated artificial pancreas. Tim Gillett and his 13-year-old son, Louis, offer a personal perspective

wenty-four hours of lazing around in bed, with a large television and an array of computer games, would undoubtedly sound like heaven to many teenagers. Of course, if you add in a strictly controlled meal regime, no snacks in between, and blood tests every 15 minutes, suddenly it’s not quite such an appealing prospect. So Dr Roman Hovorka and his team at Addenbrooke’s Hospital, Cambridge, were delighted that 12 teenagers, including my son Louis, signed up for the latest trials on the artificial pancreas, otherwise known as the ‘closedloop system’, on which they have been working for a decade.

What is the artificial pancreas? Regular balance readers may well be clued up on the artificial pancreas by now [see ‘The next best thing to a cure’, balance issue three 2011]. It consists of an insulin pump and a continuous glucose monitor (CGM) that ‘speak’ to

30 balance

one another to automatically regulate blood glucose levels. This is possible due to Dr Hovorka’s mathematical program, which interprets the CGM readings and programs the pump to deliver just the right amount of insulin. He believes that this system can significantly improve blood glucose control for people with diabetes, especially during the night. By levelling out the peaks and troughs in blood glucose levels, the artificial pancreas could help to avoid raised blood glucose levels, which over time contribute to the development of complications, and low glucose levels (‘hypos’), which can lead to unconsciousness and be very distressing. People with Type 1 must, to a certain extent, guess their overnight insulin dose before they go to sleep, based on their blood glucose level at that moment and how many carbohydrates they have eaten. While ‘bolus wizard’ programs have improved night-time control for many, there is always room for improvement.

View from the inside My son Louis developed Type 1 diabetes shortly after his fourth birthday and has been using an insulin pump to control his diabetes for the last four years. Occasionally, he forgets to administer his insulin dose after meals, despite being reminded. He’s not alone – teenagers are statistically more likely to suffer ‘irregularities’ in their insulin regimes due to missed doses at mealtimes – and the trial was aimed at showing that the artificial pancreas can deal with these issues. Taking part in the trial required Louis to stay at the hospital for two 24-hour periods. During his first stay, he was manually programming his insulin pump, as usual, but was subjected to very frequent blood glucose checks – every 30 minutes during the day and every 15 minutes at night, while his exercise and food intake were monitored closely. Meals were timed to the minute – which Louis found amusing and frustrating at the same time – and his

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feature carbohydrate intake was measured precisely, down to the individual gram. During Louis’ second stay, six weeks later, his insulin pump was controlled by Dr Hovorka’s mathematical programming rather than by the human hand. This time he was in a bigger room, with a large flat-screen TV, so he was able to spend the last couple of hours of the trial watching Liverpool win the Carling Cup final. As an Arsenal supporter this was hardly ideal, but it was still a good way to pass the time!

Parental perspective As Louis’ mum and dad, my wife Rebecca and I were always keen for Louis to take part in the trials, but we are aware that it’s much easier to say that from where we are standing. People with Type 1 have enough to contend with – including finger pricks, infusion set changes and the dreaded blood tests at annual review time – so it’s always difficult to sell the idea of extra medical procedures. However, the organisers of the trials were offering a small payment to Louis and so, having decided that it was an easier way to earn money than by delivering newspapers, he agreed to go ahead quite readily. I’m sure I heard him mutter something about helping to improve diabetes care for future generations, as well. Or perhaps that was just wishful thinking on my part… The care offered by the Addenbrooke’s team was superb. Two days before, two members visited our house to fit Louis with a blood glucose sensor, which sits just under the skin and forms part of the CGM, and they could not have been more gentle

and understanding. Throughout the trial everyone in the team was extremely attentive and made a special effort to ensure that Louis was happy and well looked after. They played Scrabble with him, exchanged jokes and holiday photos, took him on walks around the hospital – anything to distract him from the fact that 24 hours spent almost entirely lying on a bed can be, well, rather dull. Rebecca and I could spend as much time as we wanted with Louis and we were also looked after well, with a regular supply of tea and biscuits. It was also intriguing – and very encouraging – to see a nice, steady display of Louis’ blood glucose readings throughout the night on the team’s laptop. The team was also very obviously thankful that Louis had wanted to take

We really did feel that we were doing our little bit to extend the boundaries of science

part in the trials, and that we as parents had agreed. It’s something of a cliché, but we really did feel that we were doing our little bit to extend the boundaries of science.

Teen help ‘essential’ Louis, being a ‘cool’ teenager, was remarkably unfazed by the whole experience: “The trial was a bit boring because I had to just sit on my bed with a drip in my arm. But there was an Xbox, which passed the time,” says Louis. “The staff at the hospital were really nice, even if they couldn’t beat me at Scrabble, and the time went quite quickly in the end. Also, it meant that I had a day off school! I hope the trials help people to control their diabetes better in the future.” Several trials are now complete, and results published so far by Dr Hovorka have revealed a 22 per cent improvement in the time participants kept their blood glucose levels in a safe range. This halved the time they spent with low blood glucose levels and reduced the risk of both shortand long-term diabetes complications.

These initial findings are very encouraging and the team’s next move will be to arrange trials in patients’ homes rather than within a controlled hospital environment – another big step towards what Dr Hovorka hopes will be the development of an artificial pancreas for widespread use. Dr Hovorka concluded: “It is a slow process but we are very optimistic about the years ahead. There are other teams around the world working on similar systems, funding is increasing, and diabetes equipment manufacturers are investing time and money into developing better glucose monitoring systems. “All the time we have to bear in mind that the artificial pancreas will only be a ‘bridge to a cure’ – and that the long-term solution to diabetes is a biological cure – but I’m convinced we can make real improvements to diabetes care in the coming years. “I pay tribute to the young people who are helping out with this research. The data from these trials is essential, as our research scientists need to demonstrate the safety of our system in many different situations. These teenagers can be proud that they are helping to improve the health of people with diabetes in the future.” i Visit www.diabetes.org.uk/research/theartificial-pancreas1 for more on the artificial pancreas. • Find out how you can get involved in Diabetes UK research at www.diabetes.org.uk/ research/get-involved-in-research, and see page 21 for the latest studies. • See ‘Hitting the target’, page 26, for details of new Diabetes UK research projects related to improving blood glucose control in young people with Type 1.

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So you’ve been diagnosed with Type 2 diabetes and need to change your lifestyle to manage the condition successfully. Sound easier said than done? Health psychology consultant Dr Nicola J Davies gives her tips for getting to grips with self-management

he key to living well with diabetes is learning how to self-manage it successfully – you’ve no doubt heard that before. For while the care and support your diabetes healthcare team provides is vital, you are the one in charge of your condition day in, day out. Self-management of Type 2 diabetes can include: blood glucose testing, taking medication as prescribed, and adopting a healthy lifestyle with a balanced diet and regular exercise. But old habits die hard and it can be difficult to change your lifestyle suddenly – you might be feeling angry and resistant to change, or you might be feeling fine and not see the need. All of this is a natural reaction to a diabetes diagnosis. The good news is that there are a number of things you can do to help you successfully self-manage your diabetes, whether you’re newly diagnosed or have been living with the condition for years. Some of the following tips may also be used to help self-manage Type 1 diabetes, but they are more relevant to the lifestyle changes often required to manage Type 2.

32 balance

ASSESS YOUR FEELINGS Work out how you feel about living with diabetes, as well as how you currently manage the condition. You might find it useful to keep a daily mood journal, as once you have identified how different thoughts make you feel, you will be better able to work through feelings of anger, sadness or fear, to name a few, by discussing your feelings with your healthcare team or exploring support options, such as online forums or local diabetes voluntary groups (see end information, overleaf).

ACCEPT THAT YOU’RE IN IT FOR THE LONG RUN If you commit to self-management as a long-term investment and set long-term goals, you will be more likely to succeed. For example, if you want to increase the amount of physical activity you do, you’re more likely to achieve this goal if you commit to a 30-minute walk every Sunday afternoon at 2pm. It won’t be long before this commitment becomes difficult to break, especially if someone else, such as a friend, is involved.

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Illustrations: Mel Smith

2 &you Type

DO YOUR RESEARCH Take the time to read up on Type 2. The more you know about the condition, the more choice you will have when deciding how best to manage it. Start by visiting the Diabetes UK website at www.diabetes.org.uk.

feature

According to research, the healthier behaviour will become a habit within 2–3 weeks

IDENTIFY, AND BREAK, BAD HABITS Many problem behaviours, such as smoking or snacking on junk food, are habits that are difficult to break. Gradually swap them with healthier behaviours, such as taking a stroll after lunch, or keeping fruit or nuts on your work desk instead of unhealthy temptations. According to research, the healthier behaviour will become a habit within 2–3 weeks.

AVOID TEMPTATION Make a point of avoiding specific triggers that can tempt you away from your new healthy lifestyle, such as no longer shopping when you’re hungry if you tend to buy unhealthy foods during such times.

REWARD YOUR EFFORTS Managed to stick to your exercise regime for a week? Then treat yourself to a lazy Sunday. Doing well with your healthy eating regime? Then organise a healthy meal out.

Illustrations: Mel Smith

BE OPEN AND WILLING TO TALK Share what you’re going through with the people who care about you. Expressing your thoughts and feelings, you. as well as allowing yourself to lean on others for support, has been found to improve health and wellbeing. People want to help, so don’t deny them the opportunity. You might also want to consider counselling or cognitive-behavioural therapy, both of which you can access via your GP.

Learning the skills All people with diabetes are entitled to receive the education and support they need to self-manage their diabetes. There are lots of education courses available, so see what’s running in your local area. Two of the nationally developed courses for people with Type 2 are X-PERT Diabetes and DESMOND (Diabetes Education and SelfManagement for Ongoing and Newly Diagnosed). Kerry Stevens, 30, from London, was diagnosed with Type 2 in April 2011 and soon after attended an X-PERT Diabetes course. She says: “It was invaluable – it gave me back some control at a time when I was feeling scared and confused. The goal setting is now ingrained in my head. If I need to do something, rather than put it off I set a very specific plan. It helps me stay focused, especially with things I find hard, like exercising, which has now become a habit. I still have times when I feel scared or out of control, but after attending the programme I know I have the skills to manage my diabetes.” i X-PERT Diabetes: www.expertpatients.co.uk/ course-participants/ courses/x-pert-diabetes • DESMOND: www.desmondproject.org.uk • The most widely recognised education course for people with Type 1 diabetes is DAFNE (Dose Adjustment for Normal Eating): www.dafne.uk.com.

