Balance Magazine Sept-Oct 2012 by John Clarkson

balance

SUPER SUPPERS FOR YOU TO TRY PAGE 50

Your diabetes lifestyle magazine • September – October 2012

Back on track Getting ﬁt at 60

LAYING DOWN THE LAW

Police officer’s Type 1 struggle

FACING

UP TO

FAT

How to read between the lines

EXERCISE IN RESEARCH Behind the scenes on a Type 2 trial

PLUS

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

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

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Diabetes UK Insurance Services is a trading name of Heath Lambert Limited which is authorised and regulated by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 1199129 England & Wales. www.gallagherheath.com Gallagher Benefits Consulting Limited is authorised and regulated by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 0772217 England & Wales. www.gallaghereb.com Funeral plan is provided by Dignity Pre Arrangement Limited. A company registered in England No.: 1862158. VAT registered No.: 486 6081 14. 4 King Edwards Court, King Edwards Square, Sutton Coldfield, West Midlands B73 6AP Telephone No.: 0121 354 1557. Fax No.: 0121 355 8081. Part of Dignity plc. A British company. Registered with the Funeral Planning Authority. Key Retirement Solutions Limited. Registered in England No. 2457440. Registered Office: Harbour House, Portway, Preston, Lancashire, PR2 2PR. Telephone 08451 655955 Facsimile 0845 12 555 13. Key Retirement Solutions is authorised and regulated by the Financial Services Authority. All benefits payable are subject to BHSF Limited policy terms: Copies available on request. BHSF Limited is authorised and regulated by the Financial Services Authority. SD3562_A/31072012

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15/08/2012 16:30

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contents September – October 2012 • no 248

balance

The UK’s leading magazine for people with diabetes. Produced by Diabetes UK, the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. 10 Parkway, London NW1 7AA 020 7424 1000 balance@diabetes.org.uk www.diabetes.org.uk/balance EDITOR Angela Coffey DESIGNER John Clarkson EDITORIAL SECRETARY Melanie Aldridge CONTRIBUTORS Sabeha Syed, Anna Pattenden, Sheila Seabrook, Nick Myall AD MANAGER Claire Barber, 020 7878 2319 claire.barber@tenalps.com COVER IMAGE Clare Joyce ABC APPLICATION APPROVED 18/04/2012 ARTICLES & ADVERTISEMENTS

Products and services advertised in balance are not necessarily recommended by Diabetes UK. Although the utmost care is taken to ensure products and services advertised are accurately represented, it is only possible to thoroughly check specialist diabetes equipment. Please exercise your own discretion about whether or not an item or service advertised is likely to help you personally and, where appropriate, take professional advice from your medical advisor. Please note also that prices are applicable only to British buyers and may vary for overseas purchases. Paid adverts do not necessarily represent the views of Diabetes UK. Complaints regarding advertised services or products should be addressed to: Claire Barber, Advertisements Manager, Ten Alps Publishing, One New Oxford Street, London WC1A 1NU. Articles in balance written by freelance contributors do not necessarily represent the views of Diabetes UK. Diabetes UK policy statements are always clearly identified as such. ©Diabetes UK 2012 A charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136).

regulars 4 6

THIS IS DIABETES UK NEWS

features

life&health

22 EXERCISE IN

41 HEALTH NOTES

RESEARCH

Diabetes round-up

Members of Diabetes UK’s Research team take part in a new trial for Type 2

Tantalise your taste buds with these super suppers

CYCLE

14 OPINION & LETTERS 19 RESEARCH MATTERS 50 RECIPES 26 BREAKING THE

nfit and new to Type 2, U Malachi O’Doherty knew something had to give, so got back on the saddle and revisited his youth – with some pleasing results...

54 BITE-SIZED For foodies

56 WALK

Beyond Edinburgh’s Royal Mile

58 TRAVEL

A tour around the Portuguese city of Guimarães and Slovenia’s Maribor – 2012’s Capitals of Culture

60 FUNDRAISING FOCUS

Celebrating your achievements and upcoming events

64 FUN & GAMES

Win a Morphy Richards Partition Pot Slow Cooker

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

29 ALL EYES ON

YOUR CARE

year on from the A launch of Diabetes UK’s 15 Healthcare Essentials campaign, we find out whether diabetes care is improving

32 A STRONG BOND

The truth about fat; Nordic walking; ways to get the care essentials you deserve; how to protect yourself from flu now to be free from it this winter; and just what is insulin resistance?

45 ASK THE EXPERTS

Impaired Glucose Tolerance test; driving licence concerns; painful joints; & period woes

47 SPOTLIGHT ON... Necrobiosis

48 BASIC CARE

Take control: There’s a vast array of contraception and something to suit everyone. We take a look at the pros and cons of and whether diabetes can cause a problem

Identical twins Vicki and Kate have many similarities in life, but their Type 1 couldn’t be any different

37 THE DRIVE

TO SUCCEED Having Type 1 diabetes has given policeman Lee Pidgeon an uphill career struggle, but he got there in the end and tells us how

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

GOING FOR GOLD

am writing this in a spirit of euphoria after watching Charlotte Dujardin and her bouncy Access to the ball of a horse, Valegro, triumph with an 15 Healthcare individual gold in the Olympic Freestyle Dressage. But what does all this have to do Essentials is with diabetes? Though there were several fine fundamental to performances in the competition, Charlotte and her boy shone because over their years together, healthy lives Valegro has been trained with consistency to for people know what to do and what to expect. As a result, with diabetes he is a talented but calm and relaxed happy athlete for whom life is good. The Diabetes UK 15 Healthcare Essentials are founded on the same principle. They’re not the gold standard because that might imply that only a few people can aspire to them. They are the essential care standards that all health service providers should deliver every year for people with diabetes and that everyone with diabetes has a right to expect. They are the steady annual consistent standards of care that should enable everyone with diabetes to manage their condition effectively and avoid complications, which could otherwise be serious. We launched the campaign almost a year ago, based on official NHS guidance across the UK. Since then we’ve got them into the hands of more than 1 million people with diabetes and 200,000 healthcare professionals. They are still being distributed widely, through Diabetes UK information services, through GPs, consultants and diabetes and practice nurses, through pharmacies and through our network of Diabetes UK groups and volunteers. More is planned. More than 3,000 people completed our survey on whether they have received these essential care measures, which allows us to get an up-to-date local picture of how well or patchily they are being delivered. We have published our State of the Nation report on how the essential care standards are being delivered in England to help drive improvements locally, and similar reports for Scotland, Wales and Northern Ireland will follow shortly. If you are a person with diabetes, make sure you are receiving all of the checks and ask your doctor or nurse for any you aren’t getting – and please complete our online survey to let us know whether you are getting this standard of care. If you are a healthcare professional, make sure your patients receive all of the necessary checks every year, promote awareness to people with diabetes and help us distribute copies of the Essentials to your patients. Consistent access to the 15 Healthcare Essentials is fundamental to healthy lives for people with diabetes – just like consistency has been the key to Charlotte and Valegro’s Olympic gold. Baroness Young, Chief Executive, Diabetes UK i Download the checklist at www.diabetes.org.uk/15-essentials or call Diabetes UK on 0800 585 088 for a hard copy. • Complete the survey at www.diabetes.org.uk/care-survey.

JOIN

Diabetes UK membership keeps you up to date with diabetes developments and connects you with a network of people who understand your condition. And, of course, you receive balance six times a year. To join, call 0800 138 5605 or, for details, call Supporter Services on 0845 123 2399.

CARE

Diabetes UK’s Careline provides confidential support and information to all people affected by diabetes. Call 0845 120 2960, Monday to Friday, 9am–5pm. Careline accepts TypeTalk calls and has an interpreting service. Please check the cost of calls to 0845 numbers with your phone provider. Write to: Diabetes UK Careline, 10 Parkway, London NW1 7AA for a response within 21 days. Email careline@diabetes.org.uk for a response within 10 working days. Careline cannot provide individual medical advice.

CONNECT

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

CAMPAIGN

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

Connect online

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

balance September – October 2012

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WHAT DID YOUR METER TELL YOU TODAY?

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*TERMS AND CONDITIONS Offer open to those who are on insulin and making their own insulin dosing decisions (e.g. Multiple Daily Injections of insulin), aged 16 or over and resident in the UK, including users of meters other than OneTouch® meters. Applicants who currently use a OneTouch® meter must have had their meter for 12 months or more and not received a free OneTouch® upgrade during this period. Offer closing date 31st Dec 2012. Those eligible to participate in the free meter trial will be offered a OneTouch® Verio®IQ Blood Glucose Monitoring System, 25 test strips and a questionnaire about their experience of using the OneTouch® Verio®IQ to complete and return in the reply paid envelope provided. Only one free OneTouch® Verio®IQ trial per person. Meters are subject to availability. This offer is limited to a maximum of 4,000 free OneTouch® Verio®IQ meters. Allow 28 days for delivery. LifeScan, LifeScan Logo, OneTouch® and OneTouch® Verio®IQ are trademarks of LifeScan Inc. © 2012 LifeScan, Ortho-Clinical Diagnostics. AW 099-111A. 12-134

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15/08/2012 19:12

news Named and shamed: hospitals failing on specialist footcare Diabetes UK has revealed that 84 hospitals in England and Wales have not set up multidisciplinary footcare teams (MDTs), as recommended by the National Institute for Health and Clinical Excellence (NICE). All 84 have been named by Diabetes UK, using data from the National Inpatient Audit and the charity is calling for everyone to check whether their local hospital has one and, if not, is urging them to write to the hospital trust’s chief executive. Every week in the UK there are about 100 diabetes-related amputations, up to 80 per cent of which could be prevented. Foot problems associated with diabetes

Bayer discontinues Ascensia Autodisc test strip discs Bayer has announced that it will discontinue its Ascensia Autodisc test strip discs, which are used in its Ascensia Breeze meter, from 1 September. The company has stated that all Ascensia Breeze users will need to change their meter and is offering a free upgrade to its new Contour XT meter. This only affects users of the original Ascensia Breeze meter. The Breeze 2 test strip disc will continue to be available for the Breeze 2 meter, however users are advised to check their prescription to make sure it specifies Breeze 2 discs. i Call Bayer Diabetes Support on 0845 600 6030.

can deteriorate very quickly, which is why people with diabetes who have foot ulcers should be referred to a specialist MDT within 24 hours. Establishing these teams would help reduce the amputation rate in people with diabetes, which is more than 20 times higher than in the rest of the population. Diabetes UK’s ‘Putting Feet First’ campaign aims to reduce amputation rates by half over the next five years. i Does your local hospital have an MDT? Find out at www.diabetes.org.uk/Hospitals-without-MDTs and email diabetesvoices@diabetes.org.uk for details on how to ask for one to be established.

