balance Your diabetes lifestyle magazine • January – February 2012
HAPPY BIRTHDAY, INSULIN!
CASH-SAVING CUISINE
Delicious dishes for under £2
Celebrating 90 years since its discovery
SWAP SHOP
Simple changes to shed pounds
GOOD MORNING, VIETNAM
PLUS
Type 1 travels on land, at sea & in the air
Diabetic macular oedema; top 2012 go-to destinations; diabulimia; couch to 10k & inspiring art walks
HIV & TYPE 2
Why are so many people with HIV developing diabetes?
“I’m learning as I go” Actress Hannah Waterman on being diagnosed with Type 1 during pregnancy
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news ROADSHOWS NEED YOU!
Diabetes UK calls for greater specialist diabetes care to prevent avoidable deaths. Women aged 15–34 with Type 1 are at particular risk
Avoidable diabetes deaths targeted Diabetes UK is calling for greater investment in specialist diabetes care following reports that up to 24,000 people with diabetes in England die early from avoidable causes. The National Diabetes Audit report highlighted the risks to young women aged 15–34 with Type 1 diabetes, who are nine times more likely to die than other women of the same age. Men in the same age group were four times more likely to die if they had the condition. The Association of British Clinical Diabetologists (ABCD) said more must be done to prevent teenagers with diabetes from being lost in the system. This news comes as the NHS report Inpatient Care for People with Diabetes – The Economic Case for Change found that the
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NHS in England spends more than £2bn a year on inpatient care for people with diabetes. £600m as ‘excess expenditure on diabetes’ – that is, over and above the sum spent on a population of the same age and gender without the condition. Published in November 2011, the report highlights that diabetes inpatient care is often poor. Diabetes UK agrees and believes that, in the long run, poor care can be more expensive for the NHS than good-quality care. The charity is further highlighting that managing diabetes effectively and receiving all appropriate healthcare checks and services (outlined in the 15 Healthcare Essentials checklist) can greatly help to reduce life-threatening complications. i 15 Healthcare Essentials checklist: www.diabetes.org.uk/ 15-essentials.
Diabetes UK’s award-winning Roadshow tour kicks off again in April 2012, and the charity is now recruiting supporters to train as Risk Score Volunteers. This vital role involves attending a local roadshow to raise awareness of Type 2 diabetes and assess people’s risk of developing the condition. It also involves encouraging people to eat more healthily and become more active to reduce their risk. Risk Score Volunteer Izzy Cullingford (pictured bottom left), who has Type 1 diabetes, told balance: “At the Liverpool Roadshow last year, we did 471 risk assessments over two days. It was crazy! There were non-stop queues out the door, but I was working with a great team of staff and volunteers and there was a fantastic atmosphere. We were able to help a lot of people. I can’t wait to involved again this year.” i If you are interested in becoming a Risk Score Volunteer, call the Volunteer Development team on 020 7424 1000 or email volunteering@diabetes.org.uk. • Dates and locations of the 2012 Roadshow tour will soon be announced at www.diabetes.org.uk/roadshow.
{£2bn
The amount spent on inpatient care for people with diabetes
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Source: Inpatient Care for People with Diabetes – The Economic Case for Change
Apidra shortages There is continued disruption to the supply of sanofi Apidra (insulin glulisine) SoloSTAR prefilled pens and ClikSTAR reusable cartridges, due to a production problem. It is now likely to be March before normal supply is resumed. OptiSet pens were also affected but were discontinued in December 2011, alongside other older pens in a bid to improve safety. SoloSTAR and ClikSTAR are sanofi’s two remaining insulin pens. i www.diabetes.org.uk/apidrasupply-disruption. • sanofi’s 24-hour Patient Support Line: 0845 606 6887.
Back to the future It’s 90 years since the breakthrough discovery of insulin by Banting and Best in what turned out to be one of the greatest discoveries of the 20th century. Diabetes UK is using the anniversary as an opportunity to highlight the fantastic medical and research achievements in the past 90 years, and to look to a future where perhaps the next Banting and Best will make the ultimate breakthrough and deliver a future free of diabetes. Here’s to the next 90! i See pages 32–36 for an extended feature on insulin.
balance January – February 2012
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Everyone’s talking about... Licence forms to be redrafted The Driver and Vehicle Licensing Agency (DVLA) has agreed to work with Diabetes UK and people with diabetes to rewrite the driving licence application forms, following concerns that drivers with diabetes could lose their licence because of new rules. Under the new European Directive, people with diabetes who report two ‘severe’ hypos in a 12-month period may have their Group 1 licence revoked, and Diabetes UK expressed concern that the word ‘severe’ could be misunderstood. After a meeting with Transport Minister Mike Penning in November, Chief Executive of Diabetes UK Barbara Young and other charity representatives then met with the DVLA in December. The DVLA agreed to clarify how severe a hypo has to be before it needs to be declared, and to ensure that the information being collected will more accurately assess people’s fitness to drive in accordance with the new rules. The DVLA also agreed to share monthly reports about how many people with diabetes are having their licences revoked due to the new rules. Nikki Joule, Senior Policy Officer at Diabetes UK, told balance: “We are delighted that changes will be made to ensure the process for drivers with diabetes who are applying and re-applying for licences is fair, consistent, transparent and safe.” i For more on this story, visit www.diabetes.org.uk/driving.
balance rounds up all the latest diabetes news
Lucentis update Diabetes UK is continuing to campaign for Lucentis, a potentially sight-saving drug, to be made available for people with diabetic macular oedema (DMO), after the National Institute for Health and Clinical Excellence (NICE) turned down a joint-charity appeal for it to be available on the NHS. Diabetes UK, JDRF, the Macular Disease Society (MDS) and the Royal National Institute of Blind People (RNIB) are urging the manufacturer of Lucentis, Novartis, to agree a patient access scheme with NICE and the Department of Health in order to reduce the treatment’s cost. NICE announced its original decision not to recommend Lucentis as
a treatment for people with DMO on the NHS in July on the basis of cost-effectiveness (see ‘News’, balance issue four 2011). The charities appealed, arguing that NICE failed to act fairly as key patient organisations and clinicians were not given the opportunity to comment on significant new evidence submitted by Novartis, which may have led to incorrect conclusions being drawn in NICE’s final decision. NICE has also made clear that people who are already receiving Lucentis treatment on the NHS should have the option to continue until they and their clinician consider it appropriate to stop. i Turn to page 43 for more on DMO and Lucentis.
CELEBRITY CELEBRATIONS Joe Pasquale has done it again! This time raising £6,000 for Diabetes UK on ITV quiz The Chase celebrity special in December. Earlier in 2011, Joe also appeared on Celebrity Family Fortunes, winning £10,000 for Diabetes UK, and completed the 2011 London Marathon, raising more than £7,000. Congratulations also go to The X Factor contestant Amelia Lily (left), who reached the final and came third in the competition. The 17-year-old singer was diagnosed with Type 1 diabetes aged 3, and hopes to raise awareness of the condition. Amelia told balance: “It’s important to get people talking about diabetes, and for me to show other young people and children that you can still get out there and follow your dreams.”
You’ve got a friend Diabetes UK has launched a new support scheme for people living with diabetes. The scheme will connect those in need with people who know first-hand that dealing with diabetes can be tough, and who can offer an understanding ear. Peer Support offers a telephone and internet service run by volunteers who are living with diabetes, offering empathetic and heart-felt support to people across the UK. It’s a confidential, safe and secure service, and the volunteers are specially trained. Ruth Wilson, Peer Support Project Manager, told balance: “This is a chance to talk to someone who understands how worried you might feel about your first retinopathy tests. Or what it’s like to be a parent, juggling school, insulin and carb counting, as well as everything else that family life brings. “Support can make the difference between a good day and a really tough one.” The service will be open for calls every Wednesday, Friday and Sunday; see below for times. i Full details of each peer, their email address and areas of experience can be found at www.diabetes.org.uk/peersupport. • You can get in touch via the Diabetes UK website or by calling 0843 353 8600 at the following days and times: Wednesday: 12pm–3pm; Friday: 9am–12pm; Sunday: 7pm–10pm.
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THEY SAY, WE SAY
Congress success
Main picture: the IDF’s young leaders. Inset above: Alex (left) is ready for the challenge Diabetes UK was well represented at the International Diabetes Federation (IDF) World Diabetes Congress held in Dubai between 4 and 8 December. The event saw over 15,000 delegates from 172 countries and more than 1,500 speakers – making it the largest IDF congress in history. At the congress, Diabetes UK Volunteer Development Officer Alex Silverstein was elected as the first ever President of the IDF Young Leaders Programme, which is a new scheme aimed at improving the lives of young people with diabetes worldwide, through the development of tomorrow’s leaders in the diabetes community. Alex, 24, who has had Type 1 since he was 18 months old, will over the next two years lead a group of 69 young leaders from 47
countries to launch the programme. He will not only aim to create a global platform to support people with diabetes, but will also oversee the delivery of projects by young leaders in their host countries in collaboration with their IDF member associations. Further details of Alex’s work, and his own project in partnership with Diabetes UK, will be featured in balance at a later date. It was also announced that the next President of IDF will be Sir Michael Hirst, who is a previous Diabetes UK Chairman; the next Treasurer is Diabetes UK Board member John Grumitt; and Diabetes UK’s Chairman, Sir George Alberti, received a lifetime award for his services to diabetes. i www.idf.org. • See ‘In brief’, page 10, for news of another Diabetes UK worker hitting the headlines.
NHS Shake-up In December 2011, the Department of Health released the indicators that will be used to judge the performance of the NHS in 2012/13. The NHS Outcomes Framework sets out the improvements that the NHS should deliver, and is responsible for providing a national overview of how the NHS is performing. The coalition government’s reforms have created the NHS Commissioning Board. This will take responsibility for at least a quarter of the total NHS budget and will be accountable to Secretary of State for Health Andrew Lansley.
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For diabetes, in 2012/13 the NHS Outcomes Framework will record the number of people dying prematurely from diabetes, the number of people who feel supported to manage their condition, and the health-related quality of life for people with longterm conditions. For emergency care, unplanned hospitalisations for diabetes will also be recorded. As these are national overviews, Diabetes UK will submit views on locally appropriate indicators for the new GP-led clinical commissioning groups.
No quick fix December’s diabetes headlines included the misleading claims that just three minutes of exercise could prevent or treat Type 2 diabetes. The Daily Mail, the Daily Mirror, and The Independent, to name but a few, referred to the study published in the European Journal of Applied Physiology, which claimed that performing short cycle sprints three times a week could be enough to prevent and possibly treat Type 2 diabetes.
DIABETES UK SAYS Very intense sprint training is known to improve insulin sensitivity, but whether the same result could be achieved by making the exercise sessions easier and shorter has not been previously investigated. Although the researchers at the University of Bath saw a 28 per cent improvement in insulin function, the study was based on a very small sample, and the results should be treated with caution. Dr Iain Frame, Director of Research at Diabetes UK, told balance: “On no account should these results be seen as a quick fix to prevent or ‘cure’ Type 2 diabetes. There is no cure and it is unrealistic that such minimal levels of exercise could have any positive impact on helping people to reduce their risk of developing the condition. “This study was based on a very small number of people without diabetes. The authors also admit that this type of short, intense exercise is not suitable for weight loss, which is a widely approved method to reduce the risk of Type 2. “Diabetes UK recommends that people should follow a balanced diet and exercise for 30 minutes at least five times a week to reduce their risk of Type 2 diabetes.”
balance January – February 2012
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Volunteer your views The Council of People living with Diabetes (CPD) has places available for new members with Type 2 diabetes. Those from minority ethnic communities, Scotland and the north of England are particularly sought, as they are underrepresented. The CPD is a group of volunteers from across the UK with a wide range of diabetes experiences that advises Diabetes UK’s Board and Executive Team. If you are passionate about having your views about living with Type 2 heard and want to shape the work of Diabetes UK, please apply by 17 February 2012. i For more information or an application pack, call the Governance team on 020 7424 1000 or email governance@diabetes.org.uk.
Community Champions reach out Diabetes UK has been awarded a grant of £116,000 from the Department of Health’s (DoH) Volunteering Fund to roll out its Diabetes Community Champions scheme nationally. Piloted in London in 2010, the programme has so far trained 111 ‘Community Champions’, who raise awareness of diabetes in Black, Asian and minority ethnic communities. Jenne Patel, Head of Equality and Diversity at Diabetes UK, told balance: “We are delighted to have been awarded this grant. The funding recognises the success of the programme and will enable us to extend it to further cities across England: Luton, Leicester, Birmingham, Slough, Ilford, Leeds, Manchester, Bradford, Sheffield and Liverpool.” i For information on becoming a Diabetes Community Champion, please call the Equality and Diversity team on 020 7424 1000. • www.volunteeringfund.com
Newly trained Champions
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Enjoy precision.
DELIVERING RESULTS IN SANDWELL A team at Sandwell and West Birmingham Hospitals NHS Trust has found that sending people their HbA1c blood test result ahead of their diabetes care planning review is a success. They found that it: • makes it easier for people to talk to their doctor or nurse • promotes positive changes in eating, activity and taking the right medicines • makes the HbA1c test easier to understand. The scheme, ‘Delivering Results to You’, aims to increase understanding of the HbA1c result, presenting it in different ways with simple descriptions. Dr Pete Davies, Diabetes Consultant at Sandwell hospital, told balance: “Our results show that sharing blood test results like this really does help people take more control of their diabetes. Patients asked to receive their HbA1c result by mail and that allowed us to present information in a more digestible way than simply giving a number.” i For more information, email Dr Pete Davies at p.davies@nhs.net.
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news
In brief... INPUT FOUNDER AWARDED MBE
Torchbearers show the way for Type 1
WARM WELCOME GUARANTEED
Two young women with Type 1 diabetes have been chosen as Welsh torchbearers in the run-up to the London 2012 Olympic Games. Melanie Stephenson (below right), 23, from Cardiff, and Hannah Jarrett (below left), 14, from Bridgend have both been given conditional offers to bear the torch for a section of its route through Wales in May 2012. Melanie is a longstanding volunteer for Diabetes UK Cymru, which nominated her; she has given talks, volunteered at events and helped to raise awareness of diabetes in the Welsh media. She is also a sprinter who has competed for Wales in 100m and 200m competitions and came close to being selected for Team GB. Hannah, nominated by a local youth worker, has taken part in dozens of charity events to raise money for good causes, including Diabetes UK Cymru. Well done, ladies!
Congratulations to INPUT founder John Davis, who was awarded an MBE in the 2012 New Year’s Honours, for services to people with diabetes. INPUT is a not-forprofit organisation run by insulin pump users and their families to raise awareness of diabetes technology – including insulin pump therapy – in the UK. i www.input.me.uk The Sunderland Diabetes UK voluntary group is seeking new members. Group members emphasise that they are warm and friendly, and enjoy meeting and sharing news, views and an occasional game for fun. i www.sunderland.diabetesukgroup.org
MORE BALANCE
balance is delighted to be back to six issues this year, bringing readers more regular diabetes news, views, features and healthcare information. In order for this to happen, the number of pages has come down, but you’ll still find all the regulars, and even a few extras, such as the new travel section. i If you have any feedback or suggestions, please email balance@diabetes.org.uk.
DIABETES UK CYMRU WORKER SCOOPS AWARD
Media and Communications Officer Kerry-Lynne Pyke, based at Diabetes UK Cymru in Cardiff, was named one of the brightest and best young PRs in the UK by the magazine PR Week. She was chosen from hundreds of entrants as one of 29 young professionals under the age of 29. Kerry-Lynne told balance: “It’s a pleasure to work for Diabetes UK Cymru to help raise awareness and understanding of the serious lifelong condition.”
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DOCUMENTING DIABETES Film gradudate and independent producer Adam Fine is looking for volunteers with diabetes to feature in a documentary about how people deal with diabetes both psychologically and physically during different life stages. Adam told balance: “I’m looking for people of different ages and backgrounds, and would particularly like to explore the impact that diabetes has had on the lives of people who have struggled to cope with it.” The documentary will also look at the impact of recent developments in diabetes care and technology. i For further information, email Adam at gabrielsez@gmail.com.
Correction
‘Driving a million away’ (They say, we say, balance issue five 2011), reported the DVLA’s definition of severe hypoglycaemia as ‘more than two episodes during a 12-month period’. It should have said ‘two or more episodes during a 12-month period’. balance apologises for any confusion this may have caused. i See ‘Everyone’s talking about’, page 7, for more on this story.
Angela, above with Claudia, was recognised for making a difference
Mother of five wins award A mother of five has won the inaugural Quality in Care (QiC) Diabetes People’s Award for setting up a website after her 10-year-old daughter, Claudia, was diagnosed with Type 1. Diabetes Power is an online forum for other parents and children living with diabetes to share experiences. Through the site, Angela has also fronted a campaign to raise awareness of diabetic ketoacidosis, a potentially-life threatening complication of undiagnosed and untreated Type 1 diabetes. It also provides factual information and news, as well as blogs and video stories detailing what it is like to live with the condition day to day. The QIC Diabetes Award, supported by Diabetes UK, aims to recognise someone very special who cares for/ has cared for someone with diabetes. It is awarded to someone who has made a real difference to people’s lives and goes beyond the call of duty. Angela, from Preston, said: “I’m thrilled to win the award, and what it means is hard to put into words. Since Claudia was diagnosed we have worked towards a Type 1 awareness campaign, and to see it finally moving forward means all the hours and work have been worth it.” i www.diabetespower.org.uk • www.qualityincare.org
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Three cheers for three years Diabetes UK forum ‘Diabetes Support’ celebrated its third birthday on 14 November – World Diabetes Day. Since its 2008 launch, the site has grown rapidly and now has more than 5,300 users of all ages. Free to join, the forum is highly valued by its users, who exchange support and information on every aspect of living with diabetes. i www.diabetessupport.co.uk
SUPER DEALS FOR HEALTHIER MEALS The Department of Health’s Change4Life scheme launched its nation-wide Supermeals campaign on 2 January to help families prepare healthier meals quickly and cheaply. The campaign offers money off healthy ingredients in more than a thousand Asda, Co-operative and Aldi stores throughout January 2012. A new Change4Life cookbook by Ainsley Harriott (below) has also been published, containing a month’s worth of healthy recipes, each for under £5. From 20 January, 50,000 copies of the cookbook will be available free through the Daily Mirror with Asda as redemption partner. A further 50,000 free copies will be made available to Change4Life supporters. Inserted into this issue of balance, you will a find Change4Life Supermeal recipe pack, with 14 recipes for low-cost, quick-and-easy, healthier meals. In total, four million recipe packs will be distributed to Change4Life supporters. New online recipe finder, meal planner and shopping list tools are also available on the Change4Life website, to help families make healthier food choices. i For further details of the offers, visit www.nhs.uk/change4life. • Turn to page 46 for some cash-saving balance recipes.