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NOWK5

feature

CONSIDER YOUR ENVIRONMENT Could changing your surroundings help you to better manage your diabetes? If you are finding it hard to stick to healthy eating to lose some excess weight, try keeping a photo of you at your heaviest at hand for extra motivation. If you sometimes forget to take your medication, keep it in a place where you will see it to remind you. Simple.

SOCIALISE WITH OTHERS WITH TYPE 2 Many people with diabetes swear by online forums, local support groups and educational courses, such as X-PERT Diabetes or DESMOND (see box, page 33), to help them better manage their condition. Share experiences with others in the same boat – don’t go it alone (see end information, below).

BE CONFIDENT You are more likely to succeed in selfmanagement and persevere when difficulties arise if you have confidence in your abilities. To increase your confidence, write down challenging but achievable goals and tick them off when you’ve completed them; seek inspiration from others who self-manage their Type 2 diabetes successfully; and learn to think positively – for example, being breathless after exercising can either be interpreted as a sign of being in poor shape or a great workout!

i See page 4 for details of Diabetes UK’s Careline and Peer Support network. • Visit Diabetes UK’s online forums: www.facebook.com/diabetesuk and www.diabetessupport.co.uk • Follow Diabetes UK on Twitter: @DiabetesUK • Find your local Diabetes UK voluntary group: www.diabetes.org.uk/local-support-groups.

SWIM CYCLE

Take on a challenge and raise funds for diabeTes uk

JUMP

There are hundreds of exciting uk and overseas challenges you can do throughout the year.

TREK

find out more today: 020 7424 1000 events.fundraising@diabetes.org.uk www.diabetes.org.uk/fundraise

RUN A charity registered in England and Wales (215199) and in Scotland (SC039136). © Diabetes UK 2012

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21/06/2012 15:16

feature

A steer in the right direction There’s been a lot of confusion and frustration surrounding driving licences and diabetes recently, so what’s been going on? balance gets the lowdown from Diabetes UK’s Senior Policy Oﬃcer, Nikki Joule, on that form – and how it’s all about to get a lot clearer

What’s the deal with diabetes and driving?

What are the new rules for Group 1 licences?

People who are treated with insulin are only given Group 1 driving licences (for cars and motorbikes) that last for 1–3 years. Those in England, Wales and Scotland have to reapply frequently to the Driver and Vehicle Licensing Agency (DVLA), demonstrating their ‘fitness to drive’. This is assessed in their application form, which asks questions on diabetes management.

You will not be issued a licence if you’ve had more than one episode of severe hypoglycaemia (low blood glucose) in 12 months or if you’ve lost all awareness of the onset of hypoglycaemia. ‘Severe hypoglycaemia’ was defined as ‘requiring assistance’ from another person. Somewhat controversially, the new rules did not state that such episodes only relate to ‘waking hours’ as before.

So when and why did it change? The DVLA introduced changes to the rules for assessing fitness to drive in September 2010. They came about due to a European Union Directive, which tightened up the criteria for people with diabetes when applying and reapplying for a driving licence. In contrast, the ban on people treated with insulin from driving lorries and passenger-carrying vehicles was lifted.

36 balance

What happened next? The DVLA updated its application form, but this led to much confusion as the new rules were difficult to understand and were not clearly explained. Over the course of the first year, Diabetes UK heard that people were losing their licences when they’d never had any previous problems with diabetes and driving. Some were

Having a hypo?

» Stop driving as soon as it is safe

» »

to do so. Don’t attempt to start again until the symptoms have disappeared. The DVLA advises that you wait 45 minutes after blood glucose has returned to normal levels. Take glucose tablets or some other form of fast-acting carbohydrate, such as a non-diet fizzy drink or some glucose tablets, immediately. Make it clear that you are no longer in charge of the car by leaving the driving seat, stepping out of the car (if safe to do so) and by removing the ignition key. This is to refute any suggestion that you are in charge of a car while under the influence of any drugs, which includes insulin.

July – August 2012

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feature

526

}

people in the UK lost their driving licence in 2011 due to the new standards on hypoglycaemia, compared with 111 in 2010 Source: DVLA

}

obviously devastated by the potential damage to their livelihood and felt that they had been unfairly treated.

guidelines and access to test strips to take these new DVLA rules into account.

What did Diabetes UK do?

Will some people still lose their licence?

In November 2011, the charity set up a meeting with the Transport Minister, Mike Penning, to voice these concerns. As a result, a working group was set up to review the guidance and the questions used to assess people’s fitness to drive. This group included staff from Diabetes UK, the DVLA and people with diabetes.

What was the outcome?

Worryingly, the number of people losing their licence is still rising and Diabetes UK will be monitoring this closely. People with diabetes generally don’t pose a greater risk to road safety than other road users, so if people do lose their licence it should be fairly assessed – we will be concerned if people are having their Unnecessary questions licence taken away when have been removed and the they (and their guidance on filling it in is doctor) don’t think it is much easier to understand justified.

Thanks to the working group, the form has been updated and is hugely improved. Many unnecessary questions have been removed and the guidance on filling it in is easier to understand. This should now make it much more straightforward for people applying for licences and lead to fewer delays and errors.

Does the new form explain about blood glucose testing?

People treated with insulin or certain diabetes medication (any tablet from the sulphonylurea or prandial glucose regulator groups) are at risk of hypos, which can pose a serious risk to road safety. Many of the accidents caused by hypos are because drivers continue to drive even though they are experiencing hypo warning signs (eg feeling hungry, sweating, shaking, palpitations, feeling faint, dizziness, nausea or a headache). Having a hypo while you are in charge of a motor vehicle can be fatal, not only for you, but for others as well. So it’s vital to: • Check your levels before you drive and whenever you take a break. The DVLA recommends every two hours. • Keep glucose tablets and biscuits, fruit or sandwiches in the car. • If you have a passenger, tell them you have diabetes and what to do if you need help dealing with a hypo.

If you are refused a licence can you reapply? Most people should be able to get their licence back once they have not had more than one episode of severe hypoglycaemia in a year or regained awareness of hypoglycaemia with the help of their diabetes healthcare team.

Does this mean that regular drivers have to be prescribed enough test strips?

i To view the improved form, visit www.direct.gov.uk/en/Motoring/ DriverLicensing/MedicalRulesForDrivers/ MedicalA-Z/DG_185427. • For clear guidance on how to fill in the form, visit www.diabetes.org.uk/driving. • We’ve heard from many frustrated readers about reapplying for a driving licence. Keep sending in your experiences – good or bad – especially from those using the new form and guidance. See page 4 for address details.

A person’s need for test strips should be agreed on an individual basis with their doctor. If you need to drive this definitely needs to be taken into account. Many local health bodies are amending their self-monitoring

The Driving and Vehicle Agency (DVA) in Northern Ireland is likely to introduce the new rules with the improved form later this year.

People are now asked to sign a declaration on the form, to say that they understand the need to test their blood glucose levels at times relevant to driving (see ‘Driving know-how’, top right).

Driving know-how

Tell all You must inform the DVLA if: • you have more than one episode of severe hypoglycaemia within 12 months, or if you are at high risk of developing severe hypoglycaemia (defined as requiring the assistance of another person) • you have difficulty in recognising the warning symptoms of low blood glucose levels • you have a hypo while driving or an existing medical condition gets worse or you develop any other condition that may affect your driving. i DVLA: Call 0300 790 680 or visit

www.dvla.gov.uk.

July – August 2012 balance 37 36-37 FEAT Driving.indd 37

21/06/2012 19:06

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life&health

Stealth sugar You’re probably getting more than you think...

How much is too much? For good health, added sugars shouldn’t make up more than 11 per cent of the energy you get from food and drink. So you shouldn’t consume more than around 50g of added sugars per day – about 12 cubes. The guideline daily amount for total sugars (added and natural) is up to 90g for women and 120g for men.

Where’s the harm? While it’s fine for people with diabetes to indulge in the occasional sugary treat, and use sugary drinks and glucose tablets for hypo treatments, it’s important not to overdo it. Many foods that contain added sugars, such as sweets and cakes, often lack nutritional value but are high in calories and fat. Eating such foods too often can lead to weight gain, which can make your diabetes harder to control; raise your triglycerides (blood fats); and cause dental problems. But added sugar isn’t just in ‘sweet treats’, it’s also lurking in products you might not expect, such as sauces, ready meals, bread, cereals and even bottled water.

What should I look for? Check the ‘carbohydrates (of which sugars)’ value on the nutrition label. This tells you how much sugar is present and includes natural and added varieties. More than 15g of sugars per 100g is high, and 5g of sugars or less per 100g is low. If the quantity falls between the ‘high’ and ‘low’ figures, it’s a medium amount. However, your actual serving size will determine your sugar intake. As nutritional information doesn’t state how much sugar is natural and how much is added, you can find out if the product is high in added sugars by looking at the ingredients list, which always starts with the largest amount first. Be aware that many foods and drinks may not have ‘sugar’ listed – but honey, sucrose, glucose, dextrose, fructose, galactose, lactose, maltose, hydrolysed starch, corn or maize syrup are all added sugars. It’s also worth noting that many reduced-fat foods actually contain more sugar than ‘full-fat’ options, to compensate for the altered taste and texture caused by the fat being removed – so don’t forget to check the food label. And, as you are no doubt aware, all carbohydrate affects blood glucose, so you need to look at ‘total carbohydrate’ to determine how a food or drink will affect your levels.

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e all need some sugar – it’s what gives us energy – but the Department of Health has revealed that most adults and children are consuming too much. It’s not the foods containing natural sugars, such as fruit and vegetables (which contain fructose), and milk and milk products (which contain lactose), that you might need to cut down on – these form an essential part of a balanced diet. It’s the sugars added to processed foods and drinks, known as ‘added sugars’, that you might be getting too much of.

sugar cubes – the equivalent amount of sugar consumed by the average Brit every week Source: www.nhs.uk/change4life

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21/06/2012 17:34

life&health where’s the sugar hiding? » So, You can see how easy it is to consume more

How to... handle the heat

sugar than is recommended for good health: SUPERMARKET CHICKEN KORMA & PILAU RICE (550G) 3 CUBES (12G)

COFFEE SHOP STANDARD HOT CHOCOLATE & CREAM

CAN OF ORDINARY COLA (330ML)

9 CUBES (36G)

10 CUBES (40G)

STANDARD CHOCOLATE BAR (40G) 4 CUBES (16G)

PORTION OF RICE & WHEAT FLAKES (40G)

1½ CUBES (6G)

SERVING OF BAKED BEANS (12.2G)

5½ CUBES (22G)

3 CUBES (12G)

FLAVOURED MINERAL WATER (0.5L)

5 CUBES (20G)

FRUIT JUICE (500ML)

i For Diabetes UK’s guide to shopping, food labelling and menu planning, visit www.diabetes.org.uk/storetour.