Specialist footcare teams in all hospitals will help to reduce the amputation rate

HEART DISEASE PROGRESS THREATENED Progress made in the fight against cardiovascular disease is under threat from rising levels of obesity and diabetes, a task force of MPs has reported. The problem is fuelled by unhealthy lifestyles in an ageing population, according to the cross-party parliamentary groups on heart disease, diabetes, stroke and kidney disease. Their report, Tackling Cardiovascular Diseases: Priorities for the Outcomes Strategy, highlighted problems created by NHS restructuring, financial pressures, increasing life expectancy and rising levels of obesity and diabetes. It calls for the Department of Health to do more to sustain and improve progress in preventing cardiovascular disease. The report calculated the treatment of cardiovascular disease costs £14.4bn per year, while the estimated cost of lost working days and informal care amounts to another £16.3bn. Transferring responsibility for NHS health checks to local authorities in April 2012 could mean even fewer people access this service, it warned, as only 14 per cent of those eligible were offered a check and three primary care trusts failed to offer any health checks at all. The report’s findings and recommendations are intended to inform the Government’s Cardiovascular Disease Outcomes Strategy. i www.diabetes.org.uk/Documents/News/appg-cvd-report-0712.pdf

balance September – October 2012

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balance rounds up all the latest diabetes news

Everyone’s talking about...

Diabetes UK has responded to the government’s consultation on front-ofpack food labelling. The charity is calling for labels to include traffic light coding, percentage guideline daily amounts and ‘high’, ‘medium’ and ‘low’ text to be written on all packaging to help people understand the contents of different foods and to make healthy choices. Diabetes UK has also highlighted the importance of effective food labelling to help people with diabetes manage their condition, as diets high in fat, salt and sugar increase the risk of developing serious complications, including heart disease, stroke, kidney disease and amputation. The charity has also taken the opportunity to emphasise the importance of including carbohydrate content on all packaged foods, as this information is essential to people with diabetes. i Diabetes UK’s full response to the consultation can be found at www.diabetes.org. uk/Food-labelling.

Photo: Stu Forster/Getty

It’s ready, steady, go for traffic light food labelling Funmi as a 1940s nurse

‘THIS IS FOR EVERYONE’ A Diabetes UK’s Community Champion featured in the spectacular London 2012 Olympics Opening Ceremony in July. Oluwafunmilayo, or Funmi, Vaughn is also a Community Outreach Worker with a background in Health Promotion and Public Health. Funmi featured as one of the NHS nurses from the 1940s, dressed in traditional nursing attire. Her segment was a tribute to the National Health Service, which comprised of Lindy Hop dance and the use of LED-lit beds to spell out ‘GOSH’ (Great Ormond Street Hospital) and ‘NHS’. The beds used will now be donated to hospitals in Tunisia.

Funmi told balance: “I’m delighted to have been involved in the making of history. It was a show to be remembered. I sometimes took off for rehearsals at 9am and was not finished till midnight. But I say to friends only a few things keep you dancing till midnight for so many weeks. But it was the Olympics, a once-in-a lifetime event!” The Community Champion volunteer programme trains community and religious leaders from Black, South Asian and minority ethnic backgrounds to raise awareness of diabetes to their local community. i Email: communitychampions@diabetes.org.uk

DSN care ‘similar to doctors’ Diabetes specialist nurses (DSNs) were more than capable of taking the central role in multidisciplinary healthcare teams, a two-year trial by Maastricht University Medical Centre has found. The trial compared hospital care provided by DSNs with the care given by doctors. Around 300 patients with Type 1 or Type 2 diabetes took part. Quality of life in terms of health was found to be similar for patients receiving care from either type of clinician. When a DSN acted as the main caregiver, fewer patients were hospitalised, fewer side effects from drugs were reported, and overall costs were slightly reduced. In addition, fewer

of those treated by a DSN went on to develop diabetes-related complications. Simon O’Neill, Diabetes UK’s Director of Care, Information and Advocacy, told balance: “Diabetes UK has long championed the role of the diabetes specialist nurse, and this paper adds to the evidence that they provide excellent and cost-effective care. Nurses are already responsible for about 80 per cent of direct diabetes care and we need to ensure that these nursing posts – hundreds of which are currently being frozen – are protected. We believe the current trend of reducing their numbers is short-sighted and will have a negative impact on the long-term health of patients.”

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news

RUGBY HERO BACKS DIABETES CAMPAIGN Veteran Welsh rugby star Robin McBryde is backing a major public health campaign across Wales to find the one in 10 people who are at risk of developing Type 2 diabetes or having a stroke. Rugby star Robin is backing Robin, whose mother had a stroke, is visiting a the Welsh health campaign pharmacy for his own risk assessment and hopes the campaign, run by Diabetes UK Cymru, the Stroke Association, Public Health Wales, Community Pharmacy Wales and all seven health boards, will encourage people to come forward. All 714 pharmacies in Wales are offering free risk assessment testing for two weeks from 3 September 2012. i To find out when your local pharmacy is holding assessments, visit www.diabetes.org.uk/one-in-ten.

Calling all rugby fans… For a fantastic family day out, head to Wembley Stadium at 2.15pm on Saturday 15 September when Saracens will play Leicester Tigers in a top Premiership tussle. Booking tickets online is quick and easy and if you quote the unique password, Diabetes UK will receive a donation of £5 per adult ticket and £2 per junior ticket. Tickets are on sale now and cost £16 for adults and £6 for children. i Visit www.saracensatwembley.com/groups and buy your tickets using charity code: DIABETESUK – make sure that you enter the charity code when you select the number of tickets you require.

Swings & roundabouts A peer mentoring scheme has been created for young people with Type 1 diabetes who attend clinic within County Durham and Darlington Primary Care Trust. The scheme, called Swings and Roundabouts, was piloted successfully and will run four times a year. The next programme starts in September and runs for four weeks on a Saturday morning. It involves young people meeting together to talk to others just like themselves, to think about what it means to be a young person with diabetes. It also involves fun, games, cooking and a gym session. One young person from the pilot scheme said: “I enjoyed making new friends and learning more.” i If you would like to take part or just find out more about what is happening in Co Durham and Darlington please contact Helen Mulhearn on 03000 261500, email helen.mulhearn@durham.gov.uk or visit www.iic-org.uk and click on projects/diabetes.

THEY SAY, WE SAY

Three cheers for cheese? It was a veritable feast of cheesy headlines when stories by the Daily Mail, Daily Express and The Daily Telegraph all claimed that eating cheese could reduce the risk of developing Type 2 diabetes. So, is there a whiff of truth to this or does it smell like ripe stilton?

DIABETES UK SAYS The stories were based on the results from a study published in The American Journal of Clinical Nutrition, which aimed to find out whether eating a diet high in dairy products is associated with a change in the risk of developing Type 2 diabetes. Overall, the study found no link between total dairy product consumption and diabetes risk, but the results did suggest that people who ate a lot of cheese and other products such as yogurt and buttermilk, may have a lower risk of developing the condition. However there is no significant link between eating more of one particular dairy product and a reduced risk of Type 2. Also, the European-wide study found the difference in risk varied between countries – people in the UK who ate more cheese were at increased risk, while people in France were at a reduced risk. While the study was well designed, the possible preventative effects could be down to luck, not cheese. Iain Frame, Diabetes UK’s Director of Research told balance: “It is too simplistic to concentrate on individual foods and this study gives us no reason to believe that people should change their dairy intake in an attempt to avoid diabetes. We recommend a healthy balanced diet, rich in fruit and vegetables and low in salt and fat.”

balance September – October 2012

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08356 SimpLance Press_HPV 95x255 v2_Layout 1 15/02/2012 16:08 Page 1

Cash injection for Type 1 vaccination research Diabetes UK is delighted to have received a £120,000 donation from the Freemasons and Masonic charities to fund research into a vaccine for Type 1 diabetes. The money will be used to continue to fund the work of Clinical Research Training Fellow Dr Yuk-Fun Liu at King’s College London, who is looking into the effectiveness of a potential vaccine for Type 1 diabetes. Recent research has made progress in the development of a vaccine, which – it is hoped – will protect insulin-producing cells from being destroyed. Preserving just a few cells could make a huge difference to people with newly diagnosed Type 1 diabetes, by helping them retain their ability to regulate blood glucose. A second series of vaccination trials will soon be under way in people who have recently developed the condition. This grant will enable Dr Yuk-Fun Liu to investigate how the vaccine works, in order to help develop and refine it. Dr Iain Frame, Director of Research at Diabetes UK, told balance: “We are very interested in seeing the results of this exciting research and reporting on its possible impact for people’s long-term health.” i Keep up-to-date on Diabetes UK research at www.diabetes.org.uk/research.

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Diabetes UK Clinical Advisor Cathy Moulton features in the diabetes video

An interactive website has been developed to help people better understand their diabetes so they can cope more effectively at home and improve their quality of life. The Sound Doctor contains around 60 short films featuring key practical advice from some of the world’s leading experts and people with diabetes. There is also a chatroom where people can share stories and pass on advice of their own to others. It’s the brainchild of BBC presenter and Today programme reporter Dominic Arkwright. “From everybody I spoke to working in health, there was an overwhelming desire for better information for patients, delivered in an accessible way. We know people like to get their health information from a doctor, so we’re trying to bring the doctor’s consultation into people’s homes so it’s available 24/7,” he said. Simon O’Neill, Diabetes UK’s Director of Care, Information and Advocacy Services, said: “The whole thing has a very positive and upbeat feel to it. I think it is an excellent resource.” i Lifelong membership to The Sound Doctor is available for £8.99 via http://thesounddoctor.org/referrer/diabetesuk.

a better way all round Convenient: SimpLance is the only lancing device on the market to contain 20 micro-lancets. Comfortable: silicone-coated needles designed for pain-free testing with 4 depth settings. Safe: a sealed unit of single use lancets means you won’t have to handle needles and reduces the risk of infection.

For more information or to request a FREE starter kit sample contact your BBI Healthcare representative or call 0845 677 33 49. Visit www.simplance.co.uk for more information.

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news

CORRECTIONS • In our feature ‘A steer in the right direction’ (July–August 2012) we reported that people should tell the DVLA if they have had a hypo while driving. In fact, we should have stated that you need to contact the DVLA if you have had a severe hypo while driving. balance apologises for any confusion. See page 45 for more on driving. • ‘Stealth sugar’ (Life&health, July–August 2012) featured a chart of food and drink that showed sugar content. The fruit juice was wrongly labelled and should have been listed as a ‘fruit drink’. • Following an article on recycling used blood glucose meters (Can I?, Life&health, July–August 2012), the IDDT cannot accept these, as reported. The organisation will accept new meters, along with other diabetes equipment. Under strict protocols, they are sent to clinic doctors in developing countries for them to distribute to people in need. For more details, visit www.iddt.org/here-to-help/helping-developingcountries.

Brainstorming at one of last year’s conferences

Celebrating the work of volunteers This year’s Diabetes UK Volunteering Conferences are celebrating volunteering being at the heart of everything the charity does. Each conference, held across the country between September and November, will include interactive workshops on different aspects of volunteering at the charity, as well as updates on Diabetes UK’s work. The new Inspire Awards, in recognition of the fantastic support volunteers give to Diabetes UK, will also be presented. i Details and to book: www.diabetes.org.uk/volunteering2012 or contact your local Diabetes UK1office.   newinsulcheckbleed.pdf 09/08/2012 17:34

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oes using your PC drive D you nuts? The wretched things really do seem to have a

September – October 2012 16/08/2012 14:50

Chloe said...