Porcine and Bovine insulins are still available. Speak to your diabetes healthcare professional now to find out more.
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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research matters MANAGING TYPE 1 DURING PREGNANCY Two studies funded by Diabetes UK and led by researchers at the University of Cambridge have reported new findings that could help pregnant women with Type 1 diabetes to manage their blood glucose levels more effectively. During pregnancy, maternal glucose is vital for the growing foetus, and expectant mothers seem to produce more glucose to cope with the heightened demand. Late on during their pregnancies, women who have Type 1 diabetes spend an average of eight hours a day with raised blood glucose levels. This occurs mostly after eating a meal and can lead to complications when giving birth. One study, published in the journal Diabetologia in November, explored the mechanisms that contribute to elevated blood glucose after meals in 10 pregnant women with Type 1 diabetes, both early and late on in their pregnancies. The researchers found that glucose was absorbed by the body more slowly in late pregnancy. Although more research is required to validate their findings, they suggest that modifying insulin doses in late pregnancy might help women to control their blood glucose. Understanding how blood glucose varies after a meal could also help with the design of a computerised system to monitor blood glucose levels and automatically administer the appropriate insulin doses needed to regulate them – known as a ‘closed loop’ or ‘artificial pancreas’. In a further study, published in Diabetes Care in October, the researchers tested the safety and effectiveness of such a system among 12 pregnant women with Type 1 diabetes over a 24-hour period incorporating normal daily activities. They found that the new system was just as effective as an insulin pump but potentially safer, because it reduced the extent of hypoglycaemia (low blood glucose). However, the system could not prevent hypoglycaemia related to exercise. Testing overnight with larger numbers of people and in longer-term real-life conditions is now required to determine if it can be applied as a treatment for Type 1.
An international team led by scientists at the University of Exeter has gained an unexpected insight into the development of the pancreas, which could help inform the design of new therapies for Type 1 diabetes. With funding from Diabetes UK, the researchers studied the genes of 27 people with a rare condition, known as pancreatic agenesis, where people are born without a pancreas. In 15 individuals they identified mutations in a gene called GATA6. The team now thinks this gene plays a key role in the growth of pancreatic beta cells, which regulate blood glucose by secreting insulin.
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Artwork of the human pancreas (yellow) showing production of the hormone insulin
In Type 1 diabetes the beta cells are destroyed by the immune system, while in Type 2 their function gradually declines. Understanding what causes these cells to develop could help scientists find new ways of regenerating them. “Our study suggests that GATA6 plays a very important role in this process,” said Professor Andrew Hattersley from the University of Exeter. “We hope this research will help the crucial work to try to develop beta cells for patients with Type 1 diabetes.” The research was published in the journal Nature Genetics in December.
Image: John Bavosi / SPL
RARE DISORDER SHEDS LIGHT ON THE PANCREAS
January – February 2012
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Using stem cells to improve islet transplants Islets transplanted from the pancreas of deceased donors can be used to treat people with Type 1 diabetes. Once transplanted, the islets produce insulin, which leads to improved control over blood glucose. However, transplanted islets are often rejected by the body, leading to a progressive decline in their function. As a result only 10–15 per cent of people who receive islets remain insulin independent after five years and multiple transplants become necessary, limiting the effectiveness of transplantation as a therapy. Studies have suggested that if stem cells (pictured above) derived from the
MISSING MODY MUTATIONS
kidneys of adults are transplanted at the same time as islets, improved insulin secretion and control of blood glucose can be achieved. With funding from Diabetes UK, Professor Peter Jones at King’s College London will use experiments in the lab to explore the mechanisms by which this occurs and determine the sites of use and varieties of stem cell that work best. This research could enable the development of more effective islet transplantation methods, which could improve the treatment of people with Type 1 diabetes and reduce the number of donor islets needed. Prof Peter Jones of King’s College London; £197,820.60; 3-year Project Grant.
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The number of amino acids that form the insulin molecule See pages 32–35 for more on insulin
Image: John Bavosi / SPL
Diet, ethnicity and Type 2 risk In the UK, the risk of Type 2 diabetes is 4–6 times higher among South Asian people and 2–3 times higher among black people than among people of white European descent. To date, the exact reasons for these differences are unclear. The Child Heart And Health Study in England (CHASE), run by Professor Peter Whincup and colleagues at St George’s, University of London has examined a wide range of risk factors for heart disease and Type 2 diabetes among 5,000 children from 200 primary schools. It revealed that differences in insulin resistance and blood glucose levels associated with ethnicity were apparent by 9–10 years of age. However, it also determined that childhood obesity, physical activity and social class were not the main cause of these differences. Now, Prof Whincup’s team will use a statistical analysis of data from 2,000 children who took part in CHASE to model the relationship between childhood diet and ethnic differences in the risk of Type 2 diabetes. Their results will shed light on why the risk of Type 2 is higher among black and South Asian people and could help doctors to develop dietary interventions to prevent the condition among these high-risk groups. Prof Peter Whincup of St George’s, University of London; £70,324; 18-month Project Grant.
Maturity Onset Diabetes of the Young (MODY) is linked to variations in eight genes that affect the development and function of the pancreas, but additional MODY-related genes are yet to be found. Dr Michael Weedon and colleagues will use the latest technology to sequence the DNA of people with MODY and their families to pinpoint these additional variations. Their work could help improve the diagnosis and the treatment of this condition. Dr Michael Weedon of Peninsula Medical School, Exeter; £123,514; 2-year Project Grant.
B CELLS AND TYPE 1
B cells are a type of white blood cell involved in the attack on insulin-producing islet cells that leads to Type 1 diabetes. Professor Wong’s lab will study these cells in people with and without Type 1 to clarify their role and determine how their numbers and properties change as the condition develops. This will help the researchers to understand why people develop Type 1, improve monitoring of the condition and inform the design of new therapies that target B cells. Prof Susan Wong of Cardiff University School of Medicine; £269,880; 3-year Project Grant.
A NOVEL RECEPTOR IN TYPE 2
G-protein coupled receptors (GPCRs) are the target of at least 30 per cent of all prescription drugs. Professor Persaud recently discovered a new GPCR and demonstrated that insulin secretion increases when it is activated in islet cells. Her
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influence on specific cell types. This will extend knowledge of islet cells and could enable the development of therapies to stimulate insulin secretion and the growth of beta cells in people with Type 2. Prof Shanta Persaud of King’s College London; £193,231.97; 3-year Project Grant.
TARGETING THE IMMUNE SYSTEM
Genetic risk factors for Type 1 diabetes are closely associated with HLA molecules. In people with Type 1 these help trigger the destruction of islet cells by binding fragments of islet proteins and using them to activate the body’s immune system. Dr Michael Christie will develop our understanding of this process by studying the action of one particular islet protein, known as IA-2. This could improve the targeting of vaccine therapies to prevent Type 1. Dr Michael Christie of King’s College London; £236,900; 3-year Project Grant.
NEW LOOK AT CELL SIGNALLING
Dr Ian Salt’s laboratory at the University of Glasgow will purchase an imaging system to help run analyses of cell signalling pathways more rapidly and with greater accuracy. Defects in such pathways are a key characteristic of insulin resistance in people with Type 2 diabetes and are thought to contribute to diabetes-related heart disease. The system will improve knowledge of how insulin acts on cells and how diabetes and its complications arise. It could also identify targets for future therapies. Dr Ian Salt of the University of Glasgow; £28,204; Equipment Grant.
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TYPE 1 IN CLOSE-UP Researchers at the La Jolla Institute for Allergy and Immunology have created the world’s first videos showing in detail the real-time destruction of insulin-producing cells, which leads to Type 1 diabetes. The dynamic images, which show T cells from the immune system attacking pancreatic beta cells in mice, reveal information about these processes that previously had to be surmised from photographs, computer models This video shows real-time destruction and lab experiments. They were captured using of insulin-producing cells a two-photon microscope that uses pulses of light to monitor the interaction of cells without destroying them. The information revealed in the videos could help researchers to develop new therapies aimed at preventing the autoimmune attack that leads to Type 1. i View the videos online at http://jci.org/articles/view/59285.
The mechanics of glucose uptake After a meal, blood glucose levels are controlled by the action of insulin on fat and muscle cells. The binding of insulin to its receptor causes numerous glucose transporter proteins to move from storage sites within each cell to the cell surface, where they act as pores that allow glucose to enter. This process requires the interaction of a complicated array of proteins known as SNARE complexes. The defective assembly and regulation of these complexes is thought to underlie the insulin resistance that causes Type 2 diabetes; however, the exact mechanisms by which this occurs are poorly understood. Using healthy fat cells grown in the laboratory, Professor Gwyn Gould and his team at the University of Glasgow will study two proteins that are intimately associated with this process: Syntaxin 4 and Munc18c. By modifying these proteins and analysing the resulting changes in cell function, they will attempt to determine the effects of insulin at the molecular level. The researchers hope that advances in our understanding of the mechanisms of glucose uptake could help improve the design of targeted therapies to prevent and treat Type 2 diabetes. Prof Gwyn Gould of the University of Glasgow; £190,224; 3-year Project Grant. i See page 34 for more on Prof Gould’s work.
EXPERIENCES OF PEOPLE WITH DIABETES Studies that record the experiences of members of the public can be used to evaluate the quality of health services and allow feedback on poor experiences to drive improvements forward. However, up until now assessments of healthcare for people with diabetes have focused largely on treatment outcomes and people’s experiences of stays in hospital. Drawing on the 2012 General Practice Patient Survey (which is likely to include the responses of around 117,000 people with diabetes), Dr Charlotte Paddison’s team at the University of Cambridge will address gaps in what is known about the experiences of GP care among people with diabetes. Insights could be used to help politicians and health professionals understand the difficulties that some groups may face in accessing primary care and encourage the design of new strategies to improve the quality of diabetes care within a variety of different communities. Dr Charlotte Paddison of the University of Cambridge; £42,897; 15-month Project Grant.
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your views
balance Your diabetes lifestyle magazine
“I WAS DETERMINED TO GET JUSTICE” Fighting diabetes discrimination
POLDARK
Actor Robin Ellis on diabetes and delicious dinners
A VERY VEGGIE CHRISTMAS
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.
STAR LETTER Tip top!
In response to Bill Bailey’s letter ‘Senior Moments’ (Your views, balance issue five 2011), I too occasionally wonder if I have taken my insulin. This led me to devise a simple system. Before bedtime, I place two pen tips in a small, lidded, plastic container. If, after breakfast, the next day I wonder if I have injected, all I do is check the container. One tip remaining means I did, two tips means I did not, and no tips at all means I had a ‘senior moment’ and forgot to insert them! It also means I haven’t injected and this is easily remedied.
Pat Visanji, via email
Careless talk
e She or a been here is
In response to Brian Mason’s letter ‘No laughing matter’ (Your views, balance issue five 2011), the ‘lighthearted’ letter he referred to made me cry. How lucky Brian is that he ‘knows nothing about injections’. My son is 9 and has had Type 1 diabetes for five years. He would give anything to go to school without testing, injecting and ensuring that he has his snacks, lunch and hypo equipment. He tests himself three times a day, more if he feels low or if he has swimming, for which his blood sugars must be a certain level. This ensures that he doesn’t have a severe hypo, which could cause the teacher and other 30 children stress and upset, my son embarrassment and cost a fortune in emergency treatment and NHS services, which seems to be Brian’s main concern. I want my son to grow up healthy and happy, and this means testing and injecting the correct mixed dose
you 2 k the
re to
bed
able
18 balance
Festive fare to tempt all your guests
WIN
Morphy Richards kitchen makeover Virgin balloon flight Cordon Vert cookery course
YOUR DIABETES CARE REVEALED
issue five 2011 • £3.95
Rebel who found a cause How a former wild child mended her ways after her Type 1 diagnosis
THE NEXT GENERATION
Young researchers and their work
PLUS
Hypo signs; coping with stress; alcohol awareness & foot care facts
issue five 2011 balance 01 Cover JC.indd 1
1
24/10/2011 17:51
of insulin. Hang the expense, my son’s health is too important to penny pinch.
or blockage in the artery of the arm. This causes the arm to ‘steal’ blood from the arteries that go to the brain, Rachel Stephens, via email resulting in dizziness. His initial diagnosis was confirmed by ultrasound I was diagnosed with Type 1 five and an angiogram. I would urge Jean years ago, aged 53. It was a shock, as to ask her doctor to investigate it as I have always led a healthy lifestyle many medical staff are unaware of and taken lots of exercise. I take it the condition. very seriously, and have very good Sally Magill, County Down control and no side effects, due to my healthy lifestyle and regular Cortisone caution blood glucose testing. When I injured my right shoulder My diabetes healthcare team last year, I had cortisone [a steroid has always told me of the dangers used to treat inflammation] injected of re-using lancets and needles. into it. I couldn’t sleep that night as I consider that the cost of these is I was burning up. The next morning, offset by the fact that I do not have my face was extremely red, my right any complications. I was aghast to cheek was swollen and my teeth were read John Marsden’s letter (‘Cutting aching. I tested my blood glucose and back’, Your views, balance issue it had risen to more than 22mmol/l. five 2011). As for Brian Mason’s It remained consistently high for the ill-informed comments, I would next 48 hours, necessitating more love to have been given the choice insulin injections. I subsequently of controlling my diabetes with found out that cortisone can cause tablets and diet, but this was not a temporary rise in blood glucose an option for me. If he wants to levels, so people with diabetes taking take up the issue of the cost to the insulin should check their blood often NHS (to which I have contributed and adjust their insulin dose, if needed. significantly for more than 40 Neither of the two doctors I saw told years), I suggest he confronts the me of the possibility of side effects. pharmaceutical companies that Janet Mutch, via email charge exorbitant prices for test strips and have no interest in finding Testing patients’ patience a cure, as they would lose a fortune. One of the biggest issues I have with Judy Ferry, via email the NHS is the lack of access that working people have to the service. Different readings Being offered a ‘late’ appointment at I read the letter from Jean Turner 5pm to get my flu jab isn’t on, when (‘A surprising find’, Your views, my cat can get a late appointment balance issue five 2011) with great at the vet’s up till 7pm. Even more interest. I, too, have very different embarrassing is the wait; my sevenblood pressure readings depending monthly diabetes check-up – despite on which arm is used. After 10 years being little more than 20 minutes of of not being given a satisfactory reason medical work – takes at least an hour for this, my new GP suggested that I and a half with all the waiting. And may have subclavian steal syndrome, when you add on the travel to get to a condition caused by a narrowing the modern out-of-town hospitals, it
January – February 2012
18-19 Your ViewsKFb&w.indd 18
10/01/2012 12:21
your views
can take up to half a day. With large numbers of people on contracts and forced to travel further to their work, it pushes people to decide if waiting for hours in hospitals and GP surgeries is worth it for the money lost. The NHS needs to put its working patients – who actually pay for the service – first for once.
for asking for a day for partners of people with diabetes. My brother has Type 1 and my husband Type 2. When my brother was ill last year, I didn’t know whether it was better to let him sleep, after two nights of pain, or to wake him up so he could administer his insulin. Should I have given him the insulin from David Sandilands, via email his pen while he was asleep? What dose should he have – given that Less is more he had been immobile for 48 hours I was interested to read the recent with little food? Who should I have letters concerning the limited choice asked – the Diabetes UK Careline, of sugar-free soft drinks available in the GP or the diabetes clinic in pubs and restaurants (‘Soundbites’, the hospital? My brother has a balance issues three and four 2011). new partner, unfamiliar with I recently visited an express diabetes, where should she get supermarket in London to buy reliable information from? several small bottles of sugar-free Pamela Morgan, via email or no-added sugar soft drinks, yet Editor’s note: The Diabetes UK the only one available was Diet Coke. Careline can provide general It also amazes me how much information and support, but only your brother’s diabetes healthcare sugar and salt manufacturers add team can provide advice tailored to a whole variety of things from to his diabetes. baked beans to peas. Even a tin of ham (re-constituted) has added sugar. Why do they do it? As such Aspirin alternative excessive use is not good for your I used to take aspirin, having health, maybe there should be discussed its benefits to the heart tighter regulation. If individuals with my GP. When I told him that want added sugar or salt, they can it upsets my tummy, he prescribed add it themselves. omeprazole 10mg gastro-resistant Reverend Geoffrey Squire, via email capsules. This works perfectly.
Help for partners
Thank you to Robin Ellis (‘D for delicious’, balance issue five 2011)
I love my...
Blogs, tweets & posts www.facebook.com/diabetesuk http://twitter.com/diabetesuk “I am Type 2 and do find it helpful chatting to other Type 1 and Type 2s... I would like to thank those who help me and hope I am some help to them too.”
Debra Scudamore, via the Diabetes UK Facebook page “I just got your iPhone Diabetes tracker. It’s going to help when out and about – thanks Diabetes UK!”
Jodie Jordie, via Twitter “The last 10 years have really given me different challenges to deal with and one of these is operating within British sport with diabetes.”
Team GB cyclist Barney Storey explains how he manages his diabetes and his sport in his new blog post for Diabetes UK: http://blogs.diabetes.org.uk.
THE BIG QUESTION What do you wish everyone knew about diabetes? Email balance@diabetes.org.uk or post on the balance Facebook group wall. A selection of answers will be printed next time.
John Evans, via email
For extra balance letters, visit www.diabetes.org.uk/balance.
Is there someone you couldn’t do without? Tell us about them at the usual balance addresses marked ‘I love my…’
My thanks are due to Julie Barnaby, the housekeeper where I live in an Abbeyfield residential home, particularly for the care she takes with my diet. I have diabetes and so follow a low-sugar diet, and I have heart problems, which necessitate a low-fat diet. Julie always produces something special when needed, eg a fresh-fruit sundae instead of a baked pudding. She never needs to be reminded or makes me feel a nuisance. In addition to her housekeeping duties, Julie is a friend – giving attention to one’s life and interests, and providing a shoulder to cry on when needed (not often, I’m glad to say). Thank you, Julie. Denise Williams, Caerphilly
Me & my balance J Moore took his copy along to Machu Picchu, Peru, not letting the 3,300m (10,827ft) altitude get in the way of a quick catch-up. Mr Moore, 67, who’s had Type 2 diabetes for 17 years and is about to go on injections, said: “Keep up your helpful information, balance.”