After the cold spring and a fleeting week of May sunshine, you may be hoping for a heatwave or jetting off to warmer climes. But don’t forget to take care when it’s hot and humid HEAT EXHAUSTION happens when the body can’t keep cool. Water and salt levels drop, causing heavy sweating, headache, nausea, dizziness and tiredness. These symptoms could also be due to unstable blood glucose, so check your levels. Heat exhaustion needs immediate treatment to avoid heat stroke developing: move to a cool place, sip a cool drink and remove any excess clothing. You should start to feel better within half an hour. HEAT STROKE is life-threatening and requires urgent medical attention. It happens when the body overheats. Symptoms include: hot, red skin; confusion; hallucination; vomiting; rapid breathing; high temperature; and unconsciousness. Call an ambulance if you suspect heatstroke and move the person to a cool area and give them water, if conscious. HEAT RASH is a red, itchy rash that occurs when you sweat a lot in humid climates. Calamine lotion can soothe it and antihistamines may relieve the itch. TO AVOID OVERHEATING: • keep out of the sun between 11am and 3pm • wear a wide-brimmed hat in the sun and loose-fitting, lightweight and light-coloured clothing made of natural fabrics • drink plenty of sugar-free fluids – especially important if you have high blood glucose levels • avoid alcohol • eat lighter meals • avoid excessive exercise. If you are changing your activity levels or food intake, you may need to adjust your diabetes medication. And don’t forget to keep your meter and medication out of direct sunlight. i Order Diabetes and Travelling, a balance supplement (6953, free): call 0800 585 088 or visit www.diabetes.org.uk/shop.

40 balance July – August 2012 39-42 Life and Health-kfB&W.indd 40

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life&health

Off your food? It’s hard to think about food when you’ve lost your appetite, but you need to eat to keep on top of your diabetes. Try these tips…

llness, anxiety, stress, or having one too many drinks the night before can put you off your food. But during these times your body still needs energy from food and drink to function normally and keep your blood glucose levels stable. Missing meals can lead to hypoglycaemia (low blood glucose), so try to stick to your normal meal pattern – this will also help to stimulate your appetite and keep your energy levels up. If you can’t manage this, try to have small, frequent meals or snacks. You may find these easier to stomach: • Soups and porridge – add cream, cheese, lentils or beans to soup, and whole milk to porridge, to increase the energy, protein and carbohydrate content. • Nourishing fluids such as milk, energy drinks, smoothies and fresh fruit juice are good sources of energy and carbohydrate, as well as some vitamins and minerals. • Meal-replacement drinks are designed to provide most nutrients to help substitute the meals you are missing. But these should not be the only source of food and drink as they are not substantial enough. • Light snacks such as crackers, dried fruit, toast, breakfast bars and yogurts can provide additional carbohydrate.

What if I still can’t eat? Drink plenty of sugar-free fluids to stay hydrated, but also sip sugary drinks – such as Lucozade – to make sure you get some carbohydrate to prevent hypos. Your blood glucose will be higher when you are ill or stressed, so keep taking your diabetes medication, even if you are not eating. However, if you are treated with insulin, you will need to adjust the dose in response to your test results. Speak to your diabetes healthcare team if you are not sure how to do this. Test your blood glucose frequently (at least eight times in a 24-hour period), and if you have Type 1 diabetes and your blood glucose is 15mmol/l or more, test for ketones. If ketones are present or if you are unsure about what to do, contact your GP or diabetes healthcare team straight away. If you are vomiting uncontrollably, contact your GP or diabetes clinic immediately (if it’s out of hours, call NHS Direct on 0845 4647). And seek medical advice if your appetite doesn’t return within a few days. i www.diabetes.org.uk/illness

Can I… recycle my blood glucose meter? Yes! If you have a spare meter that is in good condition with plenty of battery life left in it, the Insulin Dependent Diabetes Trust (IDDT) will take it, along with any unopened insulin, blood glucose test strips, lancets and needles – if they have at least three months to the expiry date. IDDT is the UK arm of a not-for-profit Australian organisation, Insulin for Life (IFL), which collects unwanted diabetes equipment and sends it to developing countries. In 2010, IDDT collected and distributed more than 9,000 pre-filled pens, cartridges and vials of insulin to those in need. If you have any of these items to donate, send them in a Jiffy bag or box to: Insulin Dependent Diabetes Trust, PO Box 294, Northampton NN1 4XS.

Top tips to get your appetite back

1 2 3 4 5

Have smaller meals with highcalorie snacks in between. You may find bright and colourful food more appealing. Try something new – eating out can make a nice change. You may eat better at certain times of the day – be flexible. If you feel nauseous, eating or drinking ginger (a ginger biscuit or some ginger ale) may help for a short time, allowing you to eat something more substantial.

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life&health

»»»ON««« »TARGET«

Get checked out

As everyone is different, you and your diabetes healthcare team should agree your individual blood glucose level target range. These targets are to be used as a guide only.

Health problems can develop without any obvious symptoms – so, as well as your diabetes annual review, it’s important to make the most of the other free NHS health checks...

» 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 DIABETES UK’S 15 HEALTHCARE ESSENTIALS – there are 15 key health checks and services that every adult with diabetes should receive or have access to. Speak to your diabetes healthcare team if there are gaps in your care. • Download a checklist: www.diabetes.org.uk/ 15-essentials NATIONAL CHLAMYDIA SCREENING – for those aged 25 and under who are sexually active. You should be screened for chlamydia annually or when you change sexual partners. You can have the test at your GP surgery or a sexual health clinic – men simply need to give a urine sample and women can do the same or give a swab. You can still be screened if you are over 25 – consult your GP or sexual health clinic. • www.chlamydiascreening.nhs.uk NHS HEALTH CHECK – open to all 40–74 year olds. You should be invited by your GP once every five years to have your blood pressure, cholesterol, weight and height measured. The check assesses your risk of stroke, heart and kidney disease (and Type 2 if you don’t have diabetes). You will be offered support through your GP surgery to reduce your risk of developing these health conditions. • www.healthcheck.nhs.uk

42 balance

CERVICAL SCREENING – for all women aged 25–64. A doctor or nurse will carry out the test, which checks the health of the cervix by looking for early cell changes that may lead to cancer. Early detection and treatment can prevent around 75 per cent of cancers developing. You should receive a letter asking you to book an appointment every three years between ages 25 and 49 and every five years from the age of 50. • www.cancerscreening.nhs.uk/cervical NHS BOWEL CANCER SCREENING – for all 60–69 year olds (in Scotland 50–70 year olds). A self-sampling kit will be sent every two years for you to collect tiny samples from your bowel motions. You then send it back for analysis. • www.cancerscreening.nhs.uk/bowel BREAST SCREENING (mammogram) – every woman aged 50–70 should be offered breast screening every three years and get their first invitation before they turn 53. In England, the programme has started to extend to invite women in their late 40s and up to 73 years. If you are over 70, you are still welcome to attend an appointment every three years, just call your local breast screening unit. • www.cancerscreening.nhs.uk/breastscreen

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

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

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

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

»»» «««

July – August 2012

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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

LET THE GAMES BEGIN I have tickets for the Olympic Games – do you know if I’m allowed to take my insulin, test kit and hypo treatments into the events? And will healthy food options be available? Jo, Salford Karen says... Firstly, congratulations on getting your hands on tickets! The official London 2012 website states that people can take their medication into events with them but should carry either a prescription or a letter from their doctor to accompany it. According to the website, it seems that there will be a range of affordable foods available inside the venues, including healthy, nutritious options. Although ‘excessive quantities of food’ is listed on the ‘restricted items’ list for people entering the venues, there is no mention of a total food ban, so you should be able to take in some hypo treatments. It’s also worth noting that you can’t take bottles containing liquids greater than 100ml into the venues, but you can take an empty water bottle to fill up, as free water is available inside. Enjoy! i Find out more about restricted and prohibited items at www.london2012.com.

plasma glucose (the level of glucose in a sample of blood taken after fasting); a random plasma glucose (the level of glucose in a blood sample taken at random); an oral glucose tolerance test (OGTT) (the level of glucose in a blood sample taken two hours after a glucose drink); or an HbA1c test (the average level of glucose in the blood for the previous 8–12 weeks). The tests have different levels at which diabetes is diagnosed: • fasting plasma glucose of 7mmol/l or above • random plasma glucose of 11.1mmol/l or above • OGTT two-hour plasma glucose of 11.1mmol/l or above • HbA1c result of 48mmol/mol (6.5 per cent) or above.

ask the experts While there shouldn’t be any risk to people with diabetes having this treatment, it is not recommended for people with epilepsy, or women who are pregnant or breastfeeding.

FREE BUSS PASS?

My doctor said I can’t drive for the time being as I’ve had a number of unexplained hypos (I’ve informed the DVLA). Am I entitled to free bus travel? Tilly, Oxford Cathy says… Yes. In England, Scotland and Wales, there are schemes that provide a bus pass for free national off-peak travel for people who have been refused a driving licence under section 92 of the Road Traffic Act 1988 (this relates to medical conditions and physical fitness). Off-peak is from 9.30am– 11pm, Monday to Friday, and all day It seems you have been diagnosed at weekends and on public holidays. with the HbA1c test, but ask your In some local authorities, if you doctor for details if you are unsure. are entitled to this national bus pass, PEARLY WHITES you can also travel free at peak times My dentist suggested I have my teeth in your local area. whitened with laser treatment, but You can apply for your buss pass some people have told me that having through your local authority, which diabetes may mean I can’t use this will give details of whether peak method. I don’t have any trouble with time travel is allowed. my teeth or gums. Should I avoid it? In Northern Ireland, you are Paul, Swansea entitled to reduced-cost travel if Cathy says… you’ve had your driving licence As your dentist recommended the revoked for medical reasons. NEW TO TYPE 2 treatment, and assuming he/she i www.direct.gov.uk/en/travelandtransport/ I was diagnosed with impaired glucose knows you have diabetes, I can’t publictransport/busandcoachtravel/dg_ tolerance two years ago but recently, 10036264 • See page 36 for more on diabetes see any reason why it would be after another blood test, my doctor and driving. unsuitable. Perhaps your dentist told me I have Type 2. For my previous could recommend a clinic to you? tests I had to fast (I didn’t this time) The gums are protected while and my results were around 9.4mmol/l. the lasers are used so no damage To speak to a trained counsellor, My latest result was 68mmol/mol – can be done to lead to injury call 0845 120 2960, I’m confused! or infection. Monday to Friday, 9am to 5pm. Tommy, Dumfries One thing to note is that laser careline@diabetes.org.uk Cathy says… whitening can make your teeth • See page 4 for more details. Diabetes can be diagnosed by very sensitive temporarily, which different blood tests: a fasting may restrict your food choices.