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• Free control solution • Meter replacement for life** With the new iBGStar, SANOFI DIABETES gives you more options for life with diabetes. Go to BOOTS stores or www.boots.com for your iBGStar, today. For further information go to www.diabetesmatters.co.uk or call Freephone 08000 35 25 25 iBGStar® does not include the iPhone or the iPod touch. iPhone and iPod touch are trademarks of Apple Inc., registered in the U.S. and other countries. *iBGStar® Diabetes Manager App is available on the App Store. ** Terms and Conditions apply

GBIE.BGS.11.12.13

Date of preparation: January 2012

news

And now the next big thing... The Big Event, Diabetes UK’s first national day for everyone affected by diabetes, took place in Coventry on Saturday 14 July with great success. More than 300 people attended on the day, which was packed with interactive workshops and seminars covering a wide range of subjects and issues. Speakers included Professor Peter Hindmarsh, Paediatric Consultant at University College Hospital, who gave a talk on what diabetes care children with diabetes should expect. Dr Michael Trenell, Clinical Physiologist at Newcastle University, led a session around the latest research into Type 2 diabetes and there was information on pumps, apps and other gadgets from Chris Cheyette, Senior Diabetes Dietician at King’s College Hospital. There was also a host of practical workshops covering topics such as the latest employment rights for people with diabetes, as well as how to make sure children with diabetes have the confidence they need in adolescence. Richard Lane, President of Diabetes UK said: “It was a fantastic day with so much

In brief... A SLICE OFF THE PRICE

knowledge and expertise on hand.” While parents enjoyed the event, the charity’s popular Care Events team ran supervised activities for children, which included a climbing wall, as well as arts and crafts. The day also saw a meeting of the charity’s new Young Leaders – 16- to 30-year-olds who are helping shape services and support for people with diabetes within that age range. Plans will soon be underway for next year’s even bigger Big Event, so look out for details in a future edition of balance. i See page 22 for more information on Dr Trenell and his work.

40million {

{

The number of prescriptions given for diabetes drugs in primary care in England. Visit www.diabetes.org.uk/40-million.

Chat, click, call A Diabetes Pharmacy Campaign that urges people to ‘chat’ to their pharmacist, ‘click’ the mydiabetesmyway.org.uk website or ‘call’ Careline has been launched. The Diabetes Pharmacy Campaign is jointly run with Diabetes UK Scotland and the Scottish Government, and sees all 1,297 pharmacies in the country taking part by displaying large posters and distributing 600,000 leaflets with the important message, which will help to stress the importance of being well informed about managing diabetes. i Find out more at www.diabetes.org.uk/scotland.

12 balance 6-13 News.indd 12

People diagnosed with coeliac disease are entitled to receive foods such as bread, pasta and flour mixes on prescription to help manage the condition and prevent the disease developing into a more serious illnesses. But a recent BBC Newsnight programme revealed that the huge handling and delivery costs can quadruple the cost to the NHS. In one instance, a £2.50 loaf of bread was subjected to a £32 handling fee. So it’s great news to hear that gluten-free prescription food manufacturer Juvela is guaranteeing that from 1 August 2012 all its fresh products supplied on prescriptions to pharmacies and dispensing doctors will not incur additional handling and administrative charges for the NHS.

WEB SHOP GETS MAKEOVER

Diabetes UK’s new-look web shop will be up and running this autumn. Improvements include product images that can be enlarged and an easier login process, which will offer a smoother online shopping experience. You will also be able to log your views on the new-look shop by clicking on the feedback button and adding your comments. The new-look shop is due to go live during October, and you could be one of the first to shop there by visiting shop.diabetes.org.uk. i For a selection of Diabetes UK Shop products, turn to page 55.

VAT-FREE TIMESULIN

Fans of Timesulin pen caps will be pleased to hear that they are now available in the UK and EU, free of VAT. i For details, email support@timesulin. com or visit www.timesulin.com.

September – October 2012 16/08/2012 14:50

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What are the symptoms?

Symptoms may be mild or severe and can happen frequently in some people and less often in others. If food lingers too long in the stomach it can cause: nausea, vomiting, early feeling of fullness eating, weight loss, abdominal when bloating, erratic blood glucose levels, heartburn and poor appetite. As these symptoms are common and may be due to other reasons, speak to your doctor if you experience any of them.

What are the complications?

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Uncovering the extraordinary life of Dr RD Lawrence

the doctor can look at the lining of the stomach to check for any abnormalities. You would normally be sedated for this test. • obarium study: a meal containing barium is eaten, which allows the radiologist to watch the stomach as it digests the meal. If there is any food in the stomach after a 12-hour fast, this suggests gastroparesis.

What causes it?

The most common cause of gastroparesis is diabetes. High blood glucose levels can cause chemical changes in nerves, and can damage the blood vessels that carry oxygen and nutrients to the nerves. Over years, this can damage the vagus nerve. Other causes of gastroparesis include: surgery on the stomach or vagus nerve; viral infections; anorexia nervosa or bulimia; medications – anticholinergics and narcotics – that slow contractions in the intestine; and nervous system diseases, such as Parkinson’s disease.

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Since gastroparesis makes stomach emptying unpredictable, blood glucose levels may be erratic bezoars) that may cause obstruction in the stomach. These can be dangerous if they block the passage of food into the small intestine. Gastroparesis can also make blood glucose levels difficult to control. When food that has been delayed in the stomach finally enters the small intestine and is absorbed during digestion, blood levels rise. Since gastroparesis glucose makes stomach emptying unpredictable, blood glucose levels may be erratic.

The article on gastroparesis MOBILITY (Spotlight on...,08 May–June 00 197 7981 2012, balance), has made a difference to my life. For quite a few years I’ve been having lots of problems with eating as loads of foods make me sick, which has resulted in a very big weight loss. No GP knew what the problem was and I was put on loads of medication but none of it helped, in fact it made my problem a lot worse. But this article described everything that was happening to me. I showed it to a friend and she agreed. I have now moved to a new area and this problem is now being looked into and hopefully soon it will now be confirmed. But for now it is nice to know what it could be. Thank you. If food lingers too long in the stomach, it can lead to bacterial overgrowth from the fermentation of food. Undigested food can harden into solid masses (called

42-43 SpotlightColourAC.indd

How is it diagnosed?

First, to rule out obstruction or other conditions, your doctor may perform the following tests: • upper endoscopy: a long, thin tube called an endoscope is gently passed through the mouth down the oesophagus into the stomach. Through the endoscope,

To confirm the diagnosis, the doctor will undertake a further test – either a gastric emptying scan, which monitors the digestion of food containing a radioisotope (a non-dangerous, slightly radioactive substance that shows up on the scan), or a gastric manometry, which measures electrical and muscular activity in the stomach, to show how it is working.

How is it treated?

Contact Careline!

I wrote to Diabetes UK’s Careline for some much-needed advice, for which I cannot say thanks enough. My queries were answered very quickly and information on diabetic neuropathy sent by post. I urge readers to contact Careline – you may find your worries will be over. Thank you. Mrs P Morris, London Editor’s note: Call Careline on 0845 120 2960 (see page 4 for more ways to get in touch).

In most cases, treatment does not cure gastroparesis, but it can help you to gain control of your blood glucose levels and manage the symptoms, so you can be as healthy and comfortable as possible. There are several medications available doctor and diabetes healthcare – your team try different ones, or combinations, may to find the most effective treatment for you. To help improve your blood glucose control if you are on insulin, you may be advised to take it more often, to inject after you eat instead of before and to check your blood glucose levels frequently after you eat. Making changes to your eating habits, such as what you eat and when, may also help. Your dietitian will be able to give you specific advice depending on your symptoms. In very severe cases, feeding tubes, intravenous feeding and surgical implants may be needed to manage the symptoms of gastroparesis. i www.diabetes.org.uk/gastroparesis. • For individual advice, speak to your diabetes healthcare team.

May – June 2012 balance 43

16/04/2012 11:07

Hello Bydureon

Having read your excellent article about Bydureon (Spotlight on... July–Aug 2012, balance), I’d like to Dana Robinson, via email submit my personal observation. I’m a 73-year-old retired Senior Nurse and I was diagnosed as suffering from Type 2 diabetes in Lean on me February 2001. My gliclazide tablets research matters I was interested to read had to be stopped as I developed the article on ‘Lean severe skin irritation. I then LEAN GENES & TYPE 2 Genes & Type 2’ switched to metformin but had (Research matters, to be put back on 30mg gliclazide July–Aug 2012, balance). tablets, one daily, and my I’ve had Type 2 for the metformin was reduced to last 25 years, with the two tablets of 500mg twice daily. {1976 last three being on However, my blood sugar was still the needle. fluctuating so I was put on Byetta My current weight is more or less (exenatide) 10mcg solution, twice a exactly the same as it was when I day. But I developed a needle phobia went in to the RAF at 18 years of and have been on 2mg of Bydureon age (I’m now 75). once a week since April 2012. My weight has always been in Initially for the first three months, the region of 12st 4lb–12st 10lb my average blood glucose level was (78kg–80.5kg), so was very surprised between 5.5–6mmol/l before to find that I was diabetic when breakfast and 5.9mmol/l before I turned 59. There is no known bedtime. I have had no hypos or history of diabetes in the family. hypers since being prescribed Ian Coutts, via email Bydureon. I am still taking 30mg of Low testosterone linked to Type 2

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

{

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

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

20 balance

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

July – August 2012

20-21 Research Matters COLOUR.indd 20

Machu Picchu on a pump

Take control for a happier, healthier you

What is it?

Gastroparesis, or ‘delayed stomach emptying’, is a chronic disorder where the stomach takes too long to empty its contents. Normally, the vagus nerve controls the movement of food from the stomach down into the intestines for digestion. But when this nerve is damaged or stops working, the muscles of the stomach and intestines cannot contract normally and so the movement of food is slowed or stopped.

BRITAIN

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

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gliclazide daily and two 500mg tablets of metformin twice a day. My weight has reduced from around 12st 9lb (80kg) to around 11st 1lb (70kg) although my mobility is greatly reduced. As the measurement for blood glucose has been changed, I would like to know where I can get a conversion table.

Gunter Heise, Llanelli, Carmarthenshire

Editor’s note: You can visit www. diabetes.org.uk/HbA1c for an online conversion chart – and see page 44 for a basic guide. I’ve gained a great deal, thanks to Bydureon. I’m no longer tired by mid-afternoon and enjoy life much more and sleep much better. The removal of gliclazide and then its replacement at half the previous dose has had little or no noticeable effect. I have also lost weight – and kept it off. Since January, I’ve dropped from around 22st (140kg) to 19st 10lb (125kg) and am still losing weight – not fast, but at a steady rate. My goal by the end of 2012 is to have got down to 18st (115kg) and then lose a little more. That would put me back at the same weight I left Basic and Officer training in the Army as a very fit young man of 18. Bydureon is a great product and I’d recommend it to anyone, I only wish it had been around 12 years ago when I started the diabetes journey. Don’t be put off by the fact you have to inject yourself, it’s only once a week.

Jim Dawson, via email

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

14 balance

September – October 2012

14-17 Your Views columnists text copy3.indd 14

16/08/2012 16:54

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

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Who is it suitable for?