January – February 2012 balance 19 18-19 Your ViewsKFb&w.indd 19
10/01/2012 12:22
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20-21 ColumnistsColour.indd 20
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09/01/2012 16:08
columnists
The joy of being president
The big picture
Richard Lane
Patricia Debney
One of the most enjoyable aspects of my role as President of Diabetes UK is attending a wide variety of events, and some recent commitments have emphasised the inspiration I get from this. I met Julie Parker, Gibraltar’s only diabetes specialist nurse (DSN), at the Diabetes UK Professional Conference 2011. There are 29,000 people living in Gibraltar and 2,500 have diabetes, so being the only DSN must be daunting. But Julie and her team provide the best level of care, education and support. I was invited to attend and speak at the launch of Diabetes Gibraltar, at which I pledged support from Diabetes UK, and we have recently been able to help in meaningful ways. I also represented Diabetes UK at the press launch of the Bupa Greater Manchester Run,
Diabetes UK having been nominated as the charity for the Bupa runs for the next three years. I met some celebrities, including Liz Dawn, Coronation Street’s Vera Duckworth, and she offered to help us in the future. Lastly, I have recently had the privilege of meeting two amazing ladies in their 80s, one from Scotland and one from Sussex. Both have been on insulin for more than 80 years – one was even treated by Dr Frederick Banting in Canada, then Dr RD Lawrence and Dr David Pike at King’s College Hospital! My role as president is extraordinarily satisfying and humbling, and I am very much looking forward to 2012. I wish you all a happy, healthy and peaceful new year. i Richard Lane OBE, President of Diabetes UK, has Type 1 diabetes and was one of the first people in the UK to receive islet cell transplants.
Our first Christmas with diabetes, just four weeks after Eliot was diagnosed, was hard. We all worried as he ate ‘normally’ – chocolate from his stocking, ice cream after turkey – with no clue how to control his blood sugar levels. We saw them rocket into the teens and stay there. I cried and cried: how were we ever going to keep him away from danger? Three years on, we know now that out of routine, high blood sugar is inevitable. Now too we understand which variables in the diabetes ‘equation’ are fixed – insulin sensitivity, carbohydrate counting; and which are slippery – the rates of digestion, the effects of exercise, temperature and hormones, etc. And now we have the tools we need – a good blood
glucose meter and the brilliant pump. We are fortunate to have Eliot’s own determination and discipline. We know the drill. But there’s something else. Now, when I see 12mmol/l or even higher, my heart no longer drops to my stomach. I no longer see Eliot’s life disintegrating with each high reading. In the last three years, we have learned to live differently in so many ways. Before, we believed life could be ‘solved’. Now we know that Eliot’s diabetes cannot be solved, like a puzzle, number by number. Rather, it – all of life – is a complicated and constantly changing seascape. What matters in this ocean are good sea legs, a strong boat and an eye on the horizon. i Patricia is an author and senior lecturer in Creative Writing at the University of Kent. Her son, Eliot, has Type 1. Visit her blog at www. wavingdrowning.wordpress.com.
get my prescription right in the six months that I’ve been there, this surgery is a lot better at helping me manage my diabetes. The terrible truth is that some GPs are not very good, while others are excellent. The government is committed to releasing more data
about GPs – when it comes it will hopefully provide the public with a way of measuring their quality. i New balance columnist Andy Kliman was diagnosed with Type 2 diabetes in 2009; he also writes a blog for Diabetes UK at http:// blogs.diabetes.org.uk. You can follow Andy on twitter: @andykliman.
NHS choices Andy Kliman The new NHS Choices website is packed full of interesting information on GP practices. Start at www.nhs.uk and look for ‘health services near you’. If you then select ‘GPs’, you can find out the prevalence of people with diabetes at your GP surgery
– and how many end up in A&E. Since having a recent bad experience with my GP, where he gave me some upsetting drug advice that I later found to be wrong, I decided to move to a nearby GP practice that my pharmacist recommended. Apart from not being able to
January – February 2012 balance 21 20-21 ColumnistsColour.indd 21
09/01/2012 16:08
running head
A new script When actress Hannah Waterman, 36, toned up and lost weight back in 2009, she felt great. But when her weight continued to plummet – even during pregnancy – alarm bells started to ring and she was diagnosed with Type 1. Angela Coffey finds out more
22 balance
Photo: Alex James / Photoshot
W
hile Hannah is well-known for TV roles such as EastEnders’ Laura Beale and New Tricks’ Emily Driscoll (where she stars alongside her father, Dennis Waterman), in recent years she’s often been the subject of the media’s obsession with weight. When unflattering holiday photographs were published in summer 2009, it was enough to spur on Hannah to get fit, eat healthily and shed the pounds. That Christmas she released her fitness DVD, Body Blitz, which showcased her dramatic weight loss (from a size 16 to a size 6). Hannah continued to lose weight slowly while working in theatre, touring two years back-to-back with Calendar Girls, followed by a part in Carries War. Exhausted, Hannah and her partner, actor Huw Higginson, took a break in Sydney. There it was discovered that Hannah, who was five months’ pregnant, had developed Type 1 diabetes. She went on to give birth to son Jack, via emergency C-section in June 2011, and has now thrown herself into learning all about the condition.
Jan/Feb 2012
22-25 Hannah WatermanColour.indd 22
09/01/2012 19:02
feature
Congratulations on the birth of Jack. While you were expecting, you felt exhausted, thirsty and went to the loo all the time – classic signs of the onset of diabetes. Did you just put it down to common pregnancy symptoms? Yes, I was well into my second trimester and I was supposed to be blooming, as they say, but I was so ill, exhausted and thin. I was five months gone but only weighed 7st 5lb (46.7kg) [Hannah is 5ft 3in]. I had a constant pain in my side, which actually turned out to be my liver struggling, so I saw a GP in Australia and had some blood tests. It turned out that my blood glucose level was 29mmol/l and my sodium levels were very low. I was diagnosed with Type 1 and was also in diabetic ketoacidosis (DKA). I’d never been to hospital before, except when I was a kid with a broken bone, so it was quite something to be hooked up to so many machines.
Photo: Alex James / Photoshot
How long was it before you started to feel better? Within 24 hours my blood glucose levels had been sorted out but it was scary how much my muscles had deteriorated. I’d gone from being super fit and swimming long distances to struggling to walk up the road. The doctors in Australia couldn’t believe that I had still been functioning. It’s quite unusual for someone to be diagnosed with Type 1 diabetes during pregnancy. Did you find that people thought it was gestational diabetes? Yes – the doctors warned me that I may find people insisting that it was gestational diabetes [a condition that usually arises during the second or third trimester, and goes away after giving birth]. On the whole there’s so much misinformation out there when it comes to diabetes. I knew nothing about the condition or the different types before – there’s no family link – but I’ve been learning as I go.
Quick fire
Do you think the media has confused people about diabetes? Yes, it seems that every week there’s a story in the media about a diabetes cure – I don’t think it’s dealt with responsibly. It’s so frustrating, which is why I want to talk about the condition more. I’ve heard people say, ‘Oh, you can’t have sugar.’ Well, actually, I can – it has nothing to do with that. No matter what, I would have developed Type 1 at some point. I have a healthy lifestyle anyway – I eat well and exercise – so at least I’ve got that bit sorted!
What was the last health book or magazine you read? balance – my diabetes midwife gave it to me. What would you abolish from diabetes life? Injections, or at least not as many of them. What advice would you give to someone just diagnosed with diabetes? Not to panic. My partner’s ex-girlfriend gave me the best advice: ‘You can have a normal life – and take as much as you can!’
How did the rest of your pregnancy go? Did you take it easy? Back home I took the time to recover and was closely monitored. I spoke to my diabetes midwife twice a week on the phone, and I was usually seen once every two weeks, and more often leading up to the birth. Being pregnant meant that my insulin requirements were pretty high and I was injecting five times a day. I also met with a dietitian and began to learn about carb counting. Towards the end of my pregnancy I made sure I went out and walked the dog for about 45 mins a day to keep active.
What’s the strangest myth you’ve heard about diabetes? Someone said that I could cure my Type 1 if I lost weight – I’m not even overweight! What’s the most and least healthy food in your fridge? I always have lots of fruit, although I’m having to carb count that now. When I was pregnant the least healthy was peanut butter – it’s a guilty pleasure!
What happened during labour? I was induced at 38 weeks because at 36 weeks it was estimated that the baby was 8lb (3.6kg). I did get a bit worried – my diabetes midwife (who also has Type 1) said that women with diabetes can practically give birth to toddler-size babies! But it turned out they had got the size wrong – Jack was actually 6lb 14oz (3.1kg) when he was born. Unfortunately, the inducement didn’t work and after three days I had to have an emergency C-section because I was so tired. How was your diabetes monitored? I ate regularly and my blood glucose was checked every hour. I was also on an insulin drip set to a sliding scale.
»
There’ll always be comments, whether you lose weight soon after pregnancy or take a while to lose the extra pounds
Hannah’s DVD showcased her dramatic weight loss
January – February 2012 balance 23 22-25 Hannah WatermanColour.indd 23
09/01/2012 19:03
feature
A young Hannah with dad Dennis Waterman Since you’ve had Jack, how has your diabetes management changed? Well, I have less insulin now and I seem to be managing well. We were hoping that I would have a ‘honeymoon period’ after the birth [sometimes after a person is diagnosed with Type 1 and is treated with insulin, the pancreas produces some insulin before it
Since you did the fitness DVD you’ve mainly kept up the exercise. What made you get fit in the first place? Getting papped looking fat! After those pictures were printed in the press, I lost 3st (19kg) through healthy eating and exercising regularly. It was hard but it worked! Many celebrities’ figures are wrongly scrutinised by the media during pregnancy and soon afterwards – have you felt under pressure to get back into shape? You can’t win – there’ll always be comments, whether you lose weight
soon after pregnancy or take a while to lose the extra pounds. But I’m more concerned about the health of me and my baby. Being diagnosed with Type 1 – being in hospital and seeing lots of really ill people – does put things into perspective. But I have been upping my exercise recently and I’ve been running, boxing and doing circuits in the gym. I really recommend exercise, but obviously you need to adjust your insulin according to your fitness and the type of exercise you do. So, what will we see you in next? There is a lot of work being offered but Huw and I want to share childcare, so we want our work to fit in with us. It’s good that before Jack starts school we can be more flexible – have cot, will travel! i For more information on pregnancy and diabetes, including a preconception-care video, visit www.diabetes.org.uk/Pregnancy. • DAFNE: www.dafne.uk.com
FremantleMedia Ltd/Rex Features
stops working altogether], but that didn’t happen. I have also registered for a DAFNE (Dose Adjustment For Normal Eating) course to learn more about carb counting, and in the meantime I’m guided by the principles of it. Knowledge is power and you need to take responsibility for yourself.
SENSING YOUR WAY • • • •
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22-25 Hannah WatermanColour.indd 25
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26-27 Brand review KF.indd 26
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09/01/2012 16:13
announcement
Brand new look for Diabetes UK Next month, Diabetes UK launches its new brand as the charity addresses the need to raise its profile and increase awareness of diabetes as the major public health issue. Diabetes UK’s Director of Communications, Louise Ansari, explains the thinking behind it Why is Diabetes UK changing its look? Diabetes is a serious, misunderstood and growing condition that affects around 3.7 million people in the UK, with a further 7 million at risk – that’s more than 10 million people with whom we need to connect. We have a tough challenge on our hands and must ensure that diabetes is taken as seriously as cancer and heart disease. This re-branding will help us to improve the impact of the work that we do in caring for and campaigning on behalf of everyone affected by or at risk of diabetes. Evidence shows that our current brand doesn’t clearly communicate to people who we are, what we do and why they should connect with us. We decided to change the brand to improve public awareness of the charity and the condition, and to ensure that we appear relevant to everyone affected by or at risk of diabetes.
Why spend money on this in difficult economic times? We know that times are tough, and all charities are having to work harder for support, so it’s more important than ever that we raise the profile of Diabetes UK and diabetes. We’re aware that there will be concerns about the cost of this process. That’s why we’re doing it as costeffectively as possible; we will be gradually phasing in the new brand and using up existing stocks of materials until they run out.
How did you develop the new brand? It was developed in consultation with people with Type 1 and Type 2 diabetes, and many other audiences, including parents of children with Type 1, healthcare professionals, supporters, volunteers and staff. Readers of balance were asked to take part in a survey at the end of 2010, and the findings of all of this research have informed the development of the new brand.
Top of page: the new Diabetes UK logo. Above: examples of how the charity’s new materials will look
How does the logo work? Central to the new logo (see above) is the strapline ‘care. connect. campaign.’ This is designed to communicate clearly, at a glance, who we are and what we do: we provide care so that people can manage their diabetes effectively, we connect people with diabetes with each other and the services they need, and we campaign and fund research to create a better future for people with diabetes and those at risk.
What can I do to help with the re-brand? We are really grateful to all of our members, supporters and volunteers for their continued support and hope that they will join us in raising the profile of Diabetes UK and diabetes – the most serious health risk of our time. i Diabetes UK welcomes any comments and questions by email to brand@diabetes.org.uk.
January – February 2012 balance 27 26-27 Brand review KF.indd 27
09/01/2012 16:13
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10/01/2012 12:31 02/12/2011 10:12
are ld
g
e
11 10:12
feature
When Steve Craftman, 55, (left) developed Type 2 in 2007, he knew exactly what had caused it – the early antiretroviral medicines he took to treat his HIV. As he tells balance, it was the price he had to pay to stay alive
HIV, diabetes & me
W
hen my little brother was diagnosed with Type 1 in the early 1980s, I knew very little about diabetes. There was no family history of the condition, and once he had it under control, the subject rarely came up. It never crossed my mind that, 25 years later, I’d develop diabetes too. Back then I also knew very little about human immunodeficiency virus (HIV) – identified in 1981 as the virus that can cause Aids – nobody really did. In 1986, I heard that a man I’d had a fling with the year before had died of an Aidsrelated illness and I thought, ‘well, if I didn’t have it before, I’ve sure got it now’. I had the test and, as I expected, it was positive. Like many gay men at that time, I felt resigned to the news. Received wisdom was that you had about five years left to live once you were diagnosed. The key thing became
stopping others from getting it while looking after ‘our own’.
Experimental medicine In the knowledge that there was apparently nothing that could stop HIV wrecking our immune systems, we learned to clutch at straws. Often the patients knew as much as or more than the doctors. Nobody knew the correct doses of the antiretroviral drugs that were slowly being discovered, and many of us were overdosing on these toxic drugs. By 1998, I’d been through pretty much every drug available and had lived way past my ‘dead-by date’. I then started on a new class of drugs: protease inhibitors. I was warned that research showed all protease inhibitors, while effective against HIV, had the side effect of causing metabolic changes, especially hyperlipidaemia (high levels of blood fats) and hypergylcaemia (high blood glucose). But who cared?
Diabetes, heart disease, high blood pressure, lipodystrophy (changes in body shape) and the rest were better than your own funeral. The following year my cholesterol level started to climb, but so did my CD4 count (at the time this was considered the most important figure in assessing how well a drug was working). Even though the drugs made me feel ill and put me at risk of diabetes and high blood pressure, I stuck with them because they were doing some good.
Life changes In 2003, my partner, John, discovered that he had a longstanding HIV infection. He was already very ill and died in the spring of 2007. After four years as John’s sole carer, I wanted not to have to remember things, to sleep around the clock if I felt like it, so I immediately went on a treatment ‘holiday’. For the drugs to work, you
»
January – February 2012 balance 29 28-31 Feat HIV KFfinal.indd 29
10/01/2012 12:31
Balance
feature can only afford to miss one dose per month, at most two, otherwise there’s the risk of resistance developing; I couldn’t see myself remembering every dose so I decided it was safer to stop them altogether. Despite this, I still went to the HIV clinic every three months for blood tests.
recommended eating patterns (the very idea of breakfast makes me feel ill). Together, we’re still working out how to deal with diabetes and HIV. It was only a couple of years ago that my DSN casually mentioned that when the body is fighting an infection, blood glucose levels are
I knew what had brought on my diabetes: I’d taken the chance with the antiretrovirals and this was the price of staying alive In October 2007, after a usual clinic appointment, I received a phone call: “Steve, get to your GP straight away – you have Type 2 diabetes.” My GP confirmed that a fasting blood glucose reading of 20mmol/l was pretty conclusive and put me on gliclazide. My CD4 count had dropped by about three-quarters at this point, and my viral load (a measure of HIV nucleic acid, which monitors the status of HIV) had increased to levels that were not unsafe but of concern. My treatment ‘holiday’ was over: I immediately went back on the antiretrovirals. I believe I developed diabetes in 2004 – my fasting blood glucose had been up in the ‘diabetic range’ since then but had somehow been overlooked. At the time, I put my bad temper down to the stress of looking after a very sick partner and paid little attention to the amount of fizzy drinks I was getting through, my frequent peeing and my ability to eat a pack and a half of biscuits with one cup of tea. I knew what had brought on my diabetes: I’d taken the chance with the antiretrovirals and this was the price of staying alive.