CARELINE

July – August 2012 balance 43 43 ATE Colour JC.indd 43

21/06/2012 15:02

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012 16:56

life&health

Spotlight on...

Bydureon What is it? Bydureon is an injectable prescription medicine that can improve blood glucose control for some adults with Type 2 diabetes. It was approved as a treatment option by the National Institute for Health and Clinical Excellence (NICE) in February 2012, and is the newest type of medication in the incretin mimetics family, joining Byetta (exenatide) and Victoza (liraglutide). Although taken by injection, this type of medication is not insulin. Incretin mimetics act like (mimic) the natural hormones (incretins) in the body that lower blood glucose. Bydureon is a long-acting form of Byetta and only has to be taken once a week, whereas Byetta has to be taken twice a day and Victoza once a day.

•

How do you take it?

Bydureon only has to be taken once a week

How does it work? Bydureon (like other incretin mimetics), helps to control blood glucose by: • stimulating the pancreas to produce more insulin in response to rising levels of glucose in the blood • reducing the amount of glucose being produced by the liver when it is not needed • reducing the rate at which the stomach digests food and empties, which in turn reduces the rate at which glucose from food is released into the blood • acting on the brain to cause a feeling of fullness, which reduces appetite and the amount of food eaten – this can result in weight loss.

Who is it suitable for? As Bydureon is not insulin, it can only be used for the treatment of people with Type 2 diabetes. There are restrictions on who it can be prescribed for, but you could be considered if you are unable to get your

as dual therapy if you are unable to take the combination of tablets as above.

If you are prescribed Bydureon, it should be administered once a week, on the same day. It comes in a kit containing a vial of powder and a liquid-filled syringe. The powder has to be mixed with the liquid in the syringe immediately before use – your healthcare professional should teach you how to prepare and inject Bydureon before you start to use it. Each dose should be given as a subcutaneous (just under the skin) injection in your tummy, thigh, or the back of your upper arm. Treatment with Bydureon can only be continued if, after six months of treatment, there is a drop of at least 11mmol/mol (approximately 1 percentage point) in your HbA1c.

Are there any side effects? HbA1c below 58mmol/mol (7.5 per cent) and have: • a body mass index (BMI) of 35kg/m2 or higher and specific psychological or medical problems associated with high body weight • a BMI below 35kg/m2, but where insulin therapy could cause problems with your work, or weight loss would help other existing health problems.

Is it taken in combination with other diabetes medications? Yes. Bydureon is not licensed as the first line of treatment, so you could only be prescribed it if your tablets are not sufficient to maintain your HbA1c target. Then it would be prescribed: • as triple therapy if you are already on metformin and a sulphonylurea, or metformin and pioglitazone

As with most medication, some people may experience side effects when taking Bydureon. The most common side effect reported is nausea at the start of treatment, which decreases over time.

Is it widely available? Bydureon can be prescribed for those who fit the criteria set by NICE. However, it belongs to a group of medicines that is relatively new and, like all new drugs, incretin mimetics are more expensive than others and this may prevent doctors being willing to prescribe Bydureon widely. i Have you started taking Bydureon? If so, please tell us how you’re getting on. Email balance@diabetes.org.uk or post on the ‘balance magazine’ Facebook group wall. • See www.diabetes.org.uk/overweight-criteria to work out your BMI. • Visit www.diabetes.org.uk/medication for more on Type 2 treatments.

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21/06/2012 15:03

basic care

happy A few years ago it would have been inconceivable that your phone could help you look after your health. But now, thanks to smartphone apps, it’s a reality Almost half of the UK population now owns a smartphone, and more and more people are downloading apps (software applications) to better manage various parts of their life, including their health. The Department of Health has recognised this, and GPs could soon be ‘prescribing’ apps to help people manage certain health conditions, including diabetes. While apps can’t replace the expert advice of your healthcare team, they can be excellent tools to help you self-manage your day-to-day health and get the motivation to keep up the good work. So, if you’ve joined the smartphone revolution, try out these 10 of the best:

WALKMETER GPS WALKING STOPWATCH £1.99 • iPhone, iPod Touch, iPad This useful pedometer app monitors your speed, steps taken and distance walked via GPS. It also counts your calories burned, taking into account the terrain. You can see your route on a map while walking, and the app can support other activities, such as cycling, running and skiing. It also enables you to use iCloud to load your fitness data on to an iPad for you to track your progress.

46 balance

Free • iPhone, iPod Touch, iPad Diabetes UK’s app can help you better manage your diabetes. You can store all your diabetes data – blood glucose, blood pressure and blood fats levels – in one place to view results across days and weeks; record your feelings; save specific records as ‘talking points’ for your next healthcare appointment; and share data with your diabetes healthcare team. Download it today!

NHS DRINK TRACKER Free • iPhone, iPod Touch, iPad, Android, Blackberry Confident that you don’t drink more than the recommended maximum units of alcohol per week? If you’re not, you might want to keep track of the alcohol units in your drinks with this app. It calculates the units for you – when you input what you drink – and tracks your alcohol intake over weeks and months; it also analyses your habits, supports you to cut down and gives you personalised tips.

NHS QUIT SMOKING Free • iPhone, iPod Touch, iPad If you want to quit smoking, this app will provide you with daily support and instant tips. It keeps track of how much money you are saving – to give you extra motivation – and shows how many days you’ve been smoke free. It also includes a direct link to the NHS Stop Smoking telephone helpline and provides links to local NHS Stop Smoking services.

July – August 2012

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Prices and information correct at the time of going to press

APP

DIABETES UK TRACKER

basic care

WELLNOTE Free • iPhone, iPod Touch, iPad Developed by leading surgeon Lord Darzi, this app helps you find high-quality local health services. You can view the Care Quality Commission ratings for all hospitals in England and get the latest medical news. You can also rate your overall experience of a service, store your medical information, keep an up-to-date list of your medication and set medication reminders.

CARBS & CALS LITE

Prices and information correct at the time of going to press

Free • iPhone, iPod Touch, iPad, Android This handy app helps you to count the carbohydrates, calories, protein and fat in your food and drink, so you can control your diet for managing diabetes, weight loss and healthy eating. It’s easy to use and uses a large database of photos of foods and drinks in different portion sizes – the number of carbohydrates and calories are clearly given beneath each serving size.

SLEEP CYCLE £0.69 • iPhone, iPod Touch, iPad Ever feel like you’ve not slept at all? It could be because the alarm clock goes off during a deep sleep phase. This app uses the accelerometer in your electronic device to monitor which phase of sleep you are in. It uses a 30-minute alarm window that ends at your set alarm time and wakes you in your lightest sleep phase (to mimic how you naturally wake up), so you feel rested and relaxed.

NHS DIRECT Free • iPhone, iPod Touch, iPad, Android This handy app gives you access to NHS healthcare advice and symptom checkers; it covers a wide range of problems such as diarrhoea and vomiting, rashes, back pain and burns. You can also receive advice about how to relieve symptoms associated with specific conditions, such as flu and hay fever, and more specialist advice on issues such as mental health and contraception.

NHS BMI CALCULATOR & TRACKER Free • iPhone, iPod Touch, iPad If you want to find out if you are a healthy weight for your height, you need to calculate your body mass index (BMI) – and this app will do it for you. You can also track your weight and BMI as it changes over time, get tips each time you enter a new weight, set goals and reminders, and access lots of handy weight-loss information.

MY FITNESS PAL Free • iPhone, iPad, Android, Blackberry, Windows Phone 7 This easy-to-use calorie counter can help you manage your weight. Set your daily calorie goal, then input what you eat throughout the day from a database of more than 1 million foods. The app will deduct the calories from your daily goal. You can also input your exercise and it will tell you how many calories you’ve burned and add these to your daily allowance – easy!

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recipes £1.37 per serving

Best of British greens

Freshly picked and full of ﬂavour and goodness, British greens are integral ingredients of a truly British summer. Make the most of this season’s bounty with these delicious dishes

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21/06/2012 17:41

recipes

Broad bean & lemon-dressed aubergine Serves 4 • vegetarian • gluten free • 2 portions of fruit & veg per serving

• • • • • • • • • •

2 aubergines, cut in half 2 tsp olive oil salt and pepper (optional*) 200g broad beans, podded (approx 400g unpodded) 1 lemon, zested and juiced 1 tsp tahini 2 tsp extra virgin olive oil 160g feta, crumbled 30g pine nuts, toasted small bunch of flat leaf parsley, chopped

1 2 3 4

Preheat the oven to 200°C/400°F/ gas mark 6. Score the aubergines with a sharp knife, brush them with olive oil and then season with salt and pepper. Place them on a baking tray and put in the oven for 20 minutes or until golden brown. While waiting for the aubergines to cook, bring a medium-sized pan of salted water to the boil, then cook the broad beans for 2 minutes. Drain and refresh under cold water, then squeeze the beans out of their shells and set aside. In a small bowl, mix together the lemon juice and zest, tahini and extra virgin olive oil, season with salt and pepper and add the broad beans. Once the aubergines are cooked, divide between 4 plates, sprinkle over the feta, pine nuts and parsley, then spoon over the broad bean dressing and serve.

Per serving (236g) 256Kcal – 12.2g protein – –

••

• •

– 7.4g

20g fat (

carbs ( 3.7g sugars) 6.8g saturates)

1.5g salt

*Salt for seasoning not included

in analysis.