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I took my sons to their diabetes clinic last week. As usual, the care we received was exceptional. Their specialist is a fantastic doctor who treats children and teenagers as his equals. Olly Double reflects on the high quality of medical care provided by the NHS in his latest blog post ‘NHS is not a four letter word’: www.diabetes.org.uk/bloggers Been out training for my bike ride for Diabetes UK in September. Managed 40 miles in 3 hours and 10 minutes. So chuffed! Lisa Lander on Twitter

COLUMNIST Richard Lane OBE

Your right to 15 On my travels around the UK, I‘ve been amazed and horrified by the apparent lack of knowledge among many people with diabetes about the elements of their care to which they are not just entitled, but which they are not being offered or made aware of. This lack of communication may be a major contributor to the awful rise in avoidable complications, such as unnecessary amputation,

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How do you take it?

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

I’m a practice nurse in Preston and have been specialising in diabetes for seven years – an easy choice as I’ve had Type 1 since 1979 (I’m now on a pump and have several complications). We initiated Bydureon to four patients five months ago. One is a HGV/LGV driver and prior to treatment his HbA1c was 115mmol/ mol (12.7 per cent) and his BMI was 34.2. Three months later his HbA1c is down to 76mmol/mol (9.1 per cent) and his BMI is currently 32.8. He found that taking injected therapy re-awoke the seriousness of his condition, so he also made adjustments to his lifestyle. One of my new Type 2 patients who had a BMI of 44 and did no exercise, decided to change his way of life after chatting with me. He ran the London Marathon in April and when I saw him last his BMI was 26, training every day, eating a healthy diet and didn’t have to start on metformin because his fasting glucose had changed from 14mmol/l to 6mmol/l and his HbA1c was a very commendable 47mmol/mol (6.5 per cent).

Bydureon (like other incretin mimetics), helps to control blood glucose by: • stimulating the pancreas to produce more insulin in response to rising levels of glucose in the blood • reducing the amount of glucose being produced by the liver when

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high body weight 2 a BMI below 35kg/m , but where insulin your therapy could cause problems with work, or weight loss would help other existing health problems.

Is it taken in combination with other diabetes medications?

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

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

Is it widely available?

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

July – August 2012 balance 45

21/06/2012 15:03

07/06/2012 16:56

44-45 Spotlight_Colour.indd 45

and Diabetes UK’s 15 Healthcare Essentials campaign is absolutely vital in our efforts to improve the healthcare of people with diabetes, and to bring down the dreadful statistics covering unnecessary complications. Examples of this are: have your feet checked (it is vital that the skin, circulation and nerve supply are professionally checked annually), and have your kidney-function monitored (the tests referred to must be carried out, again annually). But we, too, have to play our

Not all my 503 patients are successful in controlling their diabetes as well, but the ones who do change for the better are the ones you remember. As a nurse I am pleased it is me who gave them the encouragement and information to succeed.

Sr. Janet Armer, via email

Exam tips

I was sorry to hear that Patricia Debney’s son, Eliot, felt unwell during a GCSE exam as a result of blood glucose levels (Columnists, July–Aug 2012, balance). When my daughter was due to sit her first exams, I contacted school staff and agreed a set of procedures for her, with help from a supporting letter from a wonderful nurse. The result was that, if at the start of any exam, my daughter’s levels were ‘out of range’ she could delay starting the exam until she felt well again. And, if unstable levels left her feeling unwell during an exam, it was agreed that the details would be recorded and submitted to the exam board by way of appeal. Perhaps other parents might like to consider similar action. Consultations before exam time meant that my daughter wouldn’t be unnecessarily disadvantaged. In

part in ensuring that we get these checks. We must take the list to our diabetes healthcare team each year and literally ‘tick off’ those checks that we have had, to identify those yet to be carried out, and then if appropriate, insist on having the rest of them. Only by looking after our own interests in this way will avoidable complications be reduced. Let us all play our parts – it is in our own interests to do so! i Richard is President of Diabetes UK and has Type 1. Read his blog at www. diabetes.org.uk/bloggers. • See page 29 for more on the campaign.

September – October 2012 balance 15 14-17 Your Views columnists text copy3.indd 15

16/08/2012 16:54

opinion she (and I!) felt less anxious » addition, during exams, and staff were happy

them’, which is understandable when I was tested with antiquated to have procedures in place. equipment. I passed an advanced Jacqueline Diss, via email driving test in January – no faults found. Surely this is proof that my Date to remember vision is not affected. I can see to I was diagnosed with Type 1 diabetes both sides without moving my head 15 years ago on 9.7.97, which makes but I might not be able to see weak it very easy to remember such a spots of light in a box at close range. significant date. I wonder if any It’s time that a proper test was readers were diagnosed with devised. I can see the fence posts diabetes on a memorable date? in a field half a mile away, I can Colin Levesley, via email see a sparrow at 100 yards, I can see pedestrians in front of and to Field test ‘farcical’ the side of my car. What more Over the years I have been required to does the DVLA want? If I can’t see take a visual field test for my driving I will stop driving – safety comes licence as I’ve had laser treatment for first not only other people’s, but retinopathy to both eyes and a my own too. cataract attended to in my right eye. Mr J Rogers, via email It concerns me that the test has little or no relation to actual driving Pub measures conditions, for instance I don’t sit I’m trying to lose some more weight very close to the windscreen looking – 7st 11lb (49.5kg) so far. At a recent at spots of light at any time. The spots Christening party held in a pub I are dim and flash quickly on and off. managed to negotiate the buffet Headlights don’t normally do this successfully. My husband ordered and this certainly doesn’t happen in a Slimline tonic for me and, later, I daylight driving. Even the distance decided to get two more at once as test does not really apply and dates they were so small. back to a time long ago when a man Not until I topped up the glass walked in front of the car with a red did I notice they were ordinary flag. We are required to be able to tonics. Every time we had read a number plate at 65ft but this stressed Slimline. Luckily my also bears no relation to actual blood sugars are very stable as I driving conditions. The test is farcical. had drunk 3½ and I would have My licence has now been restricted had more. to one year as the DVLA states that In future I will always want ‘there has been a deterioration in to see with my own eyes! your visual field since we last tested Ruth Haines, via email COLUMNIST Patricia Debney

Edge-walking Three years ago, on our first holiday post-diagnosis, we all wanted to ‘get back to normal’: Eliot seemed stable, and we badly needed a break. But upon arrival in the Lake District, Eliot’s readings went through the roof. He stayed above 15mmol/l for two long days. He was too high to exercise, so

16 balance

our walks and cycle rides were out of the question. We examined levels, and longed for informed medical help. Finally something clicked: even after five hours fasting, he was 17mmol/l. It must be the background insulin. We increased his insulin by a startling 50 per cent. At last he began to come down to safer levels. The 50 per cent increase became permanent. We now know that it’s likely his body chose that week to emerge from the ‘honeymoon’ phase.

I love my...

Is there someone you couldn’t do without? Tell us about them at the usual balance address (see page 14) marked ‘I love my…’

It is with great sorrow that Frank Bowles, co-founder along with his wife Anne of the Mijas La Cala Lions Diabetic Support Group on the Costa Del Sol, has passed away. Anne and Frank founded their group in 2003 with the aim of creating a forum where diabetics could meet in person in a friendly and supportive environment. At the meetings we are able to consult a qualified nurse, receive help and advice, pick up tips, and learn from professionals who give informative talks. Unbeknown to members, Frank has courageously battled several chronic conditions in addition to diabetes, which he had for 25 years. Yet he and Anne continued with the meetings until a few months before he died and he never complained. It is not often that anyone can say they have been touched by angels but more than 500 diabetics certainly have been. Anne, on behalf of the members I would like to thank you for all you have both done to help over the years, and we are truly grateful to you for agreeing to continue to organise and lead sessions in the future.

Beverley Saunders, via email

Holidays reveal our daily routine for what it is: a narrow ridge walk. And what of this summer, August 2012? We’re in the Lakes again, and it looks like Eliot’s body has chosen now to decrease insulin requirements. Sigh. Nurturing hopes for a cure, we will get, rain or shine, to the top of this mountain. i Patricia is an author and senior lecturer in Creative Writing at University of Kent. Her son, Eliot, 15, has Type 1. www.wavingdrowning. wordpress.com. @PatriciaDebney

September – October 2012

14-17 Your Views columnists text copy2.indd 16

16/08/2012 14:33

opinion

COLUMNIST Andy Kliman

Vitamin vitals

I was very interested to read the possible connection with metformin and vitamin B12 deficiency (‘B12 aware’, Your views, July–August 2012, balance). I have been taking metformin for around 17 years for Type 2 diabetes and, at intervals during the last two years, have found myself falling asleep at any time of the day for no apparent reason. When I mentioned this at my check-up, the doctor arranged for blood tests, which showed that my B12 levels had dropped to almost half of the normal reading and I had the first B12 injection a fortnight ago. Thank you for your very informative magazine.

Janet M Marven, Sawston, Cambridge

I am 86, have Type 2 and have vitamin B12 injections every three months because one of my blood tests showed a vitamin deficiency. I, too, take metformin; two tablets three times a day, plus insulin three times a day.

Peter Baldwin, Ryde, Isle of Wight

Reading Mrs Phillips letter sent me off to Google B12 deficiency. I was amazed/horrified at how many of the symptoms I had. When attending my GP I mentioned B12 deficiency. She didn’t think that would be the cause but still took a blood sample for testing. A few days later the surgery called to make an appointment for me to see my GP. B12 injections start next week. Thank you balance for providing space for us to share our experiences, which help the rest of us in the ‘diabetic gang’.

Johan McDonald, via email

Me & my balance Ronald Rattray certainly enjoyed his copy of balance while soaking up the stunning views in Reykjavik, Iceland (right) and Geiranger Fjord, Norway when he and his wife Sheila went on a cruise with their daughter Joy and her husband Willie. Ronald, who has had diabetes for 29 years, says Sheila helps him stick to his diabetes regime and last year they celebrated their Diamond Wedding anniversary. Keep your photos coming to the usual address, marked ‘Me and my balance’. Every photo printed wins a Diabetes UK drawstring bag.

Not my Type I was all set to write an acerbic article about the failure of the NHS to make correct appointments. As a diabetic patient I am sure you, like me, end up having quite a few appointments at hospitals. But then something else came up. Diabetic patients have a contract with the NHS, they help us manage our condition and we do all the hard work, such as losing weight and watching what we eat. I’ve been dealing with Barts, who failed to notice my GP surgery had made me the wrong appointment. I needed to speak to a specialist about my rising blood sugar levels, but instead they booked me in for a blood test, which I’d had done a few weeks earlier. I’ve written a blog on this problem, which I’ll post on the Diabetes UK website. I finally got to see a specialist consultant and he dropped a bombshell on me. I’ve done all the right things to get my diabetes under control. I’ve lost over 5st (approx 30kg) in three years. I’ve taken all my medication religiously and none of it was making any difference. I felt I’d been failing. He felt I’d been misdiagnosed and, in fact, I have late onset Type 1 diabetes. BOOM! I go on to insulin tomorrow and I am nervous about it. The negative is that I can’t avoid insulin any more, but the positive is that I have avoided it for 28 years longer than most people with Type 1. Stupid pancreas! i After years of treatment for Type 2 diabetes, Andy Kliman has recently been diagnosed with Type 1. Follow his blog at http://t2dkidding.blogspot.com and his Diabetes UK blog at www.diabetes.org. @andykliman uk/bloggers.