Living with HIV & diabetes My GP and I reviewed my diet and it turned out that little had to be changed as I already ate relatively healthily. My diabetes specialist nurse (DSN) is a gem – she’s always checking that my HIV prescription hasn’t changed, grateful for feedback I bring her on the connection between the two conditions, and aware that I can’t stick to the
30 balance
higher. And I’d spent all that time fretting over an 8mmol/l–16mmol/l range in the first couple of years. Unfortunately, there seems to be little communication between my HIV and diabetes clinics. I’m in favour of total information exchange between them but it doesn’t happen because it would be ‘breaking confidentiality’. Please, let’s all work together here! The more I talk to other people with HIV, the more people I find with both conditions. Had we not taken those early antiretroviral drugs, we probably wouldn’t have diabetes. However, we’d also probably be dead or dying. The link isn’t readily
recognised, partly I believe because those early drugs also cause lipodystrophy, where you lose fat from your arms, legs and face only to have it deposit around your internal organs. I look like I have a beer belly but all the fat is behind the muscle wall. People who don’t know otherwise probably assume I have diabetes because I got fat. I’m now in control of my diabetes; my last HbA1c was 39mmol/mol (5.7 per cent) and my last cholesterol reading was 4.4mmol/l. My main health problems are side effects of anti-HIV drugs. I would recommend anyone with HIV and/or diabetes and HIV to visit www.myhiv.org.uk, a user-led site, and join the forums there. HIV groups are far more tuned into diabetes than the other way around. This month marks 25 years since I was diagnosed with HIV, and I’m proud of every grey hair I’ve got. Both conditions need some serious thought and a lot of effort, but it is possible to live with them both – something I intend to do for quite some years yet. As told to Kate Flagg
The rise of diabetes in people with HIV Alastair Duncan, Principal Dietitian at Guy’s and St Thomas’ NHS Foundation Trust and HIV nutrition specialist, explains... In the 30 years since the first cases of HIV infection were reported, treatments have developed apace and now highly effective antiretroviral medicines (ARVs) are available to suppress HIV, allowing the immune system to recover and offering people living with HIV the chance of attaining a near-normal life expectancy. As a direct result of this improvement in life expectancy, it is estimated that 100,000 people in the UK are now living with HIV. A substantial minority of people with HIV will develop metabolic complications such as high cholesterol, osteoporosis, lipodystrophy and diabetes. As Steve mentions, these are sometimes due to treatment with particular ARVs, and so many of these are now avoided, wherever possible. However, other factors can lead to diabetes in HIV. Firstly, perhaps surprisingly, obesity is increasingly common in people living with HIV. Secondly, a topic of current research is a process of premature ageing being observed in those living with HIV – it is estimated that development of Type 2 diabetes and other conditions associated with older people is happening on average 15 years earlier than expected, but it is not yet known why. Diabetes and other metabolic abnormalities are now the main cause of ill health and mortality due to HIV in the developed world. In addition to the website Steve mentions, I would recommend anyone interested in finding out more to head to the UK-based National Aids Manual, which is aimed at healthcare professionals and the public alike: www.aidsmap.com.
January – February 2012
28-31 Feat HIV KFfinal.indd 30
10/01/2012 12:31
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10/01/2012 12:31
are ld
g
e
11 10:12
feature
When Steve Craftman, 55, (left) developed Type 2 in 2007, he knew exactly what had caused it – the early antiretroviral medicines he took to treat his HIV. As he tells balance, it was the price he had to pay to stay alive
HIV, diabetes & me
W
hen my little brother was diagnosed with Type 1 in the early 1980s, I knew very little about diabetes. There was no family history of the condition, and once he had it under control, the subject rarely came up. It never crossed my mind that, 25 years later, I’d develop diabetes too. Back then I also knew very little about human immunodeficiency virus (HIV) – identified in 1981 as the virus that can cause Aids – nobody really did. In 1986, I heard that a man I’d had a fling with the year before had died of an Aidsrelated illness and I thought, ‘well, if I didn’t have it before, I’ve sure got it now’. I had the test and, as I expected, it was positive. Like many gay men at that time, I felt resigned to the news. Received wisdom was that you had about five years left to live once you were diagnosed. The key thing became
stopping others from getting it while looking after ‘our own’.
Experimental medicine In the knowledge that there was apparently nothing that could stop HIV wrecking our immune systems, we learned to clutch at straws. Often the patients knew as much as or more than the doctors. Nobody knew the correct doses of the antiretroviral drugs that were slowly being discovered, and many of us were overdosing on these toxic drugs. By 1998, I’d been through pretty much every drug available and had lived way past my ‘dead-by date’. I then started on a new class of drugs: protease inhibitors. I was warned that research showed all protease inhibitors, while effective against HIV, had the side effect of causing metabolic changes, especially hyperlipidaemia (high levels of blood fats) and hypergylcaemia (high blood glucose). But who cared?
Diabetes, heart disease, high blood pressure, lipodystrophy (changes in body shape) and the rest were better than your own funeral. The following year my cholesterol level started to climb, but so did my CD4 count (at the time this was considered the most important figure in assessing how well a drug was working). Even though the drugs made me feel ill and put me at risk of diabetes and high blood pressure, I stuck with them because they were doing some good.
Life changes In 2003, my partner, John, discovered that he had a longstanding HIV infection. He was already very ill and died in the spring of 2007. After four years as John’s sole carer, I wanted not to have to remember things, to sleep around the clock if I felt like it, so I immediately went on a treatment ‘holiday’. For the drugs to work, you
»
January – February 2012 balance 29 28-31 Feat HIV KFfinal.indd 29
10/01/2012 12:31
Balance
feature can only afford to miss one dose per month, at most two, otherwise there’s the risk of resistance developing; I couldn’t see myself remembering every dose so I decided it was safer to stop them altogether. Despite this, I still went to the HIV clinic every three months for blood tests.
recommended eating patterns (the very idea of breakfast makes me feel ill). Together, we’re still working out how to deal with diabetes and HIV. It was only a couple of years ago that my DSN casually mentioned that when the body is fighting an infection, blood glucose levels are
I knew what had brought on my diabetes: I’d taken the chance with the antiretrovirals and this was the price of staying alive In October 2007, after a usual clinic appointment, I received a phone call: “Steve, get to your GP straight away – you have Type 2 diabetes.” My GP confirmed that a fasting blood glucose reading of 20mmol/l was pretty conclusive and put me on gliclazide. My CD4 count had dropped by about three-quarters at this point, and my viral load (a measure of HIV nucleic acid, which monitors the status of HIV) had increased to levels that were not unsafe but of concern. My treatment ‘holiday’ was over: I immediately went back on the antiretrovirals. I believe I developed diabetes in 2004 – my fasting blood glucose had been up in the ‘diabetic range’ since then but had somehow been overlooked. At the time, I put my bad temper down to the stress of looking after a very sick partner and paid little attention to the amount of fizzy drinks I was getting through, my frequent peeing and my ability to eat a pack and a half of biscuits with one cup of tea. I knew what had brought on my diabetes: I’d taken the chance with the antiretrovirals and this was the price of staying alive.
Living with HIV & diabetes My GP and I reviewed my diet and it turned out that little had to be changed as I already ate relatively healthily. My diabetes specialist nurse (DSN) is a gem – she’s always checking that my HIV prescription hasn’t changed, grateful for feedback I bring her on the connection between the two conditions, and aware that I can’t stick to the
30 balance
higher. And I’d spent all that time fretting over an 8mmol/l–16mmol/l range in the first couple of years. Unfortunately, there seems to be little communication between my HIV and diabetes clinics. I’m in favour of total information exchange between them but it doesn’t happen because it would be ‘breaking confidentiality’. Please, let’s all work together here! The more I talk to other people with HIV, the more people I find with both conditions. Had we not taken those early antiretroviral drugs, we probably wouldn’t have diabetes. However, we’d also probably be dead or dying. The link isn’t readily
recognised, partly I believe because those early drugs also cause lipodystrophy, where you lose fat from your arms, legs and face only to have it deposit around your internal organs. I look like I have a beer belly but all the fat is behind the muscle wall. People who don’t know otherwise probably assume I have diabetes because I got fat. I’m now in control of my diabetes; my last HbA1c was 39mmol/mol (5.7 per cent) and my last cholesterol reading was 4.4mmol/l. My main health problems are side effects of anti-HIV drugs. I would recommend anyone with HIV and/or diabetes and HIV to visit www.myhiv.org.uk, a user-led site, and join the forums there. HIV groups are far more tuned into diabetes than the other way around. This month marks 25 years since I was diagnosed with HIV, and I’m proud of every grey hair I’ve got. Both conditions need some serious thought and a lot of effort, but it is possible to live with them both – something I intend to do for quite some years yet. As told to Kate Flagg
The rise of diabetes in people with HIV Alastair Duncan, Principal Dietitian at Guy’s and St Thomas’ NHS Foundation Trust and HIV nutrition specialist, explains... In the 30 years since the first cases of HIV infection were reported, treatments have developed apace and now highly effective antiretroviral medicines (ARVs) are available to suppress HIV, allowing the immune system to recover and offering people living with HIV the chance of attaining a near-normal life expectancy. As a direct result of this improvement in life expectancy, it is estimated that 100,000 people in the UK are now living with HIV. A substantial minority of people with HIV will develop metabolic complications such as high cholesterol, osteoporosis, lipodystrophy and diabetes. As Steve mentions, these are sometimes due to treatment with particular ARVs, and so many of these are now avoided, wherever possible. However, other factors can lead to diabetes in HIV. Firstly, perhaps surprisingly, obesity is increasingly common in people living with HIV. Secondly, a topic of current research is a process of premature ageing being observed in those living with HIV – it is estimated that development of Type 2 diabetes and other conditions associated with older people is happening on average 15 years earlier than expected, but it is not yet known why. Diabetes and other metabolic abnormalities are now the main cause of ill health and mortality due to HIV in the developed world. In addition to the website Steve mentions, I would recommend anyone interested in finding out more to head to the UK-based National Aids Manual, which is aimed at healthcare professionals and the public alike: www.aidsmap.com.
January – February 2012
28-31 Feat HIV KFfinal.indd 30
10/01/2012 12:31
S
“
“ “ “ “
feature
The
discovery that
changed our world
The discovery of insulin saved the lives of millions worldwide, including Teddy Ryder, pictured before (left) and after treatment (right) in 1923
Ninety years ago, the hormone that has saved the lives of millions of people with diabetes was uncovered in a tiny laboratory just outside of Toronto, Canada. Liz Bestic reports on the discovery of insulin
T
oday, it is hard to believe that prior to the discovery of insulin, a diagnosis of Type 1 diabetes was a death sentence. But, previously, the only way to control diabetes had been through a diet extremely low in carbohydrates and sugar, and high in fat and protein – this only usually gave people a year to live, and many died of starvation before then. It was established in the late 19th century that there was a connection between the pancreas and diabetes. In 1889, scientists Oskar Minkowski and Josef von Mering, while studying fat metabolism, discovered, by chance, that removing a dog’s pancreas caused diabetes in the animal. Further research suggested that the pancreas must have at least two functions: to
produce digestive juices and to secrete a substance that regulates blood glucose. Then, in 1869, medical student Paul Langerhans discovered that within the pancreatic tissue that produces digestive juices, there were clusters of cells whose function was unknown. In 1893, Gustave Laguesse suggested that these cells, which he named the ‘islets of Langerhans’, produce the glucose-regulating substance later known as insulin. Over the following 30 years, scientists attempted to isolate and extract the substance which was to hold the key to treating diabetes, but failed. Then, in October 1920, Canadian surgeon Frederick Banting approached John James Rickard Macleod, Professor of Physiology in Toronto, with a new research idea. He suggested that the
1922
1921
Frederick Banting’s research team discovers insulin
1920
32 balance
14-year-old Leonard Thompson becomes the first person to receive insulin
pancreatic digestive juices were destroying the substance produced by the islets of Langerhans before it could be found. Banting intended to stop the pancreas from working but keep the islets of Langerhans functioning in order to locate the elusive secretion. Macleod first scoffed at this idea, but eventually provided Banting with a sparsely equipped laboratory, medical assistant Charles Best and 10 dogs on which to perform experiments. The two scientists began their experiments in May 1921 and made quick progress. They surgically stopped the flow of nourishment to a dog’s pancreas so that it lost its ability to secrete digestive juices (in order to isolate the glucoseregulating substance). They then
1934
1923
In the UK, insulin becomes generally available. In the same year, Banting and Macleod are awarded the Nobel Prize for Medicine for its discovery
The British Diabetic Association (now known as Diabetes UK) is formed. The first meeting of the Association was convened at the Baker Street flat of HG Wells, author of The Time Machine, who was diagnosed with diabetes in his early 60s
1930
January – February 2012
32-37 Feat InsulinColour JC.indd 32
10/01/2012 14:49
90
YEARS OF
INSULIN
Millions of people with diabetes worldwide continue to live long and healthy lives as a result of the team’s discovery removed the dog’s pancreas, chopped it up and froze it in a mixture of water and salts. When half-frozen, the pieces were ground, filtered and named ‘isletin’. The next step was to inject isletin into the dog that had diabetes (due to having its pancreas removed). The canine’s blood glucose level dropped and it became healthier and stronger. The men continued giving the dog a few injections a day and reported that it remained free of symptoms. Banting and Best repeated the experiment several times. The results were the same, but there were some problems due to the varying purity of the isletin. To solve this problem, Macleod enlisted biochemist James Collip to help with purification, and the team renamed the substance ‘insulin’, from the Latin word for island, ‘insula’.
Time to test By late 1921, the team had conclusively proved that diabetes was a condition brought on by insulin deficiency – it was time to test the new substance, derived from a cow’s pancreas, on humans. Leonard Thompson, a 14-year-old diagnosed with Type 1 diabetes in 1919, was the first person to be successfully treated with the new wonder drug [see box, right].
In 1923, Banting and Macleod were jointly awarded the Nobel prize for Medicine. Banting, however, felt that the prize should have been shared between himself and Best, so he gave credit to his assistant by sharing his cash reward with him. Macleod did the same with Collip. Banting and his team patented their insulin extract, but gave away all rights to the University of Toronto, which later used the income to fund further research into insulin. Soon after, medical firm Eli Lilly began large-scale production of the extract.
Synthesising In 1963, researchers managed to produce insulin chemically in a laboratory, but they could not make enough for it to be viable. At that time, insulin was extracted from pigs and cattle, and though animal
Leonard Thompson By 1922, Leonard Thompson (pictured right) had already been living with diabetes for three years. His condition was rapidly deteriorating and he was admitted to Toronto General Hospital weighing around 4.6st (65lb). The teenager was close to slipping into a diabetic coma and waiting to die when his father let the hospital try out Banting and Best’s pancreatic extract for the first time. Initially, Thompson had an allergic reaction and the insulin seemed to have little effect. But a few days later he was injected with a purer form and his blood glucose gradually returned to normal and his symptoms began to disappear. News of his recovery spread, causing people with diabetes and their families to write letters to the two scientists begging for urgent treatment. Leonard Thompson went on to live for another 13 years using insulin but sadly died of pneumonia – believed to have come about as a result of his diabetes – at the age of 27.
1955
1939-1945 World War II
1940
insulin worked well, it was not an exact match with the human hormone and sometimes caused adverse reactions, such as skin rashes. In 1977, researchers succeeded in manufacturing human insulin, by inserting the genes that code for human insulin into bacteria and yeast cells. This allowed its production on a much bigger scale. The resulting commercial product, brand-named Humulin, revolutionised the treatment of diabetes as it caused fewer side effects. While Best continued to have a successful career, Banting’s life was cut tragically short when he died in a plane crash at the age of 41. But his legacy lives on, and millions of people with diabetes worldwide continue to live long and healthy lives as a result of his team’s discovery. i Turn over for more on today’s insulin research.
Researchers at the University of Cambridge identify the chemical structure of the insulin molecule
1956
Researchers in New York developed the radioimmunological assay (RIA) procedure, which measures insulin with greater precision than ever before
1957
Frederick Sanger receives the Nobel Prize for chemistry in recognition of his achievements, which included identifying the chemical structure of the insulin molecule in 1955
1950
1960 January – February 2012 balance
32-37 Feat InsulinColour JC.indd 33
33
10/01/2012 14:49
Image: Sci-Comm Studios / SPL
...And now the science... Since its discovery, insulin has been the subject of numerous scientific breakthroughs. Richard Elliott looks at what is special about the molecule and talks to three researchers studying its role in diabetes
I
nsulin, a hormone secreted by the pancreas, is at the heart of all forms of diabetes. Type 1 occurs when the body produces little or no insulin, whereas Type 2 is caused by impaired insulin production and resistance to the insulin that is produced. As a result, people with Type 1 and more than 40 per cent of people with Type 2 require insulin injections to manage their condition. As insulin plays such an important role in the development and treatment of diabetes, scientists all over the world have strived for many years to learn all they can about it. Since its discovery in 1921 and its first use to treat diabetes in 1922, major scientific breakthroughs have helped determine the exact threedimensional structure of insulin and the key sites at which it takes effect. Moreover, technological advances have enabled production of human insulin, and the creation of devices to improve safety and comfort when injecting it into the body.
You could even say that insulin is intimately connected with research into human biology. It was the first protein ever to be sequenced (by British biochemist Frederick Sanger in 1955), and the first protein ever to be artificially produced in the laboratory (by US and German scientists in the early 1960s). However, despite all we have learned about insulin in the past 90 years, there is much we still do not know about the role of this molecule in diabetes. Three Diabetes UKfunded researchers provide their insights on the progress being made...