£2.69 per serving

Broad bean & sun-dried tomato salad with griddled lamb Serves 4 • gluten free (if gluten-free mustard used) • 1 portion of fruit & veg per serving

• 600g broad beans, podded (approx 1,200g unpodded) • 2 tbsp lemon juice • 2 tsp Dijon mustard • 1 small clove garlic, crushed • 2 tsp olive oil, plus extra for cooking cutlets • 30g sun-dried tomatoes in oil, drained and chopped • 2 tbsp shredded mint leaves • 1 tbsp chopped flat-leaf parsley • 8 lamb cutlets • salt and freshly ground black pepper (optional*)

Bring a pan of water to the boil, add the broad beans and simmer for 4–5 minutes. Drain and rinse under cold water. Shell the beans and discard the skins. In a bowl, whisk together the lemon juice, mustard and garlic, then gradually whisk in the olive oil. Add the shelled

broad beans, sun-dried tomatoes and herbs. Stir gently to combine and season to taste. When ready to serve, heat a griddle pan until hot. Brush the lamb with olive oil and sprinkle with freshly ground black pepper. Cook the cutlets on the hot griddle for a few minutes each side, until cooked to your liking. Salt to taste. Allow to rest for a couple of minutes before serving. Serve 2 cutlets to each person, along with a generous helping of the broad bean salad.

Per serving (287g) 378Kcal – 37g

••

protein – 12.2g carbs – ( 20.5g fat – ( sugars) – 0.5g salt saturates) –

••

2.4g 7.1g

*Salt for seasoning not included in analysis. July – August 2012 balance 49

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recipes

Green bean, rice noodle & prawn salad Serves 4 • ½ portion of fruit & veg per serving For the dressing:

• juice of 2 limes • 1 tbsp Thai fish sauce • 1 medium red chilli, deseeded and finely sliced • 1 tsp finely grated fresh ginger • 1 tsp caster sugar For the salad:

• • • • • •

250g thin rice noodles (rice vermicelli) 1 tbsp toasted sesame oil 200g green beans 200g cooked peeled prawns 1 bunch spring onions, finely sliced a large handful fresh coriander leaves, roughly chopped • 2 tbsp salted peanuts, lightly crushed with a rolling pin

£1.43 per serving

British asparagus, red bream & new potatoes Serves 4 • gluten free • 1 portion of fruit & veg per serving

• • • • • • • • •

400g new potatoes, sliced into wedges 4 large circles of baking parchment 8 large sprigs fresh tarragon 4 fillets meaty white fish, such as red bream or hake 300g bunch British asparagus spears, cut in half 25g butter, cut into 4 cubes Sea salt & freshly ground black pepper (optional*) 180ml white vermouth Garlic mayonnaise (aioli) to serve (optional*)

1 2

Preheat the oven to 200°C/400°F/ gas mark 6. Put the potato wedges in a saucepan, cover with cold water and bring to the boil. Boil for 10 minutes, or until just tender then drain thoroughly. Lay out the circles of baking parchment and place a little pile of potatoes in the centre of each circle. Lay the tarragon sprigs on top, followed by the fish fillets and finally the asparagus.

3 4

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5 6

Add a cube of butter to each parcel, add salt to taste and freshly ground black pepper. Fold up the parchment circles into bags: start from one end and crimp the two sides together as if you are making a pasty until you get to nearly half way. Then do the same from the other end, leaving a small hole in the top. Carefully pour 3 tbsp white vermouth into the hole, then seal the bag. Repeat with the remaining bags, then place them on a baking sheet and bake for 15–20 minutes or until the asparagus is tender and the fish is cooked. Place each bag on a plate, and serve with a generous dollop of garlic mayonnaise.

Per serving (331g) 260Kcal – 2.2g protein –

• •

•

17.9g carbs ( 3.1g sugars) – 8.1g fat 0.4g salt. ( 3.7g saturates) –

•

*Salt for seasoning and mayonnaise not included in analysis.

£4.37 per serving

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recipes

1 2

Whisk all of the dressing ingredients together in a bowl. Set aside. Place the rice noodles into a large heatproof bowl and add boiling water. Cover with clingfilm and leave to soak until tender but still with a little bite (about 4 minutes). Drain and rinse under cold water to cool. Toss in the sesame oil to prevent them sticking together. Cook the green beans in salted boiling water until just tender (3–4 minutes). Drain and rinse under cold water. Slice each bean into 2–3cm pieces and add them to the noodles. Add the prawns, spring onions and coriander to the noodles. Pour over the dressing, toss well to mix and serve scattered with the peanuts.

£1.71 per serving

4 5

Per serving (196g) 366Kcal – 17.6g

• •

protein – 55g carbs ( 3.1g sugars) 7.6g fat ( 1.3g saturates) – 2.1g salt –

••

British green bean, pea, tomato & mozzarella salad with pitta bread Serves 4 • vegetarian • 1.5 portions of fruit & veg per serving

• 200g fresh peas, shelled and cooked • 200g fresh green beans, trimmed and cooked • 150g buffalo mozzarella, torn • 4 cherry tomatoes cut in half • 2 vine tomatoes, each cut into 6 • 4 tbsp extra virgin olive oil • 1 lemon, zested and juiced • Salt and black pepper (optional*) • Small handful of basil, torn • 2 grilled flatbreads

Place the peas, beans, torn mozzarella and tomatoes in a medium-sized bowl. Asparagus recipe provided by www. britishasparagus.co.uk. Other recipes provided by www.tastesofsummer.co.uk

Mix together in a small bowl the olive oil, lemon zest and juice, pour over the salad and toss gently, then season to taste. Spoon the salad onto a large dish, sprinkle with basil and serve with grilled pitta bread.

Per serving (318.5g) 454Kcal – 18.8g

• •

protein – 50.7g carbs ( 6.4g sugars) 20.9g fat ( 7.2g saturates) – 1.2g salt –

••

*Salt and pepper not included in analysis.

Traffic light symbols:

• • high

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low.

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bite-sized

In season July Courgettes and aubergines are perfect veggie accompaniments to barbecued meat and fish, along with crunchy fennel, in season now. Simply cut into strips, drizzle with olive oil and griddle – or marinate chunks in oil, lemon juice, crushed garlic and fresh herbs to make veggie kebabs. Peaches sit happily alongside other summer fruits, such as cherries, or in salads with soft cheeses and cold meats.

GIVE PEAS (AND BEANS) A CHANCE…

This

Peas and beans may not be the first ingredients to spring to mind at dinner time but, naturally low in fat and sodium, they are a great choice for promoting a healthy heart. Plus, they are naturally low in calories, so filling up on beans and peas is a great way to eat healthily. Taking a closer look at what they can add to your diet in terms of nutrition, and the delicious recipes on page 48, may encourage you to serve up these oft-overlooked veggies more often: • Folic acid helps to form healthy red blood cells and is found in runner, green and broad beans, as well as peas. Just one portion (80g) of cooked green beans provides 20 per cent of the Recommended Daily Allowance (RDA) of folic acid. • Vitamin C is known to play a vital role in the body’s natural healing process and give the immune system a boost. It is found in runner, green and broad beans, as well as peas. Just one portion (80g) of cooked peas provides more than 30 per cent of the RDA. • Broad beans are a good source of Niacin (Vitamin B3) and peas have a high content of Vitamin B1 (Thiamin) – both thought to promote a healthy nervous system. i See page 48 for some great recipes with these delicious veggies.

Gourmet on the go

August Grate beetroot over salad leaves, or boil, cut into quarters and top with feta, a sprinkling of fresh thyme and spoonfuls of olive oil and wine vinegar dressing. Sweetcorn is perfect for a barbie, as are peppers teamed up with halloumi on skewers.

Sweet Eve & pistachio fruit salad

Recipe kindly provided by www.sweetevestrawberry.co.uk

Serves 4 • 2 portions of fruit & veg per serving • Gluten free

Hull and finely slice 200g of Sweet Eve strawberries. Toast 150g shelled pistachios till slightly browned, then chop finely. Thinly slice 2 ripe peeled mangoes and 2 ripe peaches. Divide all fruit between 4 serving bowls and add a dash of Marsala, sherry or rosewater. Top with pistachios and garnish with fresh mint. 21g fat ( 2.9g sats) / trace salt Per serving (230g) 314Kcal / 8.2g protein / 21g carbs ( 19.3g sugars) /

•

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•

£1.98 per serving

•

July – August 2012

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bite-sized

Nature’s way

Wood pigeons are on the increase and are to be found in the majority of gardens these days. They strip leaves from brassicas and steal freshly sown seeds. There are many bird-scaring devices, including lifelike scarecrows on the market, though since pigeons are so persistent, the best solution is to protect your most vulnerable veggies with a fairly fine mesh net.

Gardening columnist Stephen Rayner has some chemical-free pest solutions In my experience, squirrels love to dig up and eat pea and sweetcorn seeds and they adore ripe sweetcorn cobs. Regrettably, the problem is almost impossible to solve – bird netting won’t work because they can gnaw their way through almost anything made from plastic. A reliable, though expensive, solution is to build a veggie cage, though this must be clad with wire netting, which must also continue about 15cm below the soil level. Another rather sad solution is to stop growing the crops that these pests love most.

If you’d like to deter slugs and snails, rather than kill them with organic slug pellets, I find some old methods work better than the products that claim to do this. Try surrounding vulnerable plants with lime or soot, though both of these have to be replaced after rain. My own favourite, because it looks good and lasts a fair time, is a mulch of ornamental pine bark, bags of which are available in most garden centres.

• Got a gardening query? Send to: Grow your own, balance, 10 Parkway, London NW1 7AA or balance@diabetes.org.uk.

}

SWAP Scotch ’N’SAVE egg 98Kcal & 3 veggie bite-size (113g) 9.9g fat Scotch eggs (60g) (287Kcal, (189Kcal, 8.7g fat) 18.6g fat)

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Opening ceremo

travel

IN THE FOOTSTEPS OF THE INCAS

Fresh from hiking South America’s most famous trek, mum-of-three Angie Mason, 57, explains why the high-altitude Inca Trail is worth all the hype – and the odd hypo

Angie (right) and Helen at Machu Picchu

spent two years backpacking around the world in my midtwenties and loved the freedom of hopping from one place to another and experiencing so many different cultures. But I couldn’t stay ‘on the road’ forever, so I went home, got married, raised three daughters and began a career teaching young adults with learning difficulties after my divorce in 2000. Now my eldest daughter, 27-year-old Helen, has the ‘travel bug’. She headed off to South America last year, and when she suggested I join her to tackle the 30-mile (45km) Inca Trail in Peru (see box, overleaf), I couldn’t say no. I booked my flights and then

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considered my diabetes. The wrong order, perhaps!