September – October 2012 balance 17 14-17 Your Views columnists text copy2.indd 17

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15/08/2012 19:02 03/08/2012 10:07

012 10:07

research matters TAKE PART IN RESEARCH Researchers, funded by Diabetes UK at Peninsula Medical School and Plymouth University, are calling on people with Type 1 diabetes aged 16 to 25 to enter a competition to win money and help to improve the care they receive, as featured in July–August 2012 balance. The Diabetes App Challenge invites entrants to design an Internet or mobile phone ‘app’ to help young people with diabetes get more out of their healthcare appointments. The best apps will be made available online so that other young people with diabetes can test them and designers will receive a payment every time their app is downloaded. Apps must be submitted by 14 October 2012. For more information on what is involved and how to enter visit www.diabetesappchallenge.org.uk. Diabetes UK-funded researchers at the University of Dundee are recruiting volunteers with Type 1 diabetes or Maturity Onset Diabetes of the Young (MODY) aged 16 or older who are living in Scotland. The researchers need help to develop a ‘bioresource’ of blood, urine and DNA samples from 10,000 people with Type 1 and MODY that will be used to improve the study of both conditions and could lead to the development of new treatments. Contact Bridget Shepherd on b.z.shepherd@ dundee.ac.uk or 01382 632 353 for further information. University of Southampton researchers are looking for people aged over 18 with diabetes and depression to help improve a questionnaire designed to explore how people make sense of and manage both conditions. If you would like to participate complete the survey at www.isurvey.soton.ac.uk/2776. For further details or a hard copy of the survey, call Jenny McSharry, University of Southampton on 023 8024 1047 or email jem1d08@soton.ac.uk. i For more diabetes research opportunities, visit www.diabetes.org.uk/diabetes-research-trial-opportunities.

BIOLOGICAL CLOCKWORK TO TREAT TYPE 2?

Biologists at the University of California San Diego have discovered a molecule that offers a potential new direction for the development of drugs to treat Type 2 diabetes. The molecule, known as ‘KL001’, affects the activity of a protein called cryptochrome, which regulates the body’s biological clock and also reduces the amount of glucose produced by the liver. Various research studies have shown that diabetes and obesity might be linked to problems with the biological clock that regulates sleeping and waking. For example, when the biological clocks of lab mice are altered, they often become obese and develop diabetes.

Therefore, drugs that influence the biological clock provide a useful way of treating diabetes but, currently, only a few chemicals that target the clock’s mechanisms have currently been identified. In this study, the researchers found that adding KL001 to the liver cells of mice prevented cryptochrome from being degraded, leading to the reduced production of glucose. This molecule could therefore be used as a tool for studying the influence of the biological clock on the control of blood glucose and perhaps aid the development of therapies for diabetes focused on the biological clock. i First published in July’s Science journal.

Diabetes UK launches Alberti Fellowships Diabetes UK has announced a research fellowship that will enable NHS employees to develop a career in diabetes research by working towards a PhD or MD. The Sir George Alberti Research Training Fellowship was named in recognition of the internationally renowned diabetes researcher (pictured right) and Chair of Diabetes UK. The fellowships will support research training for up

to three years and are open to anyone working in any scientific discipline or sector within the NHS who can demonstrate a role in improving the health of people with diabetes. Dr Iain Frame, Director of Research at Diabetes UK, told balance: “Looking at the lives of people with diabetes today, compared to 50 or 100 years ago, we can see the huge impact research has had. There is still more to

be done and we want to continue to fund the best candidates, regardless of their background, to work towards a future without diabetes.” i For more information visit www.diabetes.org.uk/ Alberti-Fellowship.

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research matters

DVD promotes pre-pregnancy planning An interactive DVD for women with diabetes that improves knowledge of pregnancy and diabetes and of the need for pre-conception planning in order to avoid potential complications, has been developed by Diabetes UK-funded researchers at Queen’s University Belfast. Most women with diabetes can have healthy babies if they can achieve good blood glucose control before conception and during early pregnancy, which is why it is advisable to plan for pregnancy in advance. According to the researchers, only one third of women currently receive the recommended pre-pregnancy care and a lack of awareness about the importance of planning may be one reason why. The DVD draws on scientific evidence and the views and experiences of eight women with diabetes to provide useful information and counselling that others can watch in their own homes. After viewing the DVD, participants had a better understanding of the risks associated with pregnancy in diabetes and of ways to reduce risks by planning ahead. The DVD has now been distributed to all women with diabetes in Northern Ireland who are able to have children. Further studies will be used to evaluate its impact on the ways that women with diabetes plan for pregnancy, and on the health of mums and their babies. i Published in June’s Diabetic Medicine. View the DVD content at http://go.qub.ac.uk/womenwithdiabetes. • For Diabetes UK’s preconception and pregnancy information: www. diabetes.org.uk/ pregnancy. • See page 48 for information on contraception.

20 balance

NEW GRANTS Diabetes UK has agreed to fund 12 new research grants worth more than £2m. These funds will provide support for high quality, diabetes-related projects for up to ﬁve years, or enable researchers to purchase large pieces of specialist equipment essential to their work. Here we look at three of the new grants. UNDERSTANDING THE PANCREAS IN TYPE 1

This project will use state -of-the-art techniques to improve our understanding of the cellular and molecular processes involved in the immune attack that causes Type 1 diabetes. Dr Kathleen Gillespie will use specific markers to compare the number of harmful and helpful immune cells in Type 1 pancreases with the numbers found in healthy pancreases. The insights obtained could ultimately help researchers to identify targets for new therapies that might help delay or prevent Type 1 diabetes. Dr Kathleen Gillespie (above) of the University of Bristol £183,492; Three-year project grant.

CAN FROGS SPAWN NEW TREATMENT FOR DIABETES?

Researchers at the University of Ulster have identified several proteins in the skin secretions of frogs that could prove useful for the treatment of Type 2 diabetes. Now, with support from Diabetes UK, Dr Yasser AbdelWahab is going to study the effect of these proteins on mice.

The researchers will produce synthetic copies of four proteins (found naturally in the Chinese Edible Frog, the Volcano Clawed Frog and the Chiricahua Leopard Frog) and study their influence on blood glucose levels and the production of insulin. Dr Yasser Abdel-Wahab (below left) of the University of Ulster £175,999; Three-year project grant.

ALZHEIMER’S DRUGS FOR TYPE 2

Professor Mike Ashford and his team at the University of Dundee will find out whether drugs that inhibit an enzyme called BACE1 (which are now being developed to treat Alzheimer’s disease) can also be used to improve insulin sensitivity and the management of blood glucose in mice with Type 2 diabetes. If they can, similar drugs could be developed for people with Type 2 and provide a useful alternative to existing medications. Professor Mike Ashford (above) of the University of Dundee £227,802; Three-year project grant.

September – October 2012

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feature

EXERCISE IN RESEARCH At Newcastle University’s MoveLab, Dr Michael Trenell is putting volunteers through their paces to find ways of turning exercise and physical activity into an effective therapy for Type 2 diabetes. Dr Richard Elliott and Dr Matthew Hobbs went along to find out what it’s like to take part in this kind of research…

DR RICHARD ELLIOTT

Diabetes UK’s Research Communications Officer “I was happy with how I did, but could do with being fitter!“

22 balance

DR MATTHEW HOBBS Diabetes UK’s Head of Research “I was pleased with my result, but think I could do better if I did the test again now.“

hysical activity and exercise are key to the health and wellbeing of people who have – or are at high risk of – Type 2, and Diabetes UK funds several research projects to help improve our knowledge in this area. Such projects put volunteers with diabetes through their paces in order to find how different types of activity, at different rates, and over different lengths of time (or in combination with different drugs) can help to improve glucose control, reduce body fat or improve overall health and fitness. They also establish how difficult particular exercises are to perform and how easily they might be fitted into a daily routine. This might help people with diabetes to take part in such exercises more easily and more regularly. Dr Matthew Hobbs, Diabetes UK’s Head of Research, joined me at Newcastle University where we met Dr Michael Trenell, an expert in this field, who had agreed to put us through the same tests that people with Type 2 diabetes experience as part of his work. “Physical activity and exercise research has improved massively,” says Dr Trenell. “We try and understand their benefits to health in the same way you would understand the benefits of a drug. We can then generate information that diabetes healthcare teams need, such as the minimum and optimum amounts of exercise that are required to reduce average blood glucose levels.”

The big test… Dr Trenell takes us into the MoveLab, which is impressively kitted out with computer screens and a sophisticated range of exercise machines. “The

September – October 2012

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Sticky pads are attached to Matt’s chest to check his heart rate during the test idea is to provide the type of support that we would give at the English Institute of Sport or to elite athletes to everyday people like you and me,” he explains. “We’re really interested in three elements. Firstly, the types of fuels you burn when you are inactive and when you are moving. Secondly, your cardio-respiratory fitness – which is like your engine size. This is important because it relates to your use of glucose as a source of energy, which obviously has a relationship with diabetes, but also relates to your ability to do everyday things. And thirdly, muscle strength, which we can measure in any of the major muscle groups in the body.” Matt and I are here to take part in what is called a ‘maximal progressive exercise test’. “This is going to measure your cardio-respiratory capacity,” explains Dr Trenell. “The way I would normally describe it is that it’s like cycling up a hill that gets steeper and steeper. Except this is a horrible hill because you never reach the top. It’s about seeing how high up the hill you can go. It gets harder and harder, places increasing stress on your muscles, lungs, heart and vascular system, but provides us with lots of information.”

This information is relevant to people with Type 2 diabetes because they tend to be less physically active than people without Type 2 and, as a result, they tend to have lower levels of cardio-respiratory fitness. The reverse is also true in that people with lower levels of fitness can be more resistant to insulin. It’s also important for health guidelines, because the majority of us can change our level of fitness, whether for the worse, by becoming more sedentary, or for the better, by becoming more active. Once we’ve changed into our vests, our height and weight is

Type 2 diabetes are at a higher risk of cardiovascular complications. “Any problems with exercise, which are very rare and relate specifically to undiagnosed heart complications, are picked up through the test,” says Dr Trenell. “So it is very, very safe. We’re also increasingly looking at the heart to understand the role of physically active and inactive lifestyles and the role of

At the end of 20 minutes on the bike, it felt like we were cycling through porridge recorded before an inflatable cuff is placed on our upper arms and sticky pads are used to attach electrical leads to our chests. These allow the researchers to monitor our blood pressure and heart rate and will show how well our hearts are working throughout the test. This is also really important from a safety perspective, because people with

Richard gets on the bike and cycles uphill for 20 minutes, pushing himself to the limit

A mask is fitted over Matt’s mouth and nose so that his breathing can be monitored

exercise in reversing some of the cardiovascular impacts of Type 2 diabetes.” Once we’re hooked up to the computers, they show that neither of us has any heart problems. We then, in turn, take a seat on the lab’s exercise bike and are fitted with a facemask that sits snugly over the mouth and nose. This measures the amount of oxygen that we are breathing in and the amount of carbon dioxide that we are breathing out. At first we can pedal very easily. We sit back on the exercise bike and watch as our regular breathing and the beating of our hearts appear as graphs on the monitors in front of us. However, over the course of 20 minutes, pedalling gets heavier going and we are forced to push ourselves harder and harder just to maintain a steady pace. Our heart