Looking back – and forward Professor Ken Siddle at the University of Cambridge has been working as a biochemist for more than 40 years and has seen how scientific research has slowly advanced our understanding of insulin. “When I began my career, we knew almost nothing about how insulin worked,” he says. “We knew that it stimulated
1959
Dr Paul Lacy of Washington University used antibodies to ‘stain’ parts of the pancreas under the microscope and identify the different cell types within the islets of Langerhans
1950
1963
With funding from the British Diabetic Association (as Diabetes UK was formerly known), Cambridgebased researchers modify a technique for measuring insulin levels, which contributes to insulin’s commercialisation and use worldwide
1960
34 balance
glucose uptake into cells but really had no idea how it did it. In the last 40 years we’ve learned that there are insulin receptor proteins on the surface of cells, we’ve learned what sort of proteins these receptors are and what sort of signals they produce inside the cell. We also understand the structure of insulin itself in incredible atomic detail. But there are still lots of unanswered questions about how insulin is made in the beta cells of the pancreas and how it acts on muscle, liver and fat.” Naturally occurring variation in the genetic code within the body’s cells contributes to a wealth of human diversity (such as differences in eye colour) but also contributes to the risk of health conditions like diabetes. With help from Diabetes UK, Prof Siddle has been exploring the ways in which this variation can influence the action of insulin and similar proteins known as ‘insulinlike growth factors’ that are involved in cell signalling. He has also studied the insulin receptor on the cell surface and the way that it binds insulin and activates the signalling pathways that control glucose uptake and
1967
Washington University researchers discover how to isolate the islets of Langerhans, paving the way for human islet cells for transplantation
1970
January – February 2012
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90
YEARS OF
Image: Sci-Comm Studios / SPL
INSULIN other aspects of cell signalling. molecule that scientists are keen to Though research like this is concerned learn more about. When insulin is with only one small part of a large first produced in the pancreas, it is and complex field, Prof Siddle hopes initially known as proinsulin and is that his work will help improve our bound to another protein molecule understanding of the pathways that known as C-peptide [see diagram, determine insulin sensitivity and right]. This short molecule helps join resistance. “We want to understand the two chains of the developing the basic biochemical and molecular insulin together and allows them to pathways that underpin insulin assemble with the correct shape and action,” he says. “If we can do that, structure. C-peptide is then detached then we will have a framework for from insulin and both molecules are understanding how such pathways released into the bloodstream. malfunction in diabetes. In the Until recently, there was little future, such pathways could be interest in the function of C-peptide targeted by novel treatments or and it has been used only as a marker provide early indications of diabetes of insulin production, since the to allow people to modify their pancreas tends to release C-peptide lifestyles in ways that would help and insulin in roughly equal amounts. prevent the onset of the condition.” Like insulin, people with Type 1 Overall, Prof Siddle is optimistic diabetes produce little or no C-peptide, about the future. Within the next while those with Type 2 may be 10–20 years he resistant to its Despite all we have learned actions. Therefore, thinks that there will be about insulin, there is much when people are both better newly diagnosed we still do not know definitions of with diabetes, the different doctors often give causes of diabetes and a wider range them a C-peptide test to work out of drugs available for targeting those how much insulin they are producing causes. “That involves a very long and help determine whether they process,” he says, “because there just have Type 1 or Type 2. aren’t enough hours in the day and Recent scientific evidence suggests scientists in the world to follow up that C-peptide can help prevent every interesting lead. It’s a matter diabetes-related complications, such of using scarce resources effectively as nerve and kidney damage, but the and getting the right people to filter details of how this occurs are yet to out the right bits of information – be revealed. Professor Nigel Brunskill that’s the art of good science.” at the University of Leicester describes C-peptide as a ‘partner’ to insulin C-peptide and suggests that, contrary to past Although we know a lot about the assumptions, it could play an active structure and function of insulin role and potentially become a useful itself, there is one insulin-related treatment for diabetes. “It has become
1972
First successful islet transplant in rats
1974
First human islet cell transplant performed in the US – it only works for a short time before the patient’s immune system destroys the new cells
1980
1978
First tests of an insulin pump take place at Guy’s Hospital in London
Left: Computer model of insulin molecule. Above: The basic structure of proinsulin. The two chains that go on to form insulin are in pink and C-peptide is in green clear over the last few years that C-peptide has very important biological functions in the body and seems to affect cells and tissues in a way that would be beneficial in someone who has diabetes,” he explains. Diabetes UK is funding Prof Brunskill’s research into the cellular proteins that C-peptide binds to and the ways that resistance to it can develop. “Insulin binds to cells through a receptor and alters the way that cells function,” he says. “We believe that C-peptide functions in a similar way, so to unlock its promise we need to understand much more about how it interacts with cells and changes their function.”
Puzzle of glucose uptake Professor Gwyn Gould’s team at the University of Glasgow focuses on steps that occur after insulin has bound to receptors on the surface of fat and muscle cells. Insulin binding brings about changes within each cell, which cause them to take up glucose from the bloodstream and store it. Prof Gould explains the process in simple terms: “Basically, glucose gets into cells through
1979
1989
US biotech company creates bacteria that produces synthetic human insulin
Researchers in Leicester develop a method of purifying human islet cells on a large scale
1990 January – February 2012 balance 35
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90
YEARS OF
INSULIN
what you might imagine as a ‘doorway’ within the cell. Insulin increases the number of ‘doorways’ so that each cell can get more glucose inside. It does this by moving these ‘doorways’ from a storage site within the cell up to the cell surface.” Scientists
Insulin: the facts • Insulin consists of two linked chains of amino acids, the building blocks of all proteins. • The A chain (21 amino acids) and the B chain (30 amino acids) of human insulin differ from pig insulin at only one position and from cow insulin at only three positions. Until the 1980s, animal insulins were the only form of insulin available to treat diabetes. • Today, human insulin is used most commonly. This is manufactured by inserting the genes that code for human insulin into bacteria or yeast cells, which then produce human insulin on a huge scale. • In a dilute solution, such as the bloodstream, insulin exists as a single molecule, which is the form in which it actively regulates blood glucose. • In a concentrated solution, such as in a vial of regular insulin for injection, six insulin molecules cluster together to form a large molecule (see diagram, page 34). This form of insulin takes time to break apart into insulin subunits that are small enough to be absorbed into the bloodstream, meaning it could take up to 30 minutes for an injection of regular insulin to work. • To solve this problem, scientists have produced forms of insulin that do not cluster together and therefore take effect more rapidly after injection. • Other modifications allow the production of delayed-acting or long-acting insulins that stay in the bloodstream for longer and have a more prolonged influence on blood glucose levels. • Many different forms of insulin are available today and people with diabetes may be prescribed mixtures of various insulins at different times of day to help them control their blood glucose levels.
2001
The Diabetes UK Islet Transplant Consortium is launched to ensure that islet transplants become available in the UK
2006
2005
Exubera, the long-awaited inhaled insulin, is introduced in the UK, but is withdrawn in 2007 because of weak sales
King’s College Hospital carries out the first successful islet transplant in a person with Type 1
2000
36 balance
believe that defects in the movement of these ‘doorway’ proteins could bring about the insulin resistance that causes Type 2 diabetes; but the exact steps by which this occurs and the ways in which these ‘doorway’ proteins do not function properly in diabetes are poorly understood. Diabetes UK funds several studies in Prof Gould’s lab that aim to give a more detailed picture of what is going on. “The ‘doorways’ are packaged in little membrane parcels inside the cell,” he says, “and so what we first seek to understand is the mechanism by which that packaging is achieved. Then we want to understand the mechanism by which the packages move to the cell surface.” Prof Gould emphasises the complexity of the challenges faced by his team. “Although we have a number of the molecules identified and we have a fair idea of how they might work, it’s a bit like a jigsaw that’s half finished – you can see what the picture is but you can’t really see the absolute detail yet. Without that clear detail, it’s very hard to design an effective therapy or engineer a cure. What we are trying to do, in our very small way, is to put a few more pieces in the jigsaw.” When he looks back at the last 10 years of progress related to insulin and diabetes, Prof Gould believes that what has been really striking is the ability of researchers to do science, like the Human Genome Project, on a huge scale. “That sort of big biology has really opened up a whole bunch of new questions. Now it’s important to go back to the small-scale biology: the individual
one molecule–one protein at a time approach.” He also suggests that, as our knowledge about the action of insulin in diabetes develops, the scope of research in this area and the range of different experts involved is growing. “The links between different fields are becoming much more extensive and more intertwined than we ever imagined and that I think is really exciting,” he says. “Some of these big links are going to be really hard to address and there is a huge amount to be done, but it’s a fascinating time.”
Moving research forward In 2011 Diabetes UK aimed to spend £5.8m on research projects related to all aspects of diabetes, including insulin. The charity’s current research portfolio costs about £20m and includes around 125 different grants Dr Iain Frame, Diabetes UK’s Director of Research, emphasises the vital role of the charity in helping research move forward: “It’s important that, when people like Prof Siddell, Prof Brunskill or Prof Gould have a hunch that something might work and an idea for a set of experiments, they can come to us and ask for money to help them prove or disprove their theories. Through the voluntary contributions that people make to us, we can continue to fund these excellent research projects that will hopefully make a huge difference for people living with diabetes.” i Learn more about C-peptide and Prof Brunskill’s work at www.diabetes.org.uk/ unlock-the-promise. • Learn more about and help support Diabetes UK-funded research at www.diabetes.org.uk/research.
2007
Researchers in France discover that insulin can be delivered orally in rats by binding it with a specially formulated chemical mixture
2008
Islet cell transplantation was made available on the NHS for people with Type 1 diabetes who have lost their hypoawareness
2012
?
2010
January – February 2012
Ch
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2012
?
Take part in our diabetes trials and experience a different level of service Do you have diabetes? By taking part in diabetes research with Novo Nordisk, a world leader in diabetes care, you could help us to develop medicines that may benefit you and others like you. You can be sure the research teams we work with will keep a very close eye on your diabetes. What’s more, you could get access to potential future treatments during the trial period as well as learning more about your condition.
Call free now on 0800 088 7610 to find out if you are eligible to be involved in our clinical trials. Together we can change the future of diabetes.
www.novonordisk.co.uk Changing DiabetesÂŽ is a registered trademark of Novo Nordisk
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UK/DB/0310/0232 Date of Preparation: March 2010
10/01/2012 14:49
life&health Ready,
steady,
RUN!
As Diabetes UK kicks off 2012 as the nominated charity for the Bupa Great Run Series, balance heads to the starting line
W
e all need to do some form of physical activity. For general health, the recommended minimum for adults is 30 minutes of moderateintensity physical activity on at least five days of the week. Not only will this help you to manage your diabetes and prevent long-term complications, other benefits include a trimmer waistline, a strengthened cardiovascular system, improved muscle tone and a positive mental attitude. Running ticks all those boxes. It’s also free, which makes it a popular choice. You just need a good
BEGINNER TO 10K RACE TRAINING GUIDE WEEK WEEK WEEK 1 2 3 Mon Tue Run 15 mins, Run 18 mins, Run 30 walk 1–2 mins, walk 1–3 mins, mins run 15 mins run 18 mins Wed Thur
Fri Sat Sun
Run 15 mins, Run 18 mins, Run 30 walk 1–2 mins, walk 1–3 mins, mins run 15 mins run 18 mins
Run 2 miles
Run 5km (or 3 miles)
Run 3 miles
pair of trainers and decent support wear, such as a good-fitting sports bra for the ladies, and off you go. Celebrity personal trainer and Bupa representative Dee Thresher (pictured above) tells balance: “Not only is running fun and social, particularly when taking part in a charity run such as the Bupa Great Run Series, it’s easy to get involved in and is great for body and mind. There’s nothing more exhilarating than going for a jog in the local park. For me, it’s a great start to the morning, and a great way to wind down at the end of a busy day.”
WEEK WEEK WEEK WEEK 4 5 6 7 Rest day Run 30 Run 30 Run 30 Run 45 mins mins mins mins
Run 45 mins
Rest day Run 30 Run 40 Run 40 mins mins mins
Run 45 mins
Run 30 mins
Rest day Rest day Run Run 4 40–45 miles mins
Run 10km 10km race (6 miles approx)
Run 50 mins
WEEK 8
Running can be daunting for beginners so it’s recommended to take things slowly. You’ll be amazed how quickly you can build up your stamina. See Bupa’s chart, below, for a guide to training for a 10k (6 mile) run. Of course, you don’t have to set your sights as high as this – you can build up your stamina to suit you and your fitness levels. i Visit www.bupa.co.uk/smartrunner-app for details of Bupa’s Smart Runner app. • www.diabetes.org.uk/bupa-great-runs
HOLD ON... Before you start any new activity, talk to your GP, especially if you: • are taking any diabetes or heart disease medication • have any diabetic complications • have any conditions that may restrict your mobility or ability to be active, eg high blood pressure. You may need to talk to your diabetes team once you are active on a regular basis, in case your diabetes medication needs to be adjusted. Also remember to check your feet after exercise and watch out for blisters and discomfort. See your doctor if you develop any problems. i www.diabetes.org.uk/keeping-active
i For a guide based on your fitness, visit www.bupa.co.uk/running/training/training-programmes.
38 balance
January – February 2012
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life&health
»»»ON««« Strictly not running »TARGET«
As everyone is different, you and your diabetes healthcare team should agree your individual blood glucose level target range. These targets are to be used as a guide only.
» Adults with Type 1 Aim for 4–7mmol/l before meals, and no more than 9mmol/l by two hours after meals.
» Adults with Type 2 Aim for 4–7mmol/l before meals, and no more than 8.5mmol/l by two hours after meals.
» During pregnancy Aim for 3.5–5.9mmol/l before meals, and no more than 7.8 mmol/l one hour after meals.
» Children (under 16) with Type 1 Aim for 4–8mmol/l before meals, and no more than 10mmol/l by two hours after meals.
» Children (under 16) with Type 2 Discuss individual targets with your diabetes healthcare team.
SmartShake giveaway
Of course, running’s not for everyone, but there are many other ways to keep fit
WII WORKOUTS If you don’t fancy going public with your fitness quest, or can’t face that cold weather, there are plenty of DVD workouts available, as well as games for the Nintendo Wii and Sony PlayStation that can monitor your progress. WALKING It’s a great and free way to improve fitness levels – turn to page 52 for our inspiring walking routes.
KETTLEBALL Workouts based around this fitness aid, which originated in Russia for the strong and athletic, are a great way to tone up and improve strength. ZUMBA This fitness programme based on Latin dancing burst onto the scene in the 1990s, and has continued to grow in popularity ever since; it’s one of the most accessible and fun keep-fit classes around.
So, you get to the gym and you have nowhere to put your keys, or you’re out with the kids and want a handy drink container and place to keep an energy snack. SmartShake could be the answer! It’s a sports bottle with three built-in compartments that can store all of this – and balance has 10 to give away. To enter, send your name and address on a postcard or a sealed-down envelope to: SmartShake, balance, Diabetes UK, 10 Parkway, London NW1 7AA, by 17 February 2012. The winners will be picked at random WIN! and notified within 14 days.
Can I… have sports drinks? Yes – if you’re a devoted sports person, ‘sports drinks’ can help to optimise your physical performance, but they will raise your blood glucose levels and they’re not always necessary. It’s important to stay well-hydrated during exercise by drinking fluid to replace what’s lost through sweating. However, for low- to moderate-intensity exercise lasting less than an hour, water is generally sufficient. For moderate- to high-intensity exercise lasting more than 60 minutes, a sports drink may be useful. Sports drinks usually contain water, carbohydrate (sugar) and electrolytes (potassium and sodium) to rehydrate the body. Isotonic sports drinks (such as Lucozade Sport or Gatorade) are a better choice, as they contain similar levels of salt and sugar as in the body. There are many isotonic drinks on the market, but it’s a lot cheaper to make your own using 200ml ordinary fruit squash (not low-calorie), 800ml water and a pinch of salt. No matter which isotonic drink you choose, remember to stick to the same one. That way, you will soon get to know how much carbohydrate your body needs for a particular activity in order to maintain blood glucose levels.
January – February 2012 balance 39 38-41 Life and HealthColour.indd 39
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life&health
Diabulimia Recent research shows that up to 30 per cent of under 30s with Type 1 may be skipping their insulin injections to lose weight or have in the past. balance takes a looks at the devastating consequences
D
iabulimia is a disorder in which people with Type 1 diabetes deliberately give themselves less insulin than they need in order to lose weight. Despite not being officially recognised as a medical condition, it is a serious problem: it’s estimated that about one in three women with Type 1 diabetes under the age of 30 may be abusing insulin because of a fear of weight gain (or have done in the past). But diabulimia is often a hidden condition so these numbers may be higher. And, of course, it can affect men too.
How does it cause weight loss? Insulin is what enables glucose to move from the bloodstream into cells to be converted into energy. If the body doesn’t have enough insulin, it breaks down fat stores to get energy from there instead, causing weight loss.
What are the dangers? When there isn’t enough insulin in the body, blood glucose levels rise, which can lead to life-threatening complications. In the short term, it can cause diabetic ketoacidosis (DKA). As the body breaks down its fat stores for energy – due to a lack of insulin – acidic chemicals called ketones are released into the bloodstream. This leads to breathlessness, vomiting and, eventually, the high level of acidic ketones can lead to unconsciousness and, if untreated, death. In the long term, continuous high blood glucose can damage small and large blood
40 balance
vessels, which increases the chance of serious complications of diabetes such as stroke, blindness, heart attack, kidney disease and amputation.
What are the warning signs?
Typical signs of diabulimia include: • weight loss • fear of gaining weight • distorted perception of body shape or weight • denial of the existence of a problem • changes in personality and mood swings • symptoms of high blood glucose levels – thirst, passing urine frequently (especially at night), extreme tiredness.
Getting help
If you’re stuck in a cycle of skipping your insulin and can’t seem to break out of it, it’s really important that you get some help. You’re risking your health and even your life. • Your family and friends can support you to break the cycle. • Your diabetes healthcare team can refer you to a psychologist if you need or want. • Diabetes UK’s Careline is staffed by trained diabetes counsellors who offer confidential information and support. Call 0845 120 2960, Monday to Friday, 9am to 5pm, or email careline@diabetes.org.uk. • Diabetics with Eating Disorders (DWED): www.diabeticswitheatingdisorders.org.uk.
Lisa Bond, 27, from Dorchester, has overcome diabulimia but has suffered serious consequences “I was diagnosed with Type 1 diabetes when I was 6 years old, and by the time I reached my teens I began to manage my condition without the help of my parents. But I became lax about taking my insulin injections and discovered it was an effective way to lose weight. When I was 19, I lost more than 3st (19kg) by skipping my insulin, and my weight dropped to just 7st (44kg). Although I thought I looked good, my friends and family thought differently. I ended up in hospital several times due my poor blood glucose control. Then I was diagnosed with retinopathy, a complication of diabetes that can lead to blindness, and this shocked me into educating myself and managing my diabetes properly. I needed three eye operations and several sessions of laser surgery to minimise the damage to my eyes. I also developed neuropathy (nerve damage) due to my diabulimia. I now control my diabetes with an insulin pump, which has been life changing, and support that with a balanced diet (lots of fruit, veg, meat, fish and the odd treat), carb-counting, exercise, a positive view and acceptance of my diabetes. Support is also key – it’s really important that people close to me have a good understanding of diabetes. I decided to raise funds for Diabetes UK by not buying clothes for a year and getting people to sponsor me – this was particularly difficult as I worked in a fashion boutique. I also organised a fashion show and donated all the proceeds to Diabetes UK. The fundraising really helped with my journey as it gave me a great sense of achievement and made me feel proud.”
January – February 2012
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Karen Therapist & counsellor
Deepa Dietitian
Cathy Diabetes specialist nurse
METER FOR THE MASSES? When I saw my GP recently, he said I have to change my meter to one being prescribed to all patients – apparently the test strips are cheaper. I’m used to my old one and don’t want to change. Do I have to? Chris, Liverpool Cathy says... This is becoming increasingly common, due to primary care organisations (PCOs) being able to get some test strips a lot cheaper than other brands. This is not ideal, and we would prefer PCOs to allow patient choice; however, the alternative would be for the PCO to restrict the number of test strips it allows people to have. Unfortunately, it is unlikely that your GP will make an exception for you, unless you can make a case why you need to use your old meter. i For further advice, contact the Diabetes UK Advocacy Service on 020 7424 1840 or email advocacy@diabetes.org.uk.