Dealing with diabetes I was diagnosed with Type 1 diabetes aged 33. I contracted meningitis when I was 30 weeks pregnant with my third child and I believe that this brought it on. I spent two weeks in hospital being treated and Lucy was born a month early – thankfully with no ill effects. My diabetes seemed to disappear after the birth, but it returned two years later – by which time my three-year-old, Sarah, had also developed Type 1. My blood sugar levels were never very good, however hard I tried, so

five years ago I started using an Animas insulin pump, which has improved my overall control. I wasn’t sure how my pump would cope during the high-altitude trek, so I contacted Animas and was told that it shouldn’t be used above 3,000m (9,842ft) – the Inca Trail reaches 4,200m (13,779ft)! The thought of going back to injections filled me with horror so I sought advice from a pump user who had experienced high altitude. She reassured me that my pump would work but advised taking a spare and some insulin pens, just in case, so that’s what I did. I was already reasonably fit, but for two months I did extra dancing and Pilates classes, treadmill sessions and regular 10-mile (16km) hikes to improve my stamina. My GP had to confirm that I was up to a gruelling hike at high altitude, on request of the tour operator, but that wasn’t a problem. Exercise is good for people with diabetes but it can make controlling blood sugar levels hard. I was worried to learn that extremely high blood sugar can be caused by high altitude. On the other hand, I’d also be at greater risk of hypoglycaemia (low blood sugar) due to all the exercise, so I packed lots of high-energy snacks, GlucoGel and fast-acting jelly babies. I also took out the best insurance I could find, and packed spares of everything in my diabetes kit.

The adventure begins I joined Helen in Lima, the capital of Peru, and we travelled to Cusco, a city set at 3,400m (11,155ft) in the Andes Mountains, to meet up with the rest of our Inca Trail group. I was twice the age of everyone else so they called me ‘Mum’ and made me feel very special. We spent two days in Cusco to acclimatise to the high altitude, before travelling through the Sacred Valley to the start of the trail. Our group of 16 had two guides and 21 porters to carry everything from tents, cooking equipment and

July – August 2012 22/06/2012 13:13

Opening ceremony for the Donbass Arena, Donetsk

travel

Angie and Helen (centre) with the adventurous Inca Trail group food, to 6kg duffle bags for our dry clothes and sleeping bags. My full medical kit took my bag well over my 6kg limit so a young Australian added it to his paltry effects – I kept my blood testing kit in my day bag. The first day’s hike of 11km (6.8 miles) was to be the easiest. The sun shone as we followed a

slow right down. By concentrating on breathing and taking my time, I succeeded and my blood sugar levels remained surprisingly normal. Our first camp was known as ‘The Point of No Return’, where anyone unable to continue could go back by horse. Beyond this point evacuation would be by helicopter or piggyback! Red two-man tents were pitched on a terrace with a spectacular view of the mountains, and, as the temperature fell, we donned hats and coats to eat dinner, before retiring to thick sleeping bags.

Tough challenge We were woken in the dark at 4.30am with mugs of coca tea to start the hardest day. The early start gave us time to complete the 11km (6.8 mile) route from 3,000m (9,842ft) to 4,200m (13,780ft) and back down to 3,600m

As I recovered and saw the stunning view of the ancient city at dawn, I was elated to have made it river past small dusty fields being ploughed by oxen. Our porters had set up camp and cooked our lunch in one tent while another was set up for dining. When we arrived we were given drinks and a three-course meal of soup, chicken, rice, vegetables and fruit – a balanced meal to fortify us for the climb ahead. After cups of coca leaf tea – a local cure for altitude sickness – we relaxed before starting the afternoon hike. An advantage of the pump is being able to switch it off when exercising. I suspended my pump for as long as I was hiking and by checking my blood sugar every hour and eating regular snacks, I maintained good blood sugar levels. But I wondered if I had been rather ambitious to think I could complete the Inca Trail with such a young, fit group. That afternoon, chatting stopped as the trail climbed steeply and altitude began to affect us. I tried to keep up but got a tight feeling in my chest, so our guide told me to

(11,811ft). Horribly uneven stone steps went up and down through twisted forest and into clouds as we climbed above the tree line. Our porters, who had packed up camp after we left, overtook us with their enormous packs, heading for our next camp. Anyone can be affected by altitude and our guide carried oxygen for emergencies. I was not physically ill but had to go slowly – towards the summit, called ‘Dead Woman’s Pass’, I was climbing just 20 steps before each rest and was was elated to finally reach the top after a seven-hour climb. We then started the two-hour descent to our campsite in thick cloud and, as the rough steps were also a main route for water running off the mountain, it was as hard as going up – even with walking poles. A stop for coca and popcorn on the way helped! Our second camp was pitched on terraces at 3,600m (11,811ft) and was overlooked by snow-capped

mountains. We were impressed by the hot balanced meals provided from our chef’s tent, which helped to maintain my blood sugars. Our porters washed up in gushing mountain water, and everyone was wearing thermals and tucked up in sleeping bags by 8pm.

Onwards & upwards We left camp at 6am, after a breakfast of scrambled eggs, to start the longest day’s nine-hour 16km (10 mile) trek. The climb to Runkurakay Incan settlement at 3,800m (12,467ft) was celebrated with a group hug before we started the 30,000-step descent known as the ‘Gringo Killer’, which made my knees ache, my legs shake and my arms strain as I used my poles for support. After a welcome hot lunch, our chef produced a cake with piped icing saying ‘Welcome to the Inca Trail’. How did they do it in a tent? We climbed endless steps that afternoon, past ruins dedicated to the sun and moon, before arriving at our third camp. We were asleep by 8pm to be ready for the final day. Thankfully, my diabetes was fine. With my pump suspended while hiking I was hardly using any insulin, and although I had a small bolus dose at popcorn- and dinner-time, I reduced my basal rates overnight to prevent delayed hypos from the exertion.

The final ascent Porters pulled down our tents at 3.30am as we had breakfast, and we

Compliments to the chefs... How did they produce that in a tent?

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22/06/2012 13:13

travel raced to the checkpoint to start the final trail to Machu Picchu at 5am. We hiked at speed in the dark for 5km (3 miles) until the trail ascended steeply. I stopped to check my blood sugar. It was 4mmol/l and I was starting to feel hypo so drank some orange juice and ate a cereal bar. I knew I should have stopped to recover but everyone was in a hurry to reach Machu Picchu so I was swept along. It was in a rather disorientated state that I was faced with what I can only describe as a stone ladder. My group helped me up but the final haul to the Star Gate, the entrance to Machu Picchu, was a blur. I felt tearful, as I often do when hypo, but as I recovered and saw the stunning view of the ancient city at dawn, I was elated to have made it.

It took another hour to climb down to the spectacular ruins of Machu Picchu, where we spent several hours exploring. We then caught a bus and a train back to Cusco, where we celebrated the great achievement before going our separate ways. I had expected some hypos or high-altitude-induced hypers (high blood sugar) so was delighted with the even control I had maintained throughout the trip – and that my pump survived. Walking the Inca Trail is a lifetime achievement that I shall treasure. If you fancy taking on the challenge, go for it! However, it is hard, and expect to wear the same clothes and not wash for days. Now I’m on the lookout for my next adventure – any ideas?

THE INCA TRAIL The Inca Empire (or Tawantinsuyu Empire) was once the largest empire in South America. In the 15th century, the Incas built a huge system of trails, stretching over 23,000km and across the Andes, from Ecuador, through Peru, Bolivia and down into Chile and Argentina. It was built to transport goods, soldiers and communications. The most famous, and best preserved, section is the trail to the magnificent ruins of Machu Picchu, which takes in a variety of breathtaking landscapes and ruins along the way. You can only walk the trail with an organised group and must have a permit (this is to limit the number of tourists to protect the trail). The trail is closed during February for cleaning and maintenance, and you must book your place on a tour a few months in advance because places fill up fast!

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21/06/2012 19:31

You’ll find a wide range of kitbags, cases and cool pouches for your everyday and travel needs at the Diabetes UK shop, including FRIO cool pouches to protect your insulin while you travel, The Diet Plate weight management system, the Timesulin cap, as well as Diabetes UK-branded goods. We are sure you’ll find something for yourself or a gift for your family and friends, and you’ll have the added satisfaction that all profits support the work of Diabetes UK.

THE DIET PLATE Created by Kay Illingworth, The Diet Plate lets you eat all of your favourite recipes but in a calorie-controlled portion size so you can lose weight steadily and easily. The Diet Plate Earthenware Range: • Female plate and bowl set £39.98+p&p (code 6033b) • Male plate and bowl set £39.98+p&p (code 6034b) DIABETES UK SILICON WRISTBAND In blue with Diabetes UK logo. Order your wristband (one size) today and help raise awareness of diabetes and Diabetes UK. £1+p&p (code 4351)

HOW YOUR MONEY HELPS

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Provides vital materials and information for the newly diagnosed and people living with diabetes. Funds awareness campaigns – aiming to identify the estimated 850,000 people unaware that they have Type 2 diabetes.

Could help to fund research into ways of preventing diabetes-related complications, eg heart attack, stroke, blindness and amputation.

Shopping with Diabetes UK helps us care for, connect with and campaign on behalf of all people affected by and at risk of diabetes.

READY STEADY

SHOP! FRIO DUO PEN COOLING WALLET (IN BLUE) This handy wallet holds: • two insulin pens (either pre-filled disposable pens or refillable pens), or • one insulin pen and two 3ml cartridges, or one insulin pen and three 1.5ml cartridges, or • two 10ml vials of insulin Inner wallet dimensions: 80mm x 178mm (3.2in x 7in approx) £17.30+p&p (code 4373a)

MEDICOOL PROTECT ALL COOL BAG Travelling has never been easier thanks to this insulin cooler. Simply refrigerate or place in a cold bucket of ice for a couple of hours prior to use. The cool bag will keep your insulin safely cool for up to 12 hours. It accommodates two bottles of insulin, or a pen system and two spare pen bottles. For day trips it can hold one or two pre-filled syringes. £43.82+p&p (code 4389)

Order these and other Diabetes UK items at www.diabetes.org.uk/shop or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote B156 when placing your order. (Postage is charged on some items.)