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and oxygen intake go steadily » rate up. By the end, we are both breathing

is the one which becomes a habit, whether that’s playing a round of very heavily and it feels as if we are golf, playing tennis, dancing, cycling through porridge, until marathon training or even just eventually our legs grind to a halt. walking from the train station to the office,” says Dr Trenell. Research in progress Looking to the future, Dr Trenell Once we’ve recovered, Dr Trenell is keen to involve more and more tells us about the progress of his people with diabetes in his work research and the challenges involved and believes that progress will in turning physical activity into a come when doctors are able to more effective therapy for Type 2. work with their patients in designing “We can now say with confidence and planning physical activity that physical activity and exercise programmes, rather than just therapy can benefit people with Type telling them what to do. 2 diabetes. The challenge is how we “Ultimately, we want to see a create that behaviour change – and real impact of what we do, not just

Exercise routines need to be designed around the individual, not around science that is where we have seen an exciting shift over the last couple of years.” Dr Trenell argues that to help people with diabetes increase their physical activity, exercise routines need to be designed around them, not around science. It is also important to gain the support of care teams, who will help their patients put these routines into practice and overcome any practical obstacles that may arise. The first step to improving your lifestyle is to identify the everyday behaviours that are bad for your health and the changes you could easily make to reduce or offset them. You then need to identify the obstacles that prevent you from making these changes and find ways of overcoming them. So what are the best exercises to help us get fit and lose weight? “Exercise alone is good for weight maintenance, but it’s not good for weight loss. Eat less – that’s how you lose weight. As for which exercise helps you to get fitter, it’s the exercise that you are most likely to do frequently – that’s what we tell our patients. The best exercise

24 balance

demonstrate the effects of exercise in the lab. We want to create that same behaviour change routinely in clinical care. It’s about changing patient behaviour, but it’s also about changing professional behaviour. I think it’s an exciting arena ahead of us because we can bring together elements of molecular biology, physiology, health psychology and therapy design, and start to work out exactly what we should focus our energies on.”

It’s a thumbs up from Matt as he emerges from the test with a great set of results

THE MAN BEHIND MOVELAB Dr Michael Trenell is the founder and leader of MoveLab, a group of physical activity and exercise researchers at Newcastle University. He first studied applied physiology and exercise at the University of Leeds before moving to Sydney, Australia, where he gained his PhD in biochemistry and neurogenetics. He moved to Newcastle in 2006, and was awarded an RD Lawrence Fellowship by Diabetes UK. This prestigious grant has enabled him to carry out extensive research which shows that taking more exercise can improve glucose control it has also helped him to develop an online tool that allows people to manage Type 2 diabetes by increasing their physical activity. With support from Diabetes UK, he is now supervising a PhD student who is hoping to find out which exercises are most effective at reducing liver fat – a key contributor to the development and progression of Type 2. These include weight training and high intensity intermittent training (a workout that alternates periods of short, intense exercise with less intense recovery periods), which might help to increase the benefits of exercise for individuals with limited free time. Dr Trenell is passionate about the use of physical activity and exercise as a therapy to improve wellbeing and reduce the risks of chronic disease and MoveLab is helping him turn his passion into practice. i www.movelab.org

September – October 2012

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feature

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

Breaking the cycle Unfit, overweight and diagnosed with Type 2 diabetes, writer, journalist and broadcaster, Malachi O’Doherty, knew something had to give. Approaching 60, he didn’t try to relive his youth in a fast car; instead he tells balance how he turned back the clock to his 30s by getting on his bike and revisiting many of his cycling-route haunts in Northern Ireland… What was your lifestyle like before your Type 2 diagnosis? I had just accepted that gradual fattening and putting on weight was a normal part of ageing. I was lazy and used the car a lot even for short trips. But, even before I was diagnosed I’d started to make some changes. I was conscious that I was unfit and I was trying to walk a lot more. I hadn’t been up enough mountains and I hadn’t been out on my bike for over a decade.

26 balance 26-27 Malachi.indd 26

You have a twin brother, Roger, who seemed fitter than you. Why did you think he was healthier? He maintained his health through his love of hill walking. The summer before I was diagnosed, we walked up Knocklayde Mountain. We took a ridiculously circuitous route that ended in a steep climb. He made it to the top but I had to give up.

Did you suspect it might be diabetes before your diagnosis? There is no known history of diabetes in my family, but then there may be huge numbers of people who have it and don’t know. I wasn’t aware of specific diabetes symptoms, but I had been living with erratic discomfort in my stomach area for years, worrying about gallstones and possible ulcers. In the end it all amounted to being fat and nothing working

September – October 2012 15/08/2012 19:14

feature as well as it should. I asked my doctor to screen me for diabetes and the result only confirmed what I’d already suspected.

How did you feel when you were diagnosed? I took it well; I’d dreaded the possibility of it being something worse. The beauty of my problem was that there was something I could do about it, and once that was clear to me, I decided to be a good chap and take the best advice I was being given and mend myself. There are a lot of conditions you can’t do much to ease, but this was one that would yield to care and discipline.

You treat your diabetes with diet and exercise. What professional support were you given? My doctor’s advice was simple and straightforward: “If you could lose a stone you’d hardly know yourself”. He sent me home with a sheaf of papers that told me I could still have the odd pavlova. The best advice was to try to come down slowly at a rate of about 2lb per week. This was easy at first but occasionally my weight would plateau and more strenuous exercise helped.

Why did you decide to ‘get back in the saddle’? At 60, some men might recover a sense of being young by living out

the playboy years they feel they missed. The years that called me back were my 30s when I cycled all over the country. Some people thought it was a bit funny, like an older man trying to be younger than he is. But most people have a naive idea about cycling and don’t appreciate that even a moderately fit cyclist can enjoy a 40-mile trip on a summer’s afternoon – you don’t have to be super fit.

What are some of the best experiences from your cycling trip? Belting downhill off The Sperrins so fast that I felt as if I was about to take off. And, in total contrast to this, tootling along the Lagan Towpath with the whole day to spare.

I cycle a few miles every day to work and most weekends take a tour of 35 to 40 miles

You lost 2st 5lb (15kg) in six months. How did you feel? I felt transformed. I was, strangely, most aware of it in my fingers. I hadn’t understood that I would lose fat all over my body. Others noticed it in my face. Friends were alarmed. They worried that I was ill or that I would make myself ill. There is such concern about obsessive eating disorders that my wife fretted that I might be anorexic. In fact, I settled into a pattern of eating and exercise which maintained the weight level I wanted, without taking me below it or bouncing me back up.

Have you kept up with your exercise? I cycle a few miles every day to work and most weekends take a tour of 35 to 40 miles. Last week I cycled along

GIVEAWAY

We have five copies of Malachi O’Doherty’s entertaining and heartwarming book, On My Own Two Wheels, to give away. To enter, send your name and address on a sealed-down envelope or postcard to: ‘balance Two Wheels book giveaway’, Diabetes UK, 10 Parkway, London NW1 7AA by 21 September. The Lagan Towpath to Lisburn, then out along the A1. Then I took the road through the drumlins to Carryduff and stopped to eat with a view of the Mournes. Then home.

What do you know now about having a healthy life that you wished you knew when you were younger? I wished I had known that being fat can be at the heart of a lot of discomforts, that losing weight was the single best thing I could do to feel better.

What’s the most and least healthy food in your fridge? The least healthy is probably Irish Cheddar cheese and, the most healthy, lots of lovely vegetables.

Do you have annual check-ups? Yes, I get my blood, feet and eyesight checked annually.

Would you say that diabetes has brought anything positive to your life? It was the warning sign that prompted me to take my weight seriously. Reaching the ghastly number 60 played its part, too! i On My Own Two Wheels is published in paperback by Blackstaff Press, £8.99, www.blackstaffpress.com

September – October 2012 balance 27 26-27 Malachi.indd 27

15/08/2012 19:14

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24/07/2012 09:31

feature

All eyes on your care:

15 HEALTHCARE ESSENTIALS

a follow-up

* Source: National Diabetes Audit

It is nearly a year since Diabetes UK launched its 15 Healthcare Essentials campaign, outlining the checks or services that every person with diabetes should have access to... We focused on the care experiences of some of our readers, to see how it varied. A year on, have there been any changes to the annual checks they receive? Still empowered to take control access to a patient education course. But I’ve been told Dave Sowerby, 37, from funding is being prioritised to Type 2 patients, so Dose Lancashire, has had Type 1 since Adjustment for Normal Eating (DAFNE) or an equivalent he was 3. When he spoke to balance is not available to me. last year about the care he was I also attended the Diabetes UK Big Event and receiving from his healthcare participated in the 15 Healthcare Essentials seminar. team, he rated it as excellent. It highlighted that I wasn’t quite as knowledgeable about He also said that he felt empowered to discuss any it as I thought, and will arm me with information about aspects of his ongoing diabetes care with them. what I need to be checking at my next appointment. “I was referred back to the diabetes clinic with an I’d say my management is on a continual HbA1c of 87mmol/mol (10.1 per cent), and although improvement curve, though I feel the lack of DAFNE I was initially wary, before the appointment I made (or equivalent) is hindering me in achieving the levels a decision to sort myself out, which I did with the of control I think could be possible. The involvement of support of my wife, Laura. so many other people with diabetes around the country Around that time, I got in touch with other people – and the world – has definitely been a support for me with diabetes through online forums, such as www. in improving my control and giving me the confidence diabetes-support.org.uk and www.shootuporputup.co.uk to push for the care I should be getting.” and was encouraged by like-minded people to approach my appointment as a discussion, rather than a judgment. Different circumstances, When I last spoke to balance, I said that I enjoyed the different care – again! relationship I have with my diabetes healthcare team, Natalie, 32, from Buckingham, was as I felt able to debate what I was being told and reach a diagnosed with Type 2 diabetes in solution that we agreed on, rather than feeling told off. November 2007. Upon diagnosis, This still stands, and my healthcare team supports me she felt that she was handed her very well with the facilities they have, but they medication and told to get on with are restricted in resources and funding. it. She was forced to learn everything about At the moment, I am not accessing any diabetes herself, only seeing a diabetes extra services through my healthcare specialist nurse a few times, and never the team. In fact, same one. She never I used the 15 had her legs, feet or the number of Healthcare weight checked, and primary care trusts Essentials was never offered where less than information to emotional support. of people with of people with half of people contact my MP Twelve years on, all diabetes only diabetes received with diabetes and chair of the that changed when she received all their all their checks in received all their primary care became pregnant with checks in one PCT* one PCT* necessary checks* trust to request twins and she rated

11%

71%

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16/08/2012 10:30

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her care as excellent. When she featured in balance, she said, “My pregnancy has made such a difference to my care — I couldn’t be looked after better”. Motherhood with twins is very busy but I’m loving every second. Serenity was born at 2.47am on 25 February weighing in at 7lb 4oz and Blaze followed at 3am, weighing 5lb 3oz. They were both born naturally. I had the perfect care throughout my pregnancy but, when I left hospital after the births, everything went back to how it was before – having to fend for myself. I have recently found out I am pregnant again, and I’m due in March. Surprise, surprise I was sent straight to the diabetes healthcare team, who have been monitoring my HbA1c levels and charting my progress. They are amazing people and do a great job, but in between babies I feel very neglected. When I was pregnant with the twins, I was so afraid I’d screw up that I booked myself on a refresher course for diabetes care, which helped. But I do think there should be more education courses made available for people with diabetes. I also think there should be specific courses aimed at pregnancy, which should be compulsory, as I had no idea what to expect and

Crunch your old cars for cash and raise money for Diabetes UK in a novel fundraising scheme run by the Giveacar social enterprise. Remember to list Diabetes UK as your chosen charity.