HARDER TO LOSE WEIGHT? I recently joined a slimming club and, initially, the weight fell off. However, despite sticking with the diet, now I can’t shift more than 1lb a week. My slimming club leader says it will be more difficult for me to lose weight as I have Type 2 diabetes. Is this true? Sarah, Wrexham Deepa says… It shouldn’t be more difficult to lose weight just because you have diabetes. However, some Type 2 medications can cause weight gain, so, if you manage your diabetes with tablets, it’s worth discussing this with your doctor or pharmacist in case a change is needed. It may also be worth checking you don’t have another underlying condition, such as an underactive thyroid. If you are
Libby Paediatric diabetes specialist nurse
not taking any medication and have no other medical conditions, then it could be that your weight loss has slowed. Are you increasing your physical activity? Getting active can boost weight loss as well as lowering blood glucose levels. Doing half an hour of physical activity that gets your heart rate up, five times a week, such as brisk walking, or cycling, can really help. But shedding 1–2lb (0.5–1kg) a week is a healthy rate to lose weight, so you are heading in the right direction – you’ve done great so far, stick in there. i See page 44 for a guide to cutting calories and losing pounds.
Some people hide difficult feelings, but that doesn’t mean they are coping LIVING IN CONSTANT FEAR I’m in my 30s and have had Type 1 diabetes for 10 years. I try really hard to monitor, respond and cope with all that goes with it. I have good HbA1C results and, on the surface, I manage OK. However, inside I am terrified. This affects every aspect of my life as I am constantly in fear of dying. I know it sounds over the top, but it’s how I feel. I would be grateful for advice on how to take back control. Clare, via email Karen says… Be reassured that none of this sounds ‘over the top’. You’re having a difficult time and writing down some of the things affecting you is a great step to take – as is getting in touch with other people for help. Many people share your fears. Anxiety can be hugely debilitating and cause people to feel really
ask the experts isolated. As you are finding, this can cause a loss of confidence in day-to-day diabetes management (even though it sounds like your practical management is really good). Some people try to hide difficult feelings, but that doesn’t mean they are coping – often hidden feelings will manifest as anxiety or depression. This can affect people in different ways, but often it can leave you feeling exhausted or that you have no energy; you may have a lack of concentration and find that you are either over-sleeping or not being able to sleep at all. Have you ever had, or been offered counselling? This can be a very important part of diabetes treatment for some people, and many general practices have counselling services, or may be able to refer you. I would certainly urge you to ask your doctor or nurse for more support. You could also contact the British Association for Counselling and Psychotherapy (BACP – see details below). I would also encourage you to consider calling the Diabetes UK Careline, and join the Diabetes UK Facebook page, so you can make contact with and receive support from other people who are feeling/ have felt the same as you. And www.diabetessupport.co.uk is online support group proven to be invaluable to those who use it. With the right support, you can find a healthier balance so that diabetes doesn’t rule your life. i Call Diabetes UK’S Careline on 0845 120 2960, Monday to Friday, 9am to 5pm. • BACP: 0870 443 5252; www.bacp.co.uk. • Counselling directory detailing voluntary sector organisations offering free or low-cost counselling, and private group practices: www.counselling-directory.org.uk.
January – February 2012 balance 41 38-41 Life and HealthColour.indd 41
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Diabetic macular oedema (DMO) What is it? Diabetic macular oedema (DMO) is a common diabetes-related eye complication. It is associated with diabetic retinopathy – when the tiny blood vessels in the retina (the ‘seeing’ part of the eye) become blocked, enlarged and may leak blood or fluid, due to high blood glucose and high blood pressure. If the retinopathy is at or around the macula (the part of the retina that is essential for clear central vision), the fluid leaking from the enlarged blood vessels builds up and causes swelling (macular oedema). This can lead to blurring in the middle, or just to the side of, your field of central vision, and sight loss. However, it is also possible to develop the complication without any significant loss of vision. It is estimated that DMO affects at least 50,000 people in the UK. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the retinopathy progresses.
How can I reduce the risk? You can reduce the chance of DMO developing and progressing by maintaining good blood glucose control and keeping your blood fat and blood pressure levels as near to your agreed target levels as possible. Smoking also plays a major part in eye damage so, if you do smoke, stopping will be extremely helpful.
How is it diagnosed? If you have diabetes, you are entitled to free annual retinal screening. This involves having a photograph taken of the back of your eye to show any signs of diabetic retinopathy. It can also reveal any DMO.
What is Lucentis? Lucentis (a trade name for the medication ranibizumab) is currently the only licensed treatment for DMO in the UK. It is given via an injection into the eye; it only takes a few seconds and feels like a tiny scratch. Lucentis works by preventing the retina from producing a protein known as vascular endothelial growth factor (VEGF). This protein stimulates the growth of new blood vessels when other blood vessels are damaged due to high blood glucose levels. Therefore, inhibiting VEGF can potentially decrease the build up of fluid in the macula and limit sight loss or improve vision. By one month after their first injection, most people notice some improvement in vision – however, patients
should receive further injections monthly until there is no further improvement in vision for three consecutive months. When this happens, the treatment can stop.
How is it treated on the NHS? In August 2011, the National Institute for Health and Clinical Excellence (NICE), which issues guidance on the use of medicines by the NHS, decided not to recommend Lucentis as a treatment option for people with DMO. Lucentis is an expensive drug and it was judged by NICE to be too expensive for its benefits. NICE thinks that the evidence from this drug’s clinical trial, where patients had to have an HbA1c of less than 86mmol/mol (10 per cent), would not be the same in the population who would need to use this drug. For this reason, and others, it thinks that the manufacturer’s model
It is estimated that DMO affects at least 50,000 people in the UK
underestimated the real cost of Lucentis to the NHS and did not recommend it. People who have started treatment with Lucentis may continue to the end of the treatment, but no new patients can start it, unless they pay for the treatment privately.
How are charities responding? Diabetes UK, together with JDRF, RNIB and the Macular Disease Society, is urging the manufacturer of Lucentis (Novartis) to rapidly agree a patient access scheme with the Department of Health and NICE in order to reduce the cost of this treatment to the NHS to ensure that the maximum number of people with DMO can benefit from the treatment without delay. i See News, page 7, for more on NICE’s decision not to recommend Luncentis on prescription. • Download Your Eyes and Diabetes (free) at www.diabetes.org.uk/shop.
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basic care
Breakfast
Morning drink
Tall (12 fl oz) semi-skimmed latte 150Kcal
Tall (12 fl oz) cappuccino with semi-skimmed milk 90Kcal
Save 60 calories
2 wheat biscuits and 85ml (average serving for cereal) semi-skimmed milk 170Kcal
Save175 calories
Snack Medium slice of flapjack (60g) 300Kcal
Save200 calories
SWAP SHOP
Medium slice of malt loaf (35g) 100Kcal
If your clothes are feeling a little tight after some festive indulgence, don’t panic – you can lose those extra pounds by reducing your calorie intake without going hungry
Lunch Prawn mayo sandwich (2 medium slices of bread) 350Kcal
Save 50 calories
Standard-sized chocolate bar (55g) 280Kcal
44 balance
Packet of crisps (30g) 160Kcal
Save100 calories
Low-fat prawn mayo sandwich (2 medium slices of bread) 300Kcal
2 medium slices of toast, 70% fat margarine (20g) and jam (30g) 345Kcal
D
elicious as it may be, festive food tends to be more calorific than everyday food, and as we often eat more of it, it’s hardly surprising that the average weight gain over the festive season is 5lb (2kg)! If you are aiming to lose a few pounds, you’ll need to be aware of your daily calorie intake – and reduce it (a calorie – Kcal – is a unit of energy).
What’s that about calories? 1 medium pear 60Kcal
Save175 calories
2-finger chocolate wafer biscuit 105Kcal
The body uses energy not only for exercise but for everything you do (even breathing and sleeping). The Guideline Daily Amount (GDA) of calories needed per day is 2,000 for women and 2,500 for men (to replace energy used and maintain a healthy weight). However, these recommendations are for average adults of normal, healthy weight; how many calories you need per day can vary greatly depending on your lifestyle, age, height and weight, and level of daily physical activity. A registered dietitian can advise you of your individual need, which will help you to manage your weight. If you consume more calories than you need, the excess will eventually turn to fat, causing weight gain. On the other hand, if you consume less calories than you need, you will lose weight.
January – February 2012
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10/01/2012 12:40
basic care Busting the bulge If you are looking to lose a few pounds to get to a healthier weight, a safe and achievable target is to lose 1–2lb (0.5–1kg) a week. To lose around 1lb a week, you will need to consume 500 calories less per day than your body needs to maintain weight. This is because there are 3,500 calories in 1lb of body fat, so it’ll take seven days of cutting 500 calories per day to lose it. Increasing your physical activity levels will help you to burn off more calories and lose weight more quickly. Beware of cutting calories too low, as this can put your health at risk.
And does it work? Yes. Evidence shows that for successful long-term weight loss, small, realistic changes are crucial. Of course, alongside calorie counting, it’s also important to have a healthy, well-balanced diet that is low in fat, salt and sugar, and high in fruit and veg. And regular physical activity of moderate intensity (for 30 minutes, five times a week) is both good for your health and waistline.
Snack
Dinner 2 grilled pork sausages (80g), boiled potatoes (160g), 2 teaspoons of margarine, serving of peas (70g) and carrots (60g) 420Kcal
Save 105 calories Small roasted chicken breast (85g), boiled potatoes (160g), serving of peas (70g) and carrots (60g) 315Kcal
Bakewell tart 140Kcal
Save85 calories
100g pot of low-fat yogurt 55Kcal
How will it affect my diabetes?
High-street coffee shop skinny blueberry muffin 370Kcal
Save 275 calories
If you manage your diabetes with insulin and/or tablets, you may need your doses to be reduced as you lose weight and become more active. Your diabetes healthcare team can advise you about this. If you require specific advice on your eating habits, or to work out how many daily calories you require, ask your GP to refer you to a registered dietitian.
Swap & save
For successful long-term weight loss, small, realistic changes are crucial
As these examples of food and drink swaps show, you can easily cut your daily calorie intake without necessarily compromising on taste... enjoy!
High-street coffee shop portion of fruit salad 95Kcal
Snack 2 chocolate digestive biscuits 170Kcal
Alcohol Save 75 calories
Glass of medium dry white wine 175ml 130Kcal
1 single (25ml) measure of vodka and slim-line tonic water 55Kcal
Save 70 calories Medium banana 100Kcal
i Download Weight Creeping up on you? (free) at www.diabetes.org.uk/shop.
January – February 2012 balance 45 44-45 Basic Care JC.indd 45
10/01/2012 12:41
recipes Cash-saving cuisine
74p per serving
Inspired by cuisines from around the world, these recipes from Antony Worrall Thompson are great winter warmers (and they won’t break the bank either!)
WIN! These recipes are from The Essential Diabetes Cookbook by Antony Worral Thompson (published by Kyle Cathie Ltd). Turn to page 50 for your chance to win a copy.
46 balance 46-49 Recipes.indd 46
January – February 2012 09/01/2012 19:04
recipes
Griddled courgettes with chickpeas, goat’s cheese & mint Serves 4 • 2.5 portions of fruit & veg per serving • vegetarian • gluten free
• 3 courgettes, cut in 5, sliced lengthways • 2 tbsp extra virgin olive oil • 50g crumbled goat’s cheese • 2 ripe tomatoes, deseeded and diced • 400g tinned chickpeas, drained and rinsed • 1 tbsp chopped, fresh mint • grated zest and juice of 1 lemon • ½ tsp chilli flakes • salt and freshly ground black pepper
1
£1.72 per serving
Pistou soup Serves 4 • 5 portions of fruit & veg per serving • vegetarian • gluten free • suitable for freezing
Preheat a griddle or frying pan, brush the courgette slices with some olive oil and cook for 1–2 minutes each side until grill-marked. Season and arrange onto a large platter. Scatter the courgettes with the goat’s cheese, tomatoes and chickpeas, and drizzle with the remaining olive oil. Sprinkle on the mint, lemon zest and chillies, then drizzle with the lemon juice and adjust the seasoning to taste.
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Per serving (243g) 226kcal / 11.6g protein / 19.1g carbs ( 3.2g sugars) 12.1g fat ( 3.4g 0.8g salt saturates) /
For the pistou sauce
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2 tbsp olive oil 1 large onion, roughly chopped 2 leeks, roughly chopped 4 new potatoes, roughly diced 2 carrots, sliced 1 celery stalk, thinly sliced 1.3 litres vegetable stock 3 bay leaves 1 x 400g tin chopped tomatoes 2 tsp tomato purée 2 courgettes, thickly sliced 85g extra fine French beans, cut into 1cm pieces 50g frozen petit pois 1 x 400g tin cannellini beans, rinsed 1 x 400g tin flageolet beans, rinsed salt and freshly ground black pepper
• 4 garlic cloves • 40g grated Parmesan cheese • 14 fresh basil leaves
1
Heat half the oil in a large saucepan, then add the onion and leeks and cook over a medium heat for 8 minutes, stirring occasionally. Add the potatoes, carrots, celery, stock, bay leaves, tomatoes and tomato purée and stir. Bring to the boil and simmer for 20 minutes. Add the courgettes, French beans, petit pois, and cannellini and flageolet beans, return to the boil and cook for a further 5 minutes. Season to taste. Meanwhile, make the pistou. With a mortar and pestle, or in a mini food processor, blend the garlic, Parmesan and basil together with the remaining oil and a little water, if necessary, to make a smooth paste. Serve a small dollop on top of each bowl of soup.
2 3
Per serving (566g) 354kcal / 20.3g protein / 53.1g carbs 8.1g fat ( 14.1g sugars) 1.9g salt ( 1.3g saturates) /
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January – February 2012 balance 47 46-49 Recipes.indd 47
09/01/2012 19:04
recipes
Crab & tomato linguini Serves 4 • 2 portions of fruit & veg per serving
• • • • • • • • • •
1 tbsp olive oil 3 garlic cloves, sliced 1 small onion, finely chopped 2 mild fresh chillies, deseeded and chopped 1 bay leaf 300ml tomato passata 20 cherry tomatoes, halved 325g dried linguini 325g fresh or tinned white crabmeat salt and freshly ground black pepper
1 £1.53 per serving
Heat the oil in a large frying pan and over a medium heat cook the garlic, onion, chillies and bay leaf until the onion has softened. Add the passata and cook for 8–10 minutes until thickened. Add the cherry tomatoes and cook for 5 minutes.
2
Slow-cooked pork chops with lentils and cider Serves 4 • 2 portions of fruit & veg per serving
• 1 tbsp olive oil • 4 pork chops, about 175g each, (fat and rind removed) • 1 onion, chopped • 1 carrot, sliced • 2 crunchy eating apples, unpeeled and grated • 2 sprigs of fresh sage • 175g puy lentils • 300ml good quality dry cider • 420ml chicken stock • 1 tbsp Dijon mustard • splash of Worcestershire sauce • 100g 0% fat natural Greek yogurt • freshly ground black pepper
1
Heat the oil in a large casserole dish, add the pork chops and brown them all over. Remove the meat from the dish and set aside. Discard any excess fat in the bottom of the pan.
48 balance 46-49 Recipes.indd 48
3
Meanwhile, cook the linguini in boiling salted water for 1 minute less than the packet instructions. Drain. Fold the crabmeat into the sauce, then fold in the pasta with a little cooking water still clinging to it. Stir to combine, check the seasoning and serve.
4
Variations: Try it with prawns or cubes of white fish or salmon. You can add a few peas or chopped beans, at the same time as the tomatoes.
Per serving (399g) 399kcal / 26.2g protein / 66.4g carbs 7.7g sugars) / 5.1g fat ( 0.7g saturates) ( 1.2g salt /
•• •
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£1.87 per serving
2 3
Add the onion, carrot, apple and sage and cook over a moderate heat for 8 minutes. Stir in the lentils, add the cider and stock then bring to the boil. Return the chops to the dish, reduce the heat, cover and cook gently for 1 hour. Remove the chops, cover with foil and set aside to rest. Increase the heat under the casserole dish and boil the sauce to reduce it. Meanwhile, whisk together the mustard, Worcestershire sauce and yogurt, and season with pepper. When the sauce has reduced by half, fold in the yogurt, then return the chops, turn off the heat and season before serving.
4
Per serving (438g) 578kcal / 69g protein
• •
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16.1g fat / 36.8g carbs ( 14.1g sugars) 2.3g salt ( 4.4g saturates ) /
•
January – February 2012 09/01/2012 19:05
recipes
Crumble in a flash 66p per serving
Serves 4 • 2 portions of fruit & veg per serving • vegetarian
• 2 x 227g tins pineapple, drained and lightly crushed • 1 conference pear, diced • 1 dessert apple (Cox, Granny Smith), diced • 110g muesli (unsweetened) • 2 tbsp sunflower seeds • 2 tsp sesame seeds • 100g low-fat Greek yogurt • 2 tbsp runny honey
1
Preheat the oven to 180°C/350°F/ gas mark 4. Mix together the pineapple, pear and apple then spoon the
2
mixture into 4 medium-sized ramekins. Crumble the muesli into a bowl, stir in the seeds, then mix in the yogurt and honey and then spoon onto the fruit. Bake, uncovered, for 20–25 minutes or until golden brown. Serve with a little extra yogurt, if you like.
3
4
Per serving (247.5g) 295kcal / 6.7g protein / 52.7g carbs ( 36.4g sugars) / 7.8g fat ( 1.4g saturates ) 0.1g salt /
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ADVERTISEMENT
46-49 Recipes.indd 49
09/01/2012 19:05
bite-sized
If Antony Worrall Thompson’s recipes have whetted your appetite, balance has five copies of The Essential Diabetes Cookbook to give away. Endorsed by Diabetes UK, the book contains 200 recipes that take their inspiration from around the world. To enter, send your name and address on a postcard or sealed-down envelope to: Diabetes Cookbook, balance, Diabetes UK, 10 Parkway, London NW1 7AA by 17 February. Winners will be picked at random and notified within 14 days.
Gourmet on the go
February Steamed purple sprouting broccoli (leaves and all) is a perfect partner to meat or chicken and potato dishes, and the first rhubarb crops should start to appear.
Smoked salmon & ricotta on wheaten bread
Recipe kindly provided by Tesco Diets
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January Winter stews and soups can benefit from tasty seasonal vegetables: experiment with variations of carrots, celeriac, kale, leeks, squash, mushrooms and onions. And apples and pears are still going strong.