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Coasting along Britain’s best

Pembrokeshire Coast Path

Kinloch Hourn to Barrisdale Bay

ROUTE 300km/186 miles OVERVIEW Wales’ only coastal National Trail boasts some of Britain’s most spectacular walking. From its meeting with the Ceredigion Coast Path, to Amroth on the county’s south-east boundary, expect rugged cliffs, sweeping beaches, picturesque ports, Iron Age forts and medieval castles, with 10,700m/35,000ft of cumulative ascent and descent. BEST BIT Beyond Trefin, the scenery is increasingly dramatic and remote, as steep heather-strewn slopes and flower-strewn headlands carry you north towards Pwll Derri youth hostel, perched above some of the trail’s most spectacular cliffs with great views of Strumble Head lighthouse. LOOK OUT FOR Neolithic, Iron Age, Norman and Napoleonic structures, as well as sites established by early seafaring Celtic saints. This really is a walk through Welsh history. i http://nt.pcnpa.org.uk

ROUTE 12km/7.5 miles OVERVIEW The ‘rough bounds’ of Scotland’s Knoydart peninsula are known as Britain’s last wilderness: a mountainous, ruggedly beautiful place that’s accessible only by boat or on foot. The trail from Kinloch Hourn is tough in places, with plenty of up-and-down. Beautiful Barrisdale is a great base from which to bag the county’s remote Munros (hills above 914m/3,000ft high): Ladhar Beinn (1,020m/3,325ft), Meall Buidhe (946m/3,084ft) and Luinne Bheinn (939m/3061ft). There’s camping (£1) and an estate-run basic shelter (£3) with cold water and toilets. BEST BIT Once you’re out of sight of the car park, there’s nothing between you and Barrisdale Bay other than 11km/7 miles of some of the finest, unspoiled natural beauty to be found along Scotland’s stunning west coast. LOOK OUT FOR Red deer, otters and golden eagles. You can also peer into the clear waters of fjord-like Loch Hourn to spot sea anemones and starfish. i www.knoydart-foundation.com

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July – August 2012

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Photo: Kate Flagg Photography

Much of Britain’s coastline remains wild and untamed, oﬀering some beautiful and demanding walking trails. John Manning picks ﬁve of the best coastal routes that will get your blood pumping and the sea breeze on your face this summer

South West Coast Path

Photo: Kate Flagg Photography

ROUTE 1,014km/630 miles OVERVIEW Britain’s longest National Trail is regarded as one of the world’s premier coastal routes. If you thought seaside walking was easy, however, think again: the South West Coast Path involves more than 35,000m/115,000ft of ascent. Expect long days and short mileages! BEST BIT The 95-mile Jurassic Coast between Exmouth and Swanage has been designated a World Heritage Site due to its outstanding 185 million years of geological wonders. Here you’ll find such stunning formations as the natural arch of Durdle Dor (pictured), and towns such as Lyme Regis, famous for the fossils found on its beaches and cliffs. LOOK OUT FOR The abandoned mines, engine houses and harbours of West Devon and Cornwall’s 18th- and 19th-century tin industry, which were designated part of a World Heritage Site in 2006. i www.southwestcoastpath.com

Northumberland Coastal Path

Anglesey Coast Path

ROUTE 103km/64 miles OVERVIEW Some of England’s most beautiful beaches are also some of its least crowded, leaving you to explore this gentle, scenic trail in an atmosphere of peace. Other routes – including St Oswald’s, St Cuthbert’s and the Reivers’ Ways and the North Sea Trail – share this coast and are testimony to its popularity. BEST BIT The approach to Dunstanburgh Castle’s ruins from cosy Craster (famed for its kippers) is matched on the English coast only by that to Bamburgh Castle, a few miles further north. LOOK OUT FOR Stunning beaches. Bring your bucket and spade – Northumberland’s beaches have few rivals when it comes to open space, golden sands and cleanliness. Boat trips to the Farne Islands, where St Cuthbert established a bird sanctuary in the 7th century, are very rewarding. i www.northumberland-coast.co.uk

ROUTE 203km/125 miles OVERVIEW The variety of terrain on offer includes dramatic cliff tops, low-level paths, and a trip up Holyhead Mountain (220m/717ft). Much of the Isle of Anglesey is designated an Area of Outstanding Natural Beauty and the National Trust cares for more than 48km/30 miles of Heritage Coast. BEST BIT The 27km/17 miles between Bull Bay and Church Bay, on the island’s north-west corner, contain the trail’s highlights: from the cliffs around Carmel Head that look out to the rocky Skerries, to hidden coves and bays, and rock fissures in which the sea crashes angrily. LOOK OUT FOR Anglesey’s rich seabird population, which includes razorbills, guillemots and puffins; the RSPB visitor centre near South Stack Lighthouse is well worth a visit. i www.islandofchoice.com

i Why not walk to raise funds for Diabetes UK? Find a local ‘Walk for Diabetes’ at www.diabetes.org.uk/walk-for-diabetes. • See page 64 to win Britain’s Best Coastal Walks. • A version of this article was first published in Walk, the magazine of the Ramblers.

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fundraising focus JUMPING FOR DAISY Emma Dinning (pictured) has so far raised more than £1,000 for Diabetes UK by taking the plunge in a sponsored 10,000ft (3,048m) tandem skydive. Emma took on the challenge in aid of Diabetes UK because her 8-year-old daughter, Daisy, was diagnosed with Type 1 two years ago. i Sponsor Emma at www.justgiving. com/Emma-Dinning • See box, right, if you want to skydive in aid of Diabetes UK.

Head for heights Schoolgirl Asanti Reynolds (pictured) from Hemel Hempstead climbed Mount Snowdon on 12 April in memory of her grandfather, who lived with Type 2 diabetes and passed away last year. The 11 year old completed the challenge in three hours and has so far raised £675 for Diabetes UK. Although she hadn’t attempted anything quite like this before, Asanti’s mother, Angela, who also made the climb, was confident that her daughter could make it to the summit. Asanti said of her hike: “The view was terrifying at the start, but I didn’t feel very scared. When I got to the top I thought, ‘I’m sure my granddad is proud of me’.”

In memory More than £2,000 was raised for Diabetes UK Cymru in March at a charity rugby match held at Christ College, Brecon, in memory of former pupil Chris Hughes. Chris had Type 1 diabetes and sadly died in a car accident four years ago, aged 16. The match is to become an annual event.

A unique proposal Taunton runner Kieran Neale ran three half marathons for Diabetes UK during March and April, and celebrated crossing the final finishing line by getting down on one knee and proposing to his girlfriend of three years, Tracey Trevelyan. The happy couple Happily, Tracey said ‘Yes’! Kieran was inspired to run the Bath, Yeovil and Taunton half marathons for Diabetes UK after seeing his sister Emma’s struggle with Type 1 diabetes – she was diagnosed aged two. i Money can still be donated at www.justgiving.com/Kieran-Neale3.

Alan and Geoff in Prague at the start of the race

Eastern bloc bikers Brighton biker Alan Buttler, 37, has completed an historic East European cycling route from Prague to Warsaw in memory of his father, Alf Buttler, the former British cycling team mechanic and manager who had Type 2 and died of diabetes-related complications four years ago. Alan wished to pay tribute to his father’s first involvement in the Peace Race in 1955 (it was set up in 1948 to improve relations between Poland and Czechoslovakia), and to raise money for Diabetes UK. Riding alongside Alan was Geoff Wiles, 67, from East Peckham, Kent, an original member of the 1960s Peace Race team, who said: “It was truly a privilege to be paying tribute to such a fabulous man. Alf was not only my cycling manager but also a dear friend.” Alan and Geoff covered a gruelling 1,500 miles (2,414km) over 12 days, and the pair have raised more than £3,000 thanks to their incredible achievement. i Sponsor Alan and Geoff at www.justgiving.com/peacerace.

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Berlin

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.

ON A DATE TO SUIT YOU SKYDIVE Take the plunge with a sponsored skydive to raise funds for Diabetes UK. Jump for free if you raise the target amount. Choose from 20 venues across the UK. i Contact Lynsey Thompson on 020 7424 1000 • www.diabetes.org.uk/ fundraise

GO, MATTHEW!

On the run Eight-year-old Jack Wilson (above with his mum), took part in this year’s Grand East Anglia Run (GEAR) to raise vital funds for Diabetes UK as both his parents live with the condition. Jack completed the 1.2 mile (1.9km) Mini GEAR Fun Run on Sunday 6 May in just nine minutes. His mum, Fiona, who was diagnosed with Type 1 diabetes in 1991, said: “We are all very proud of Jack. He took it upon himself to raise money for Diabetes UK, which is pretty impressive for an 8 year old.”

Diabetes UK’s Swim22 challenge is well under way and more than 300 people have registered to complete 22 miles (35km), the distance across the English Channel, in their local pools. The youngest swimmer in Junior22 is 3-year-old Matthew Ross (pictured), who will be completing 22 lengths of a little pool with a woggle to raise funds for Diabetes UK, while his mum, Clare, takes on the full 22 miles. Matthew says the thing he loves most about swimming is ‘jumping in and making big splashes!’ Mum and son have taken on the challenge as Matthew’s grandma has diabetes – balance wishes them and everyone else taking part the best of luck!

10–14 JULY CAMRA Beer Festival, Admirals Park, Chelmsford Diabetes UK is one of CAMRA’s chosen charities of the year. Join the Family Fun Day on Saturday 14 July and support Diabetes UK. i 01376 501390 • www.diabetes.org.uk/camra

HAMMERING IT HOME Hardworking cyclists have raised more than £3,000 for Diabetes UK after taking part in an 81 mile (130km)-long event in south Devon. Around 330 cyclists entered The Hammer, a cycling endurance event through the South Hams countryside, in April. A quarter of the entry fees from the event, organised by Cycle Sport South Hams, were donated to Diabetes UK, and some participants also fundraised for the charity. Zoë Steer, Diabetes UK South West Fundraising Manager, said: “It was brilliant and we are grateful to have been chosen as The Hammer’s charity.”

}

£250,000

}

is expected to be raised by this year’s 170 Virgin London Marathon runners. Thanks also to the supporters for cheering them along.

Inspired to take part in 2013? Email events.fundraising@diabetes.org.uk or call 020 7424 1000.

WORKING PARTY A-level business students at Great Marlow School, Buckinghamshire, held a Chinese New Year-themed party earlier in the year, raising £558 for Diabetes UK. As part of their coursework to organise an event, the pupils hosted a celebration for the whole family to enjoy with a Chinese-style buffet, martial arts display, DJ, raffle and quiz. They chose to support Diabetes UK in recognition of their friends with Type 1 diabetes.