28-31 15 essentials AC1.indd 30

how to care for myself. Now that I am aware of the 15 Healthcare Essentials, I feel confident to push for the care that I will be entitled to after the birth of my baby.

Joined-up care is getting better Shazia Akhtar, 33, from Glasgow, has had Type 1 diabetes since 1989 and has additional health problems, including osteoporosis and an over-active thyroid. In 2006, she developed Charcot’s joint. Initially misdiagnosed, she will never walk without pain again. When I last spoke to balance, I had started to receive all of the annual checks but I wasn’t aware of them before the 15 Healthcare Essentials campaign. And, over the last year, I have received better care in some of these areas. With regards to my Charcot’s joint foot and reoccurring ulcer on my other foot, I believe I have received the best possible care. Last year, I strongly believed in the need for joined-up care, as a result of my initial misdiagnosis of Charcot’s joint. I currently have other health problems so surgery for this has been put on hold, but, for me, I feel there has been an improvement in joined-up care. For instance, I was admitted to hospital (not my usual one) with a foot infection but developed pneumonia in the process. After discharge, my own hospital kept an eye on me and had more tests done to make sure I was totally on the mend. Since the 15 Healthcare Essentials came out I think most healthcare professionals are now aware and I’m getting all my annual checks and care for self-managing. While I initially received inconsistent care relating to my Charcot’s joint and ulcer dressings, healthcare professionals are now happy to let me continue with my ulcer care when it gets infected and support me with what I think would help better. My overall control (HbA1c) has improved dramatically over the last year even though I had been very unwell with infections and high blood sugars. Since my last feature in balance I’ve been diagnosed with a progressive liver condition. Tests are being carried out but with my latest test I ended up having a severe hypo, which I believe was due to too much insulin through the drip and could have been prevented. I haven’t felt the need to take in the Diabetes UK checklist to my diabetes healthcare team, but with this recent experience I think I need to have a little look and take things further if need be. i To access the list, visit www.diabetes.org.uk/15-essentials or call 0845 585 088 for a printed copy. • Tell Diabetes UK about your care: visit www.diabetes.org.uk/care-survey. • See page 44 for a step-by-step guide on getting the care you deserve. • The original article, published in issue 5 2011, balance, is online at www.diabetes.org.uk/all-eyes.

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Photos: Clare Joyce

A solid bond When identical twins Vicki Aldridge and Kate Pragnell were diagnosed with Type 1 four years apart, the strong sisterly bond they’d had since childhood helped them support each other and manage their condition. But the big surprise came when their experience of managing their diabetes turned out to be so different, as Gaynor Jones discovers

ike many identical twins, Vicki Aldridge and Kate Pragnell have grown up with a strong bond and shared all the major events in each other’s lives. And the same can be said of their very different experiences of being diagnosed with Type 1 – four years apart. “Throughout our childhood Vicki would lead,” Kate recalls. “She was the first to crawl, the first to walk, the first to cut a tooth with me following behind. It was almost guaranteed that if one of us fell over the other would do the same the following day.” So although it was a shock when Kate was diagnosed with Type 1 – no one in the family was surprised when Vicki was also found to have diabetes. But this time, it would be Kate who would lead the way in getting to grips with diabetes, and it would be Vicki who would follow.

Positive attitude The sisters, though, have used their special relationship to manage their condition and support each other in the same positive way. “We both try to treat diabetes with the attitude,

we control diabetes, diabetes doesn’t control us!” says Kate. “Unfortunately, this is very hard for Vicki but we will not give up on that motto.” Kate and Vicki, now 30, are both married with their own families but still live close to each other in Maidstone, Kent. Vicki has a daughter and works as a receptionist for a cruise company in Dartford, while Kate has two daughters and runs her own mobile hairdressing business. Kate was diagnosed when she was 17. Her family thought something wasn’t quite right and began to notice the telltale symptoms. “Kate had lost a lot of weight,” says Vicki, “but the first real indication was when we were visiting a friend. Although Kate had been to the loo just prior to the journey, she was absolutely desperate by the time we arrived. Shortly after this, when she was sitting in the car with Mum, Kate said that she couldn’t read a road sign that was quite close. Mum made an appointment at the doctors and, within a few hours, Kate received her first dose of insulin.”

Vicki found her sister’s diagnosis hard to deal with, wishing that she had been the one diagnosed with Type 1 rather than Kate. “It was a massive shock, as no one in our family had diabetes,” she says. “It all happened so fast and there were a few tears, but we knew it was manageable. Looking back, the first few months were awful with Kate injecting twice a day, being advised to eat chunks of bread and lots of carbs, putting on lots of weight and none of us really knowing what to do for the best.”

Familiar symptoms But, four years later, it was Vicki who began experiencing the all too familiar symptoms. “Vicki just didn’t feel right,” Kate recalls, “and deep down we all knew what it was. I tested Vicki’s blood glucose one evening and she was at 13mmol/l. The doctor wanted us to

balance September – October 2012

32-35 TwinsAC.indd 32

16/08/2012 09:37

Photos: Clare Joyce

feature

As children, it was almost guaranteed that if one of us fell over the other would do the same the next day Kate

It would be good if we could get some answers as to why our diabetes is so different, as our lives aren’t that different Vicki

Kate and Vicki have found that in managing their diabetes, what works for one of them doesn’t necessarily work for the other

September – October 2012 balance 33 32-35 TwinsAC.indd 33

16/08/2012 09:37

feature

wait until after the weekend to test her blood again, but it was a bank holiday Monday. The next day, Vicki was in a bad way and the doctor told us to go to accident and emergency. Instead, we took her straight to the diabetic clinic. When Mum arrived a staff member, who knew our family well, took us straight in and within minutes Vicki had her first dose of insulin.” The twins supported each other through this difficult time, with Vicki describing Kate as a rock. “For some years Kate had been taking NovoRapid [fast-acting insulin] and Lantus [a form of longer-lasting insulin] and managed her diabetes really well,” says Vicki. “The clinic wouldn’t put me straight on to the 24hr+ NovoRapid insulin, as I hadn’t long been diagnosed and weren’t sure how I would cope with the amount of injections. It was very problematic and we had to really fight for the other medication.” In fact, the twins feel that Vicki has consistently struggled more than Kate to manage her diabetes. “Vicki’s blood glucose levels are always all over the place and even now we still

haven’t got to the bottom of it,” says Kate. “Despite two periods of her wearing a device for 72 hours that measures her blood glucose levels and shows the results on a graph.” Vicki has also experienced additional complications since the birth of her daughter. “During my

After she gave birth to her second child, Kate slipped into an unconscious state

pregnancy I had terrible morning sickness very early on and developed pre-eclampsia [a condition which can cause high blood pressure, fluid retention and protein in the urine]. It wasn’t the greatest pregnancy in the world. I was closely monitored and had to be induced. My daughter had low blood glucose levels and had to go to special care for the first few days. I now have an underactive thyroid and have to take medication to treat it.

The doctors were also concerned about my kidneys at one point but they seem to be working properly now, although it is a worry.” Although Vicki is full of praise for the diabetes nurses who supported her at this time, she unfortunately faced some difficulties with nurses on the maternity ward. And, as she recalls, her sister experienced similar problems. “After she gave birth to her second child, she slipped into an unconscious state in the early hours of the morning,” says Vicki. “It was Kate’s husband who found her on the ward. The staff thought she was asleep and had no idea how to treat her diabetes. Suffering low blood sugars, they gave her an orange drink with no added sugar!” Not surprisingly, Vicki feels strongly that midwives need more training in diabetes care. “Nurses need to be shown how to deal with mothers with diabetes after birth, as blood glucose levels can be erratic.” Thankfully, Vicki and Kate feel they received excellent care before and after their children were born.

Twins & Type 1 Although more than 85 per cent of Type 1 diabetes is diagnosed in people where there is no close family history, the risk of Type 1 diabetes is about 15 times higher than in the general population when a close family relative (parent or sibling) has been diagnosed with the condition. If a brother or sister is diagnosed with Type 1, the risk of developing it is 10 per cent, while for a non-identical twin the risk rises to 10–19 per cent, and increases to 30–70 per cent for an identical twin.

34 balance

Research Diabetes UK is also funding research by Dr Timothy Tree of King’s College London, where pairs of identical twins (some in which both siblings have Type 1 diabetes and some where only one sibling has Type 1) are helping scientists study the exact causes of the condition, enabling them to start thinking about new ways of preventing it.

September – October 2012

32-35 TwinsAC1.indd 34

16/08/2012 16:22

feature

Sister act Control Currently, both sisters manage their diabetes through insulin injections, but there has been discussion about going on a pump in the future. Despite Vicki’s difficulties, the sisters feel that the healthcare that they currently receive is very good, and that they do receive the necessary checks outlined in Diabetes UK’s 15 Healthcare Essentials. Vicki and Kate attended the Dose Adjustment for Normal Eating (DAFNE) course together, after which Vicki noticed some benefits. “It certainly helped us understand the calorific and carbohydrate contents of food

much better and helped us to adjust our insulin doses,” she says. However, Vicki did find that her blood glucose levels didn’t respond in the same way to food and exercise as the others in the group. “This left the instructors scratching their heads”, she says. The main frustration they do feel about their diabetes is that what works for one twin doesn’t necessarily work for the other. “It would be good if Kate and I could get some answers as to why our diabetes is so different,” says Vicki, “as our lives certainly aren’t that different!” i Dose Adjustment for Normal Eating: www.dafne.uk.com. • Education courses, visit www.diabetes.org.uk/structured.

The support the twins give each other came in useful when they decided to train for the Bupa London 10,000, and raise money for Diabetes UK. Completing the race and raising £610 for the charity, Kate and Vicki also felt a massive sense of achievement. “We’re not really competitive,” says Vicki. “We were running for each other. I persuaded Kate to do the run, and when I saw we could do it for Diabetes UK it was perfect.” i Bupa Great Run Series:

www.diabetes.org.uk/Bupa-Great-Run-Series.

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32-35 TwinsAC.indd 35

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All smiles: back to his full duties, Lee now has better diabetes control

The drive L to succeed Following an uphill struggle to become a Metropolitan police officer due to a blanket ban for people with Type 1 diabetes, Lee Pidgeon, 41, had another battle on his hands when an accident led to suspension with questions being raised over his fitness for duties such as response driving. However, Lee tells Julie Penfold how this turn of events helped him control his condition for the better

ike many young boys, Metropolitan police officer Lee Pidgeon had a fascination with TV crime dramas such as The Sweeney and Starsky & Hutch and this progressed into a passion to pursue a career in the police. But for Lee – who lives in Sidcup, Kent, with his wife, Rachel, and 5-year-old son Sam – his early attempts at becoming a police officer were dogged by a series of unsuccessful applications. Diagnosed with Type 1 diabetes at the age of 3, Lee’s first memories are of being rushed into hospital and of his parents giving him insulin injections. It was some time before he realised that Type 1 diabetes was standing in the way of his career dream due to a blanket ban on the recruitment of people with insulin-dependent diabetes as police officers.