Serves 2 • 2 portions of fruit & veg per serving • not suitable for freezing
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Prepare the salad by combining 50g of cucumber with 10 cherry tomatoes, 2 handfuls of mixed salad leaves (80g) and a sprinkle of chopped dill. Layer ½ tablespoon of ricotta and 25g of smoked salmon on a slice of Irish wheaten bread. Repeat for the second serving. Season both with freshly ground black pepper and a squeeze of lemon juice, then serve with the salad on the side. Per serving (275g): 151Kcal / 11.8g protein / 18.9g carbs ( 3.4g sugars) / 3.4g fat ( 0.9g sats) / 1.4g salt
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January – February 2012
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Diabetes cookbook
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IN
Soup is a great comfort food to help you through those long, cold winter days. It can be healthy, economical and it fills you up, helping to keep the hunger pangs at bay. But bear in mind that if you opt for a low-calorie soup and load up on cream and croutons, you won’t get the health benefit. There are many options when it comes to soup, so check the nutritional values on packets and tins for the healthiest options. Many instant soups are high in salt and can contain up to half your recommended daily salt allowance (3g) in a single portion. An easy option is to go for fresh soups, which are cheap and simple to make – and with plenty of seasonal vegetables in good supply (see right), there’s never been a better time to try. Remember, soups freeze easily so you can cook up a big batch. Bread is the traditional accompaniment to soup – grainy bread is digested more slowly than wholemeal or white bread, so it impacts less on your blood glucose levels and will help to fill you up for longer. i For inspiration, visit www.diabetes.org.uk/recipes and search for ‘soup’.
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Simmering soothers
In season
SNACK ATTACK What’s new on the shelves? Top of the pops
Newly launched Propercorn is high in fibre, 100 per cent wholegrain and less than 100 calories per pack. Flavours include: Fiery Worcester Sauce & Sun Dried Tomato, Sweet & Salty, Sour Cream & Chive and Lightly Sea Salted. Available from retailers nationwide (RRP 95p)
Skinny dipping
Get cracking
New Skinny Dippers from Skinny Cow are a lower-calorie alternative to satisfy your cravings. Chocolate and caramel ice desserts dipped in chocolate, they’re only 65 calories per dipper! Available from all good supermarkets (RRP £2.29 for a pack of eight)
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Sakata Japanese rice crackers are gluten-free and available in four tasty flavours: Sour Cream and Chive, Cheddar, Classic Barbecue and Plain. Only 9 calories a cracker but beware, they’re moreish! Available from Waitrose and Ocado in 100g trays (RRP £1.99)
Valentine’s special (14 Feb!)
2 oysters and 175ml sparkling white wine (approx 140Kcal)
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40-min romantic stroll around the park
In fact using 4-6 sprays in your pan instead of poured oil will save up to 120 calories. So you can still enjoy some of your favourite recipes - and keep in control of your diet! Versatile FryLight® is available in four varieties:
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50-51 Bite sized.indd 51
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travel
WALKS OF
ART Lowry Trail, Berwick
WHERE: Berwick-upon-Tweed, Northumberland DISTANCE: 5 miles (9km) START/END: Dewar’s Lane OVERVIEW: The Lancashire painter LS Lowry first visited Berwick-upon-Tweed for a holiday in 1935 and returned every summer for the rest of his life. This circular walk explores the picturesque former port, with its imposing medieval ramparts, as well as providing a fascinating insight into the artist’s work. He produced more than 40 drawings and paintings of local buildings and views, most of which remain charmingly unchanged. This can be seen in the 18 panels along the route featuring Lowry’s images, which are situated adjacent to the scenes that inspired them. i 01289 330733; www.berwick-pt.co.uk
52 balance
From Banksy’s urban graffiti to Constable’s classic pastoral scenes, taking a healthy walk has never been more cultured. Julia Buckley uncovers some of the best of Britain’s art-inspired walks Antony Gormley’s ‘Another Place’
WHERE: Crosby, Merseyside DISTANCE: 2 miles (3km) START: Waterloo station END: Sefton coast car park OVERVIEW: A straightforward route along the 2-mile Crosby foreshore, peppered with 100 sculptures by ‘Angel of the North’ artist Antony Gormley. Whether you arrive amid the bustle of families frolicking on the sands on a summer’s day or during the desolate depths of winter, standing among the congregation of 189cm-tall cast iron figures of men gazing eerily out to sea is bound to make you feel a little contemplative. Cut the walk short at the end of the beach, or continue on through the sand hills, past a 4,000-year-old submerged forest, to the Alt Estuary. i www.visitliverpool.com/culture/art
January – February 2012
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walk Yorkshire Sculpture Park
Striding Arches, Scotland
PLACE: Cairnhead Forest, Dumfries & Galloway DISTANCE: 10 miles (16km) START/END: Byre, Cairnhead OVERVIEW: Three stone arches, each spanning about 7m, stand commandingly atop three hills around the natural amphitheatre at Cairnhead. A fourth arch springs from a disused farm building in the heart of the glen, providing shelter and a meeting point for visitors. Created from local red sandstone, the impressive structures provide both a focal point and a frame for viewing the surrounding landscape. The artist, Andy Goldsworthy, has placed similar arches in Canada, the US and New Zealand to symbolise the travels of emigrating Scots. Until a formal trail between the arches is constructed, you’ll need to plot your own route using a map (Explorer OS 328), but navigation shouldn’t be overly difficult, as each of the three hilltop arches are visible from the other two. Be prepared for strenuous walking across open moorland. i www.stridingarches.com
Bristol Street Art
WHERE: West Bretton, Wakefield DISTANCE: Various START/END: Park entrance OVERVIEW: You might feel a bit like Alice in Wonderland while happening upon the many enchanting sculptures placed throughout this 500-acre 18th century park, not least because of some statues shaped like giant hares. Among the sculptures by established artists, such as Henry Moore, Barbara Hepworth and Antony Gormley, are more playful oddities: a huge head lies sidelong in the grass; benches play eerie tunes when you sit on them; and a bridge built over the remains of a ha-ha (ditch) declares ‘HA HA’ along its side. There’s no defined trail through it all, but plenty of paths to explore, so you’re free to either plan your route using a map of the park or just amble along at your leisure. i 01924 832631; www.ysp.co.uk
WHERE: Central Bristol, Clifton area DISTANCE: 6 miles (10km) START/END: Clifton Suspension Bridge OVERVIEW: A vibrant trail passing Bristol’s iconic street art and featuring work by many renowned names, including the UK’s most famous graffiti artist – the mysterious Banksy. Works change on a weekly basis as murals are washed or painted away and new creations appear. Many are thought-provoking, others highly amusing. More permanent highlights include the Banksy murals of a small boy behind an armed policeman and an astronaut. Sunday is the best day to see the artists in action. Or, if you fancy trying your own hand at street art, bring along an aerosol and express yourself on the practice wall on Ashley Road. i 0906 711 2191; www.bristolgraffitimap.com
Constable’s Country
WHERE: Dedham Vale, Colchester, Essex DISTANCE: 7 miles (11½km) START/END: Manningtree station OVERVIEW: This circular walk along the Dedham Vale Area of Outstanding Natural Beauty follows in the footsteps of the great landscape artist John Constable, who was born in nearby East Bergholt. Anyone familiar with his paintings will recognise the lowland country villages, rolling farmland, rivers, meadows and woodlands that feature so prominently in his work. Highlights include Bridge Cottage, which houses an exhibition about the artist’s life and works, and the ‘chocolate box’ village of Flatford, which inspired some of Constable’s most famous paintings including ‘The Mill Stream’ and ‘The White Horse’. Next to Flatford Mill is a familiar scene from Constable’s best-loved work, ‘The Hay Wain’. i http://www.visitessex.com/ ConstableCountry • Turn to page 65 for your chance to win a copy of the book Sculpture Parks and Trails of England. A version of this article originally appeared in Walk, the magazine of the Ramblers. Visit www.walkmag.co.uk.
January – February 2012 balance 53 52-53 WalkColour.indd 53
09/01/2012 16:28
feature
Life
fast
in
the
lane S
Having diabetes hasn’t stopped 48-year-old Paul James, from London, chasing his dreams – in fact, it’s given him extra drive
ince I was diagnosed with Type 1 at 17, I’ve met the highs and lows head-on and have always been determined not to let diabetes get in the way of how I live my life. The only thing it has ever stopped me doing is becoming a professional pilot with the Royal Air Force (RAF) – it was my childhood ambition but just isn’t an option for people with diabetes. So, instead, I became a quantity surveyor and, in 1994, began working overseas on major construction projects. I now head up a project management consultancy business. My work took me to Hong Kong for 11 years; Macau, China, for four years; and then to Vietnam, where I’ve been since 2009. I was worried about sourcing insulin and quality
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diabetes care overseas, but both were readily available in Hong Kong, and I still see the same doctor when I return there every three months for business.
Licensed to dive Living in Hong Kong was lifechanging – there was so much opportunity in work and travel that I’ve never looked back. It also allowed me to continue with one of my favourite hobbies: diving. I already had my Open Water and Rescue Diver certification from the Professional Association of Diving Instructors (PADI), and I decided to do a Divemaster course in Hong Kong so I’d be qualified to supervise dives. I first needed to prove that my diabetes was 100 per cent under
control (as I did with the other dive schools I trained at), and that I didn’t pose any risk to myself or others. My doctor monitored my blood glucose control and HbA1c, and confirmed to PADI my ability to dive – if certain conditions were followed. Thankfully, due to good training, careful control of my diabetes and maintaining my fitness, I became a certified Divemaster and regularly helped lead diving courses and pleasure dives. I always monitor my blood glucose one hour before I enter the water and then just before I get in; if it’s low, I won’t dive for 30 minutes until it has risen to 4–6mmol/l higher than the normal range, ie 12–14mmol/l. You put your life at risk when diving with low blood glucose, so I don’t do it – golden rule.
January – February 2012
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feature
Above (left to right): After reading an article in balance, Paul discovered that he could pursue his dream of training to become a pilot; he’d already qualified as a PADI Divemaster and was enjoying his active lifestyle; Paul and his wife, Rose, on honeymoon – during their motorbike ride from southern to northern Vietnam
Fit to fly In 2005, I moved to Macau, a former Portuguese colony boasting a rich culture and historic buildings alongside newly developed mega resorts and casinos to rival those in Las Vegas. Diabetes care in Macau was, at best, basic; finding supplies of NovoRapid and Lantus was challenging as there were only a few types of insulin on sale. Luckily for me, Hong Kong is next door and only an hour’s boat ride away, where I had access to good diabetes care and the full range of insulin and test strips. As a life member of Diabetes UK, I have balance sent to me overseas. I love reading it to find out what’s going on in the world of diabetes. One day, in 2008, I read an article about pilots flying with diabetes (‘High flying adored’, May/June 2008 balance). I was amazed and inspired to find out more, as I thought the only way I could ever fly an airplane was with hefty restrictions and a safety pilot sitting next to me – and I wasn’t interested in that. I learned that the laws had changed in certain countries, allowing people with diabetes to fly – as long as all criteria is met and the airman’s medical is passed without compromise. I couldn’t believe my luck! I contacted a well-respected flight-training school near Manila, Philippines, and in March 2009 I travelled there for the big day: my medical exam. I took along letters of support from my diabetes doctor in
Hong Kong, three months’ worth of daily blood glucose readings, HbA1c results for the past three years and various other supporting documents. After two days of comprehensive tests, I passed the medical and was ‘fit to fly’. I felt on top of the world. At last I was free to pursue my dream.
Sky high I was lucky to have a break between jobs and decided to move to the Philippines in April 2009 to train full-time at Omni Aviation, giving myself three to four months to earn my pilot’s licence. From day one, I made sure that my diabetes control was on track. I trained at a gym three or four times a week to get fit and cycled 10km to and from the airbase every day. After three months of hard work, I’d lost 1st 12lb (12kg). I also adopted a very strict plan to manage my diabetes before, during and after flight, which involves testing my blood glucose regularly and acting on the results to achieve and maintain my target range. I stick to it without fail. I pack my flight kit with fast-acting glucose tablets and have them to hand, plus two cans of non-diet Coke and a hypo kit for emergencies. If my blood glucose is low an hour before take-off, I take a few glucose tablets and make sure that it has risen to at least 12–15mmol/l before flying, to minimise the risk of low blood glucose during the flight. If my blood glucose was to become excessively
high while flying, I would land the plane as soon as possible and address my insulin requirement on the ground. I never cut corners or compromise safety by flying with high or low blood glucose levels. In June 2009, after a gruelling two months of exams covering every theoretical and practical aspect of flight training, I was told without warning that I would fly solo. Sitting in the plane on my own was a totally unique experience. If anything went wrong, I’d only have myself to turn to. With my adrenaline pumping, I composed myself and did it: I earned my wings. They were pinned on my shirt and I then had the traditional
With my adrenaline pumping, I composed myself and did it: I earned my wings solo initiation: kneeling down, I held my airplane’s propeller and had a bucket of oily aviation liquid poured over my head – what a way to celebrate one of my greatest achievements! I passed my final flight exam and ‘check ride’ in July 2009 and became a private pilot in my own right, qualified to fly a single-engine Cessna 172 Skyhawk four-seat airplane. Getting my licence was one of the hardest challenges I’ve ever faced having diabetes, but also one of the most rewarding. Since then, I’ve flown more than 100 hours,
January – February 2012 balance 55 54-56 FEAT Vietnam Final.indd 55
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feature so we wanted to see as much of Vietnam while we’re still here. The only major obstacle was the fact that I had never before wanted – or needed – to ride a motorbike and had to learn fast and obtain a licence. But Rose turned out to be a good instructor, and soon after being immersed among the four million motorbikes that tear around the roads of Ho Chi Minh with what appears to be no rules, I passed the test. We hired two classic heavyduty motorbikes, planned our route to take in the most natural beauty and history, and set off north.
On the road
Fate takes its course: Paul’s work led him to meet Rose in Vietnam, and they married in August 2011
my licence and medical »for renewed another two years, and passed exams to fly various types of ultra-light aircraft. I love putting on my goggles to fly over the beautiful Philippines and try to fly every few months to stop the rust setting in.
Vietnam, marriage and motorbikes…
My next move was to Ho Chi Minh City (formerly Saigon), Vietnam. Medical care in Vietnam is fast developing, but it has a long journey ahead of it. I’ve found that there is a lack of high-quality medical services and supplies, particularly for people with chronic conditions and those needing specialist care. I met my lovely wife, Rose, at work, and we married in August 2011. I’d finished my two-year work contract, so we decided that a great way to spend our honeymoon and see the spectacular landscape and culture of Vietnam would be a 2,500km (1,500 mile) motorbike ride from Ho Chi Minh City in the south to the capital, Hanoi, in the north. Our plan is to move to Hong Kong for at least the next few years
56 balance
Once I had mastered the art of riding a motorbike safely through hectic cities and hairpin mountain roads, riding for four to seven hours a day became a real pleasure – I enjoyed every single minute of the freedom and fresh air. We stopped off at beautiful towns along the coast
Diabetes presents extra challenges along the way, but this makes me even more determined to succeed before joining the Ho Chi Minh trail – a former major supply line for the North Vietnamese during the Vietnam War. The trail runs over the central highlands and is a spectacular ride through many small local communities, where the ways of daily Vietnamese life are on display without too much traffic. One of our most memorable rides was over the Hai Van (Sea Cloud) Pass, where the east-coast road passes over the mountains at 500m (1,640ft) – the views are stunning and I’ve never seen anything like it. I had a flat tyre at the top of the mountain pass, so we called a repair man, who promptly came on his motorbike and fixed the puncture for a staggering $2 (£1.29) – how cheap is that when you’re in a fix! In fact, the whole trip
proved to be very cheap: a good, three-star hotel room averaged out at $20 (£12.89) per night, fuel for two bikes at $15 (£9.67) per day, and a sizeable bowl of tasty noodles at $2 (£1.29). Can’t be bad. During our trip, my diabetes control was good; I kept my insulin in insulated holders to prevent excessive heat exposure (at times the temperature reached 40°C). And I was very strict with myself, testing my blood glucose before and after breakfast, and at every stop. To be on the safe side, I always made sure that my blood glucose was raised to around 10mmol/l, so I’d have a good buffer to prevent a hypo while I was riding. I also made sure that I ate regular meals.
Mission accomplished Our last major stop was at Phong Nha-Ke Bang National Park, a UNESCO World Heritage Site, to see some of the most stunning caves in Vietnam. The Son Doong is the world’s biggest cave and is more than three times the height of Niagara Falls. It was an amazing sight. When we arrived in Hanoi after 17 days and 2,500km, we celebrated our trip and safe arrival with a few beers. We then enjoyed a few days of sightseeing in Northern Vietnam, before returning home to Ho Chi Minh City by plane in just two hours. Our motorbike adventure was finally over. I believe that life is what you make it. I couldn’t join the RAF because of my diabetes, but taking an alternative path in life led me to meet my wife through my work in Vietnam. Diabetes presents extra challenges along the way, but this makes me even more determined to succeed. With good diabetes control and by looking after your health, life doesn’t have to be restricted. Beyond the odds, we can achieve our ambitions. • How does diabetes affect the way you live your life? Tell us your story at balance@diabetes.org.uk or join the discussion in the balance Facebook group (search for ‘balance magazine’).
January – February 2012
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BalanceJanFeb2012
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travel
Expand your horizons in 2012
With London 2012 and the Queen’s Diamond Jubilee, there’s plenty going on at home this year. But if you want to escape, try these hot spots
Head for the north
The heavenly spectacle of the aurora borealis (or the Northern Lights) is caused by particles from the sun, blown by the solar wind, crashing into the Earth’s atmosphere and producing a swirling array of green, red and blue lights. The best time to see them is mid-November to late March, and NASA has declared 2012 the best in 50 years for the phenomenon. Intrepid explorers can try specialist operator Aurora Zone’s Aurora Quest in Nellim, Finland, set to be the best place in northern Scandinavia owing to virtually no light pollution. Four nights’ active hunting for the lights on husky sleds and snowmobiles costs from £1,645 per person, including flights, transfers, B&B accommodation and cold-weather clothing. Or you could try the Northern Lights at Leisure, staying at a Finnish spa hotel in Luosto; four nights cost from £1,045 per person, including flights and B&B accommodation. Visit www.theaurorazone.com or call 01670 785 012. Alternatively, try Iceland, where Icelandair (www.icelandair.co.uk) is offering a three-night Northern Lights City Break to Reykjavik from £299 per person, including flights, B&B accommodation and a Northern Lights tour.