DIARY

The pupils present their cheque to Diabetes UK volunteer Charlotte Massey

15 JULY Bike It! Forest of Dean Cycle through beautiful scenery and raise funds for Diabetes UK. i www.diabetes.org.uk/bikeitfod 19 AUGUST Walk for All, Yorkshire Dales The second Yorkshire Walking Festival offers walks to suit all. i 01325 488 606 • www.diabetes.org.uk/ walkforall 30 AUG–2 SEPT 3-Day 3-Peaks challenge Climb Ben Nevis, Scafell Pike and Snowdon, the highest mountains in Scotland, England and Wales. i www.diabetes.org.uk/ 3-day-3-peaks 7–10 SEPTEMBER London to Paris bike ride i Contact Hannah Minnery on 020 7424 1000. • www.diabetes.org.uk/ londontoparis

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

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fun&games

Win

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

balance address (see page 3) marked ‘Crossword’. The first three correct entries drawn after 31 July will win a Morphy Richards Hand Blender Work Centre (see right), worth £69.99. Congratulations to last issue’s winner, David Chacksfield from Reading. 1

9 10 11 13

19 20

Name Address Postcode

HEADINGTO THECOAST?

...You might be tempted to if you get your hands on one of five copies of Britain’s Best Coastal Walks that balance is giving away. To enter: send your name and address on a sealed envelope or postcard to: ‘balance book giveaway’, Diabetes UK, 10 Parkway, London NW1 7AA by 31 July.

64 balance

blending and processing. It has an array of accessories – including blending, chopping, shredding and slicing blades – to cater for all your food preparation needs. And if you’re not lucky enough to win one, Morphy Richards is giving balance readers a 30 per cent discount on the Hand Blender Work Centre (was £69.99, now £48.99). Use discount code DU1730 at www.morphyrichards.co.uk.

www.morphyrichards.co.uk

This high-quality hand blender

Morphy and processor has a powerful Richards Hand Blender 700W motor and 1.5L processor Work Centre bowl to take all the effort out of

ACROSS 1 Coterie (6) 4 Hostilities (6) 9 Drunken revelry (9) 10 Style imitative of recent past (5) 11 Catchy part of song (4) 12 Justification (5) 14 Spectrum (5) 15 Twentieth of ream (5) 17 Biological subdivision (5) 19 Cougar (4) 21 Ring-shaped bread roll (5) 23 Trickery (9) 24 Milne’s gloomy donkey (6) 25 Modest (6)

SOLUTION to May/June 2012 ACROSS 1 Respite, 5 Sauce, 8 Tonic, 9 Dinar, 10 Haifa, 14 Neutral, 16 Strut, 17 Heart, 18 Natural, 22 Rosin, 25 Coypu, 26 Ethic, 27 Sheep, 28 Retreat. DOWN 1 Rattan, 2 Sine, 3 Inch, 4 Edwin Landseer, 5 Soda, 6 Ulna, 7 Ecru, 11 Store, 12 Stout, 13 Pupa, 15 Ewer, 19 Lancet, 20 Acts, 21 Byte, 22 Rump, 23 Neat, 24 Ghee.

LINKLETTER

GA LA

TE NT

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:

DE NO

IL RY

DO PO

GE SH

MO KI

EL CH

MO TR

PE TA A BALANCED LIFE John Byrne

DOWN 1 Priest (6) 2 Diatribe (4) 3 Puccini opera (2,6) 5 Dart player’s line (4) 6 Composer, Britten (8) 7 Bent (6) 8 Blood of the gods (5) 13 Apparent omnipresence (8) 14 Unit of information (computing) (8) 15 Egg tart, flan (6) 16 Sweet bourbon drink, mint (5) 18 Comfort (6) 20 Den (4) 22 Spiritual teacher (4)

LE ER

Last issue’s solution: ELECTORATE

July – August 2012

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Wordworkout 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. 25 = Average; 30 = Good; 35+ = Excellent. Last issue’s nine-letter word: CHAMELEON

R R U E B N H A T ER FF O

UP TO 35 PER CENT OFF A WEEKEND BREAK

Fancy a weekend getaway that doesn’t break the bank? Thanks to a great deal from InterContinental Hotels Group, you can enjoy up to 35 per cent off a UK weekend at more than 220 participating Crowne Plaza, Holiday Inn and Holiday Inn Express hotels. The offer runs till 31 August 2012, so plan your escape now. For full terms and conditions, and to take advantage of this and other great offers, visit www.ihg.com/members or call 0871 423 4874 and quote ‘Exclusive’.

SUDOKU

3 8

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

1 9

Last issue’s solution

8 4 1 9 3 2 5 7 6

2 3 7 6 5 1 9 4 8

9 6 5 4 7 8 1 3 2

5 2 3 8 1 4 6 9 7

6 1 8 7 9 3 2 5 4

4 7 9 5 2 6 8 1 3

3 8 6 1 4 9 7 2 5

7 9 2 3 8 5 4 6 1

1 5 4 2 6 7 3 8

Porcine and Bovine insulins are still available. Speak to your diabetes healthcare professional now to find out more.

3 2 6 5 8 2

8 1

5 1 4 6

2 9 4 3 8 7 5 9 8

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

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different types

ARTHUR SMITH

MARI WILSON

All in a day’s work

erforming can sometimes have an adverse effect on my blood sugar levels. I asked my consultant about this years ago and he told me that it’s due to the adrenalin rushing around my body beforehand, which causes my liver to produce extra glucose. There can be times when I’m preparing to go on stage when I feel the butterflies in my tummy and my heart racing. I always do a blood test before a performance and often it can be a little high. In the past I would give myself some more insulin, but it doesn’t really make any difference in the short term. Instead it causes low blood sugar a couple of hours after the performance, when the adrenalin subsides. So I’ve learned to just go with it, knowing that it will settle down after the show. Funny though, it doesn’t happen at every gig; in fact, there doesn’t seem to be any kind of pattern as to why some nights I’m more nervous than others. I’ve only ever had low blood sugars during a show once or twice, which means I must have been far too relaxed! Both times I popped off stage for my Lucozade or jelly babies while the band kept going. I came back and told the audience what had happened, to explain why I was talking more nonsense than usual. I was recently at the House of Commons for an event during Coeliac Awareness Week (14–20 May) and Dr Chris Steele, Coeliac UK’s Health Ambassador (you may know him from ITV’s This Morning) gave a talk. Like me, he has coeliac disease and recommends that anyone with the condition should have their children checked for it with a simple blood test. I have a 15-year-old daughter so I’ll take her to get that done. Last week I had my annual eye test – isn’t it the weirdest thing when they put those drops in your eyes to dilate the pupils? You look so spaced-out. That night I had the school play and everyone was looking at me in a strange way because I must have appeared to have taken some kind of class-A drug – of course, there was no point trying to explain, that would have raised even more suspicion. It’s so sad that we have lost Robin Gibb of the Bee Gees – they were such a huge inspiration to me from the age of 11, when I bought their first album Spicks and Specks. I remember wandering around Carnaby Street in London with my friend Mandy hoping to spot them. Unfortunately, we never did see them, but the group Dave Dee, Dozy, Beaky, Mick and Tich did make an appearance; ah well, you can’t have everything – where would you put it? i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 and coeliac disease. Her new album, Cover Stories, is out now; www.mariwilson.co.uk.

Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne

s a self-employed entertainer, writer and lion tamer, one day in my working life is rarely like the next; I may be travelling to a show, sitting in a café writing (like now), slouching around the studios of Broadcasting House, standing on stage in front of several hundred people or lying on the sofa watching daytime TV and feeling guilty. This lack of routine, allied with a natural lack of organisational ability, means that I am not always on top of my diabetic regime. I recently presented a short piece for the BBC’s The One Show, examining claims that William Shakespeare had spent time in and around Titchfield in Hampshire (I was persuaded that he did). Towards the end of an eight-hour day, as I was interviewing a local chap about Shakespeare’s putative time as a schoolmaster, I began to feel very tired and rather hot. “...So this probably was the old school.” The interviewee looked at me. It was my turn to ask another question. None came. The cameraman, sound operator and director were also looking at me. So were the man’s wife and his two friends who were grouped behind the camera. “So, er, tell me…” I couldn’t seem to concentrate and now felt distinctly woozy, “…er, what is the evidence…?” Then my thoughts went roughly like this – “Ah, I’m having a hypo, am I? Hmm, I had lunch, didn’t I? Now, what am I meant to be doing? I’ll just finish this – don’t want to look silly or be unprofessional here – now, where was I? Gosh, it’s warm, isn’t it?” Now I was experiencing double vision but I stumbled on for a few more seconds before I said, “I need something sweet,” and sat down. I felt embarrassed as the director produced a large bar of chocolate. As I bolted it down I thought, “What will they think of me? I am an idiot.” I guess most of us with diabetes have occasionally had to stop unexpectedly in the middle of working in order to ‘refuel’, and have sometimes felt foolish and incompetent in front of colleagues. Really, there is no need, especially if you are honest with people. The director knew I was diabetic and was entirely sympathetic, as well as prepared for such a scenario. The cameraman and sound guys were chuffed to have a short pause, while my interviewee was delighted because, as it turned out, he too had diabetes. As my blood sugar returned to a reasonable level we all had a good laugh about it. Ten minutes later we resumed the interview, which, now we had bonded over our shared condition, went even better than if my hypo had never happened. Turned out nice again. i Arthur Smith is a comedian, writer and broadcaster with Type 2.

Butterflies & a racing heart

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1897 - A

FreeStyle InsuLinx helps you to determine your mealtime insulin dose... If you take rapid-acting insulin the FreeStyle InsuLinx system could help make your day a little simpler. Test your blood glucose with FreeStyle InsuLinx then, using your reading along with information specific to your personal situation, the system will automatically calculate an insulin dosing suggestion for you. So you can get on with your meal.

...so you can get on with your day Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne

Ask your diabetes doctor or nurse if FreeStyle InsuLinx could help you, or for further information please visit

www.abbottdiabetescare.co.uk

Not real patient, photos for illustrative purposes only. FreeStyle and related brand marks are trademarks of Abbott Diabetes Care Inc. in various jurisdictions. ÂŠ 2012 Abbott. ADCMDP120209 66-68 A n M_Colour.indd 67 1897 - ADC FSI Advert_212x267_UK.indd 1

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Accu-Chek Mobile ®

Strip Free, Simple, Smart. NEW for INSULIN USERS

All-in-one system: test whenever, wherever. Visit www.accu-chek.co.uk/mobile or ask your healthcare professional Experience what’s possible. Roche Diagnostics Limited, Charles Avenue, Burgess Hill, RH15 9RY. Company registration number: 571546

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