Culture vulture
Millennium thriller
Following December’s release of Hollywood director David Fincher’s The Girl with the Dragon Tattoo, starring Daniel Craig, visit Stockholm, the city that inspired the Millennium trilogy by Stieg Larsson. Stay at the award-winning boutique Berns Hotel in the heart of this sophisticated capital, spread over 14 islands, and follow in the footsteps of Larsson’s characters with the guided Millennium Tour. After tramping the streets, indulge in a spa treatment at the beautiful Sturebadet Spa nearby. A two-night B&B break at Berns, including a 50-minute spa treatment, costs from £290 per person (book direct at www.berns.se). You can fly to Stockholm with Ryanair from £34 return (www.ryanair.com). Back home, follow our own literary masters. This year marks the bicentenary of the birth of Charles Dickens (from February onwards, visit www.dickens2012.org) and the World Shakespeare Festival, which runs from April to September (for details, visit www.worldshakespearefestival.org.uk).
58 balance
The birthplace of Portugal’s first king, Guimaraes in the north of the country is one of two European Capitals of Culture in 2012 (the other one being Maribor in Slovenia). Sample the city’s range of cultural activities or simply enjoy wandering its medieval streets and wellpreserved monuments – it’s one of the country’s most historic cities. And don’t forget the long sandy beaches and pretty villages among the vine-clad hills typical of this region. A seven-night stay with Sunvil Discovery costs from £720 per person, including flights, car hire and B&B at the elegant Casa do Sezim. Visit www.sunvil.co.uk or simply call 020 8758 4722.
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travel
Go forage Croatia without the crowds
At around the same size as Wales, and with a coastline as beautiful as its close neighbour Croatia, Montenegro is one to watch. Try kayaking around a stunning fjord or taking to the high ropes in Lovcen National Park, whitewater rafting along the Tara River or hiking in the Durmitor National Park. And there will still be time for some leisurely swimming, sightseeing and snorkelling on Activities Abroad’s seven-night holiday, from £1,445 per adult (£1,345 per child). Prices include flights, transfers, B&B accommodation, eight meals and all activities/ equipment plus guide/instructors. Visit www. activitiesabroad.com or call 01670 789 991.
Try kayaking around a stunning fjord, whitewater rafting along the Tara River or hiking in the Durmitor National Park
It may be the recession or it may be our increasing enthusiasm for local produce, but foraging for your supper is fast becoming a growing trend. But before you launch off with basket in hand to the woods or along the shore, try a course. Ray Mears and Bear Grylls have a head start on most of us. Wild food expert and author John Wright (of River Cottage fame) runs seashore and mushroom foraging courses in the West Country and Hampshire, at the end of which your pickings will be cooked up into a delicious meal. Seashore forays cost £95 per adult (£20 per child); mushroom forays cost £85 per adult (£15 per child). For more details, visit www.wild-food.net. Or try Fergus the Forager, who lives the foraging life and holds food-finding courses throughout the year centred around Canterbury in Kent. Days are long (12 hours) but you’ll pick up the art of foraging in woods, fields and along the coast. Costs £150 per person, which includes lunch and dinner (made, of course, with your pickings). Visit www.wildmanwildfood.com.
Best of the rest Iceland is top of the Lonely Planet Readers’ Choice Awards, followed by Italy, India and the Philippines. Top city is Reykjavik, followed by Lisbon, Istanbul, Barcelona and London. London figures large in Frommer’s Travel Guides top-10 list, specifically Greenwich, which will host several events during the Olympic Games. Frommer also favours the Albanian Riviera as a top beach destination, with all the attractions of its Croatian counterpart without the crowds or the expense. And if it’s food that tempts you, Peru is the hot spot. Reasons abound for visiting this South American wonder (the ancient ruins of Machu Picchu, deep canyons), but the coastal city of Lima is attracting visitors from afar for its Spanish, African, Chinese and Japanese culinary fusions. i Diabetes UK produces country guides for almost every country to help you prepare for your trip. Download them for free at www.diabetes.org.uk/shop-country-guides. Download Diabetes and Travelling, a balance guide, at www.diabetes.org.uk/diabetes-and-travelling.
January – February 2012 balance 59 58-59 Travel_Colour.indd 59
09/01/2012 16:30
fundraising focus SAILOR SUPREME
Festive fundraisers The cold and rain didn’t dampen the spirits of Diabetes UK supporters who took part in December’s annual Santa Dash. The sponsored runs took place across the UK, including Sutton Coldfield (pictured above), with runners getting into the festive spirit and dressing as Santa. May Milton, one of the 2,000 runners in Greenwich Park, London, said: ”For me, the Santa Dash was a run for my healthy lifestyle, for Diabetes UK’s success and achievement, and for my family’s commitment to charity work.” i www.diabetes.org.uk/festive
Keen sailor Graham Broadway, from High Wycombe, completed the 608-mile (978km) Fastnet Race in August 2011, raising £890 for Diabetes UK. The challenging sailing race starts from the Isle of Wight, goes to Fastnet Rock (off Northern Ireland’s south-west coast) and then back to Plymouth over several days. Graham has been sailing since he was a child, but thought he would never sail again when he developed Type 1 in the early 1980s, aged 36. “Back then, diabetes management was very different,” Graham explained. But in 2007, a refresher sailing course reignited his passion. “I coped well during the race; we didn’t have any extreme weather so the sailing wasn’t too difficult. My blood sugar was 5–10 mmol/l, and we came 108th out of 300 boats. I’d like to do it again.”
LONDON TO PARIS CHAMPIONS The fundraising pot has been counted for last September’s sponsored cycle ride from London to Paris – Diabetes UK supporters and staff raised an amazing £55,000! Robin Crampton, who took part, said: “A big thank you to everyone who made the weekend so wonderful. I enjoyed every minute of it – even the rain in a strange way!” i The next Diabates UK London to Paris Cycle Challenge is from 7 to 10 September 2012; visit www.diabetes.org.uk/londontoparis.
FANTASTIC FUNDRAISER Megan Brownbill, 8, from Cheshire, had a happy Halloween when she raised £206.40 for Diabetes UK by holding a Batty Ball at her school. Her mum, Karen, said: “Megan first became ill in July 2011 and was rushed to hospital, where she was diagnosed with Type 1 diabetes. Megan took it in her stride. While in hospital she made friends with another child with diabetes, and that’s when she decided to do something to help others. Megan is a little star. She does her own blood testing and injections, and we are very proud of her indeed!”
Northern soul To celebrate 90 years since the discovery of insulin, Diabetes UK Northern & Yorkshire is laying down the gauntlet with a ‘90minute Challenge’ aimed at raising funds to continue research into a future free of diabetes. The challenge is to commit to 90 minutes of a new activity each week for a month, such as running, walking or cycling, and to encourage friends and family to help you raise at least £90 for Diabetes UK. It’s free to enter and you get a goody bag with a T-shirt or running vest when you sign up, plus medals for those who raise more than £90. i Sign up at www.diabetes.org.uk/challenge and set up your own page, or email northyorks@diabetes.org.uk to register your interest.
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To find out more about fundraising for Diabetes UK, call the Events Fundraising team on 020 7424 1000, email fundraising@diabetes.org.uk or visit www.diabetes.org.uk/fundraise.
Channelled energy Diabetes UK launched its first channel-swim pool challenge in 2011, ‘Swim22’. Participants swam 22 miles (35.4km) – the distance across the English Channel – in their local pools between 22 August and 22 November. The challenge was a real success, with over 430 teams and individuals raising more than £32,000 for Diabetes UK. Gary Brooks, who has diabetes, said: “I’ve lost weight and feel fitter. The event has helped me to improve my health.” i The next Swim22 will be from 22 April to 22 July 2012. Sign up at www.diabetes.org.uk/swim22.
DIARY 14 JANUARY Diabetes UK Abseil Challenge, National Abseil Centre, Northampton i 01604 587745 • www.nationalabseilcentre. co.uk/diabetesuk/booking.html
SNAP-HAPPY WALKERS More than 340 people took part in the London Bridges Challenge on 13 November 2011. The 8-mile walk across 12 London bridges was a big success, and raised
more than £26,000 for Diabetes UK. Walkers also took part in a photography competition along the way. Roy Vinall topped the over18s category (see above photo), winning £50 Wagamama vouchers, and Nicholas Lewis won the under-18s category (see photo, left), and received a Kodak Easyshare digital camera (donated by Kodak).
SUPER TROOPER Jill Brown, from Northumberland, raised £700 for Diabetes UK in a ‘Chill out for the chicks’ night, after her 19-month-old godson, Ethan (pictured with Jill), was diagnosed with diabetes last August. “The night was a huge success,” said Jill. “Little Ethan is such a brave trooper – he takes it all in his stride.” She is planning further events in 2012, and Ethan’s grandparents and uncle are planning a bike ride and a Hadrian’s Wall hike this summer.
MIDLANDS MAGIC
Bupa Great Birmingham Run 2011
In November 2011, the Lincoln & District Diabetes UK voluntary group presented a cheque for £3,000 to Joy Tootell, Diabetes UK Midlands Regional Fundraiser. The funds were raised during 2011, bringing the group’s overall fundraising total to more than £150,000. “It’s a fantastic achievement,” said Joy. “We’d like to thank the group for their continued support.”
A great big thank you goes to the Team Diabetes UK runners who took part in the Bupa Great Birmingham Run 2011. i View the day in pictures at www.diabetes.org.uk/ bupa-great-birmingham-run-2011.
2 MARCH Spring Ceilidh, Darlington & Simpson Rolling Mills Social Club, County Durham i 01325 488606 • northyorks@diabetes.org.uk 11 MARCH Bath Half Marathon, Somerset i 01823 448260 • south.west@diabetes.org.uk • www.bathhalf.co.uk APRIL Diabetes UK Spring Bike ‘n’ Hike, Dorset – choice of trails i For date and details: 01823 448260 • south.west@diabetes.org.uk 1 APRIL Forest of Dean Half Marathon, Gloucestershire i 01823 448260 • southwest@diabetes.org.uk • www.diabetes.org.uk/fodhalf 1 APRIL South Hams Cycle Sportive – The Hammer, 130km (80.7 miles), South Devon A challenging cyclosportive through the country lanes of south Devon. 25 per cent of all entry fees go to Diabetes UK. i 01823 448260 • southwest@diabetes.org.uk • www.diabetes.org.uk/ thehammer 19 APRIL Brighton Marathon i 01372 731361 • fundraising.southeast@ diabetes.org.uk
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fun&games
Win
This revolutionary steamer has three separate, versatile cooking compartments that ensure each part of the meal is ready together, and timings can be personalised to the steamer’s memory for next time. Once the food is ready, the auto keep-warm function kicks in, keeping food ready to eat for up to 40 minutes.
Morphy Richards Intellisteam
PRIZE CROSSWORD To enter: Cut out the grid and send to the usual
balance address (see page 3) marked ‘Crossword’. The first correct entry drawn after 17 February will win a Morphy Richards Intellisteam (see right), worth £99.99. Congratulations to last issue’s winner, Mrs Helen Gardiner from Gloucester. 1
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Name Address Postcode
Wordworkout How many words can you make from this box of letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word. Names and plurals are not allowed. There is one nine-letter word in the grid. Clue: shape. 35 = Average; 40 = Good; 45+ = Excellent.
64 balance 64-65 Puzzles.indd 64
L E R E G N C A T
www.morphyrichards.co.uk ACROSS 1 Morsel (6) 4 Poem (5) 9 Internet-navigating programme (7) 10 Wall hanging (5) 11 Korean martial art (3,4,2) 12 Script, libretto (4) 13 Sauce from meat juices (5) 16 Small land surrounded by water (4) 19 Christian who rejects the notion of the Trinity (9) 21 Dutch cheese (5) 22 Small food fish (7) 23 Twig broom (5) 24 Melted-cheese meal (6)
DOWN 1 Slab (6) 2 Chest (6) 3 Small picture in larger one (5) 5 Progress (7) 6 Mooring for yachts (6) 7 Unstable atom combated with antioxidants such as Vitamin C (4,7) 8 Racecourse town (5) 13 Llama-like mammal (7) 14 Mushrooms, eg (5) 15 Physique (6) 17 Back (6) 18 Biocatalyst (6) 20 Tortilla snack (5)
SOLUTION to issue five 2011 ACROSS 4 Cobalt, 7 Paella, 8 Gloriana, 9 Logo, 10 Pulse, 12 Ewer, 18 Afghan, 19 Scroll, 20 Epee, 23 Heath, 27 Ecru, 28 Hanukkah, 29 Escrow, 30 Stream DOWN 1 Baton, 2 Sloop, 3 Bagel, 4 Clone, 5 Baize, 6 Lance, 11 Ural, 13 Wool, 14 Role, 15 Paté, 16 Ague, 17 Scut, 21 Plant, 22 Etude, 23 Hokum, 24 Ashen, 25 Hence, 26 Argot
LINKLETTER 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:
BO LA
X I
NG TY
FO CA
ST ER
RE DE
SS NT
LA SE
OP ET
DE OR
ON LE
PH AS
GM
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January – February 2012 09/01/2012 16:32
SUDOKU Fill the grid so that every column, row and 3x3 box contains the digits 1 to 9. Rating: Intermediate
7 2
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Your voice could improve your life and the life of others
4 1 8 7 5 3
ARTISTIC PATHWAYS
If, after reading our art-inspired walks feature on pages 52–53, you fancy following in the footsteps of artistic giants yourself, you will love this guide (right). balance has four copies of Sculpture Parks and Trails of England to give away, featuring the likes of Antony Gormley’s ‘Angel of the North’ and Constable’s Essex countryside. To enter, send your name and address on a postcard or sealed-down envelope to: ‘Artistic Pathways’, balance, Diabetes UK, 10 Parkway, London NW1 7AA, by 17 February.
A BALANCED LIFE – JOHN BYRNE
P T
Help the healthcare industry develop better treatments
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STOP50
different types
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ARTHUR SMITH
MARI WILSON
For the greater good
Sugartime
66 balance
Mari Wilson, ‘The Neasden Queen of Soul’, has had Type 1 diabetes for nearly 34 years. She joins Arthur Smith as a regular balance columnist and this is her first instalment...
S ‘
ugartime’ – sugar in the mornin’, sugar in the evenin’, sugar at suppertime’ – that Alma Cogan song was my party piece when I was a little girl – a premonition of my future life with Type 1, perhaps? I was diagnosed with diabetes on 21 June 1978, aged 23, having long lived with an unquenchable thirst, constant trips to the loo, lank hair, pale skin, Athlete’s foot and weight loss. I spent three weeks in hospital learning about my new life (and watching the entire Wimbledon tennis championships). Then I came home with a huge Dr Crippen-like glass-and-steel syringe (kept in a container of methylated spirits) and packs of urine tests to keep on top of my condition. I hated my new regimented ‘diabetic’ life – that was until I realised that knowledge was the key and read every book about diabetes that I could find. My attitude and diet changed and I started swimming every day. I’ve exercised regularly ever since, which has been vital for me to keep control of my blood glucose levels and stay healthy and slim. In 1981, my career took off and for the next few years I was touring the world, which brought new challenges. Crazy hours and no routine, I had to plan ahead and take lots of snacks on the tour bus. There wasn’t much sleep either, but I was young then! Then, in 1991, I was diagnosed with coeliac disease [an autoimmune disease, where the body reacts to gluten], and this seemed harder to live with than diabetes, especially at the beginning when there seemed to be nothing to eat. Things are easier now – coffee chains are selling gluten-free foods and supermarkets, too. And the BBC’s The Great British Bake Off has inspired me to bake glutenfree cakes, scones and biscuits. I still tour and make albums, but at a different pace. It’s all about planning. I make sure that I schedule in the breaks I need, but I’d be doing that now with or without diabetes. Thank you Dr Banting for your pioneering work and the life-saving discovery of insulin, which has made it possible for me and millions of others to live a full life. i Mari Wilson arrived on the music scene in the early 1980s with ‘Just what I always wanted’. Her trademark beehive hair, ‘60s-inspired fashion and 12-piece band, The Wilsations, made her a big hit. Mari’s new album, Cover Stories, is due for release early 2012; www.mariwilson.co.uk.
Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne
A
s regular readers of this column – and anyone who has ever lived with me – will testify, I am almost pathologically untidy. Therefore, when we are visited by my young niece, Sasha, my partner, Beth, is always concerned that I might have left needles or lancets lying around. Like any 6 year old, Sasha has an insatiable curiosity and 10 prying fingers (plus, of course, a love of all poo-related jokes), so Beth is rightly fearful that Sasha may end up cutting herself. This is why, before her arrival, all my diabetes kit is locked in a drawer, and why I recently overheard Sasha telling her granny: “Even I am not allowed to look in this drawer because this is where Uncle Arthur keeps his diabetes.” Sasha, we may conclude, does not really understand what diabetes is, and in this she is joined by most of the medics who have ever lived. It is one of the oldest known conditions, having been first noted more than 3,000 years ago, but nobody really knew what caused it or how to treat it. Eventually, towards the end of the 18th century, they discovered that diabetes mellitus, as the Romans had named it, was all to do with an excess of sugar, but it was another century before the pancreas was identified as the crucial organ in the mystery. Why, you may ask, am I visiting these Wikipedia-isms on you? Well, because it is 90 years since Fred Banting and his mucker Charlie Best clarified insulin and diabetes became properly treatable; this is, I suggest, a suitable occasion for those of us with diabetes to give thanks for our continuing lives. So, the next time you feel sluggish with high blood sugar, or both bored and apprehensive as you sit dumbly in the diabetes doctor’s waiting room, and the next time you are pained by the prick of that needle, or just plain depressed because of the endless palava of dealing with your incurable condition, then I propose you do not curse your bad luck or grizzle at your loved ones. Rather, you should take time to reflect on the fact that for 99 per cent of the time that humanity has existed, a diagnosis of diabetes amounted to a death penalty, and that you are enormously lucky to have been born during that last one per cent of time. Having done this, I also suggest that you raise your mug of tea to Sir Fred and all the other scientists whose work keeps us alive. And then, if you are me, you should set off with Sasha and Dora the Explorer for an afternoon of fun. • See pages 32–36 for more on 90 years of insulin. i Arthur Smith, is a comedian, writer and broadcaster with Type 2.
January – February 2012
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Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne
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