September – October balance 37 36-39 Lee copper.indd 37

16/08/2012 14:43

feature “When I found out, I was shocked. » I knew I was fit enough as I was playing semi-professional football and training twice a week,” Lee says. “I wrote to a number of regional medical officers explaining my situation. I was met with a sympathetic ear, but they said that there were Home Office regulations that could not be overturned.”

Progress

carry out riot policing duties in 2009 and as a response driver in July 2010, scoring full marks. An avid driver, Lee had also undertaken advanced driving courses with both the Driving Standards Agency and the Royal Society for the Prevention of Accidents. “I passed my driving test at 17 and loved driving, still do!”

Trouble ahead

But just six months later events took an unexpected turn. “I was policing at a Millwall FC match. At half-time I tripped and fell down about five steps, landing flat-footed on my right Above: Lee, whose childhood dream was to foot. By the time I got home it was become a police officer, with his son, Sam swollen and bruised. I went to the hospital and was advised to keep it strapped up, and elevated as much In November 2007, Lee began as possible,” Lee explains. working the busy streets of the His inspector wanted to check Borough of Lewisham, south-east Lee’s ankle before allowing him London, based at Deptford Police to return to football duty. At Station. Initially, Lee admits there occupational health, Lee told the were problems with his diabetes as nurse about his Type 1, and his riot and response driving training. As hard as it was at the time, in hindsight it was a good He was asked if he had ever been thing for me, my family and ultimately my job assessed on his fitness to carry out these duties. Lee had previously National Police Diabetic passed a fitness test for riot training he adjusted to shift work, with his Association’s (NPDA) campaign but hadn’t been aware that an colleagues often noticing his hypo against the blanket ban. Naturally, assessment was required for warning signs. “I was usually given Lee worked tirelessly with the group a nudge, so I realised I needed to response driving. He was then told to overturn this ban. “Tim had been he would need to be assessed by the test my blood sugars more often.” stripped of his driving duties and, As Lee’s career went from strength Metropolitan Police Service’s (MPS) like me, found the ban on new to strength, he completed training to medical officer. The result was a recruits with Type 1 diabetes a strange one as he, and other officers at that first meeting, were insulin dependant, and working as police The Equality Act 2010 brings together and extends existing anti-discrimination officers. This gave me hope of legislation. Part of its purpose is to prevent discrimination by employers getting the ban overturned as against disabled workers and job applicants. Having diabetes should not be I had now met some officers a barrier to working in the emergency services. The recruitment and retention with diabetes.” of police officers with diabetes should be subject to individual medical Finally, following an extension assessment, and assumptions should not be made about what duties an to the Disability Discrimination officer with diabetes would or would not be able to undertake. Act in 2004, Lee was able to The armed forces is the only employer exempt from the disability compete with other candidates discrimination provisions in the legislation. There are still restrictions in place in on a level playing field. He wasted some NHS Ambulance Trusts on people who wish to be ambulance drivers. no time in submitting another Drivers of heavy goods vehicles (HGVs) and passenger-carrying vehicles (PCVs) application to become a police who have diabetes and are treated with insulin can now apply for a Group 2 officer and was “relieved, elated licence. This is subject to an independent annual medical assessment and three and overjoyed” to be told he had months of blood glucose readings must be provided (on a memory meter). passed all the recruitment stages, a process that took two years. When Lee eventually joined the Metropolitan Police Service in 1992, his first role was as a civilian staff member and not as the officer he had pinned his childhood hopes on becoming. “I worked in traffic enforcement before moving to working in front offices and control rooms. I finished up working in a major incident room.” It was some time later in May 1997 when Lee became aware of police officer Tim Savage and the

Diabetes & work restrictions

38 balance

September – October 2012

36-39 Lee copper.indd 38

16/08/2012 14:44

feature hammer blow for Lee – an immediate two year suspension from duties. “Although I realise this was for my own safety, as well as members of the public, it was incredibly hard to take because I had already proved that I could do the duties they were telling me I could no longer do,” he says. When Lee was eventually referred, it was to the MPS’s medical advisor on diabetes, Dr Michael Feher of the Chelsea and Westminster Hospital. Dr Feher was very helpful, Lee recalls. “As a result I changed my diabetes care to be under Dr Feher’s guidance. My suspension was the kick up the backside that I needed. I believe things happen for a reason. As hard as it was at the time, in hindsight it was a good thing for me, my family and ultimately my job.”

Next steps Lee armed himself with as much information as he could. “I wrote to

Diabetes UK for information on the DVLA guidelines for driving with diabetes. I also contacted Steve Lloyd at the NPDA who advised on his situation as an insulin-dependent response driver. It helped to know there were police officers with my condition who were doing the job.” Support from his colleagues was invaluable to Lee over the next two years. His reporting sergeant would join Lee in meetings with the medical officer, while his inspector, also a driving assessor, carried out two driving assessments with Lee, letting him know he had no issues with Lee’s driving each time. Lee also credits the Dose Adjustment for Normal Eating (DAFNE) course he attended for the improvement in his HbA1c levels – his last reading being 43mmol/mol (6.1 per cent), where previously levels were always around 64–69mmol/mol (8–8.5 per cent). “My hypos have been eradicated and I have much

more of an awareness of what I am eating and how it affects my blood sugar levels. Dr Feher was very supportive. He advised occupational health that he felt I could resume all duties. It all helped me to feel that there was light at the end of the tunnel. By January 2012, my riot policing duties had been reinstated.” Looking back, Lee is the first to admit he has had his share of ups and downs. Not one to give up, Lee had some good news this summer. “I was reinstated to full driving duties in July 2012 after a night driving assessment.” So what would Lee’s advice to others in a similar situation? “Believe in yourself, dig your heels in, listen to what you’re being asked to do and do it. Give people you feel may be giving you a rough time no reason whatsoever to say ‘I told you so’!” i The NPDA, formed by Tim Savage in 2003, offers a support network for police officers, staff and their families. Visit www.npda.org.uk.

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life&health Chewing the

WHAT’S IN A LABEL?

FAT

‘LOW FAT’ OR ‘LOW IN FAT’ must contain no more than 3g of fat per 100g

‘REDUCED FAT’

We’re constantly hearing about ‘low-fat diets’ and ‘reduced-fat foods’, but what exactly are they and is eating fat really that bad for you? balance goes back to basics

must contain at least 25% less fat than the product with which it is being compared. Can still be high in fat

‘FAT FREE’ must contain less than 0.5g of fat per 100g

ncluding some fat in our diet is an important part of healthy eating. It provides us with energy, helps absorb certain vitamins and includes essential fats, which the body cannot make for itself. But like for like, fat contains more calories than the other nutrients, and eating too much can be unhealthy as well as contribute towards weight gain. So if you’re watching your weight, reducing fat in your diet is a good way to keep it in check. High levels of fat in the blood can also raise the risk of heart attack and stroke, and because people with diabetes run a

higher risk of heart disease, it’s recommended that you cut down on the amount of fat you eat. There are different types of fat and some are better for you than others: SATURATED found in animal fats such as lard, butter and meat and TRANS-FATS found in processed foods, eg cakes, biscuits and pastries are considered unhealthy because they raise cholesterol levels, which in turn increases the chance of developing heart disease. Eating less of these fats minimises the risk.

September – October 2012 balance 41 40-44 L&HAC.indd 41

16/08/2012 14:36

life&health

{

»are UNSATURATED vegetable fats and

GUIDELINE DAILY AMOUNTS The amount of fat people need varies, but no more than a third of your total daily calories should come from your intake of fat

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instead of standard mince saves 7g fat per 100ml serving

It may not be cold yet but now’s the time to think about protecting yourself from flu this winter. As the weather turns, more of us are susceptible to the cold and flu viruses that start circulating in the air. While you can’t do much about the common cold, you can have a flu vaccination, which is free to people with diabetes. Symptoms of flu include fever, aches and pains, and extreme tiredness – much more severe than a cold. People with diabetes

have an increased risk of developing complications, such as bronchitis and pneumonia, and blood glucose levels are elevated as a response to infection. This can lead to uncontrolled diabetes and the potential danger of diabetic ketoacidosis (DKA) or Hyperosmolar Hyperglycaemic State (HHS), both of which can be fatal if left untreated. The two main strains of influenza (A and B) mutate and change, which is why the vaccine has to be given each year. It doesn’t include a live virus so you cannot catch the flu by having the jab. Your body takes about two weeks to Protect build up immunity, so if you do develop yourself and the flu after having the jab it’s likely reduce the spread of that you already had the virus in bugs by washing your hands your system. Flu clinics will soon regularly with soap and water start running in GP surgeries (antibacterial sprays are a good when and you’ll either be invited or on the move), and cleaning surfaces such have to make an appointment, as keyboards, phones, door handles and but the sooner you have, it the TV remotes. Cover your mouth and nose sooner you will be protected. with a tissue when you cough or sneeze i DKA details: and bin the used tissue. www.diabetes.org.uk/dka

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life&health

What is… insulin resistance? Insulin is the key that unlocks the cells allowing glucose to enter and be turned into energy. Insulin resistance occurs when the body is producing insulin but is not able to process it properly. The pancreas then tries to keep up with this increased demand for insulin by producing more. Eventually, as it fails to keep up with the body’s need for insulin, excess glucose builds up in the blood stream. If these levels rise too high, the person may be diagnosed with Type 2 diabetes. Insulin resistance can affect all people with diabetes. Many doctors believe that insulin resistance is the main cause of Type 2 diabetes. It is thought to be caused by genes, excess weight and lack of physical activity. So, if you are overweight losing weight can make a big difference and increasing your physical activity will also help, too. i www.diabetes.org.uk/activefat

Pole position HOW IS IT DIFFERENT TO NORMAL WALKING? It’s all in the technique – a kind of walking-gliding that we are more familiar with seeing in cross-country skiers, than ramblers. Some research suggests that Nordic Walking can burn between 20 and 40 per cent more calories than normal walking, increase overall fitness, strength and tone the upper and lower body, put less pressure on the knees and joints and could improve balance. But don’t forget – any walking is good for your health.

i Visit www.uk-nordic-walking.com

for teach-yourself videos, free lessons, events and equipment. • Remember, before you start any new activity talk to your doctor to check it is right for you. You may also need to talk to your diabetes healthcare team about adjusting your diabetes medication and how often you test your blood glucose.

Originating in 1997 in Finland, Nordic walking evolved from an oﬀ-season ski-training activity in the 1930s to a sport in its own right. There are currently around 10 million walkers worldwide – and according to Nordic Walking UK, it is one of the fastestgrowing exercises in the UK

WHAT DO I NEED TO START? The key piece of kit is a set of Nordic walking poles, which are different to normal trekking or walking poles. They tend to be lighter (but are still strong), have a special glove or strap and removable rubber ‘paws’ on the tip for use when not on grass. Although instruction and lessons are available all over the UK, teach-yourself videos can be found on the web (see below). Once you have the right-fitting poles and technique, you are ready for the off... You can do Nordic walking just about anywhere.

CAN YOU DO THIS IN A GROUP? Why not? It makes walking more sociable and could help you master the technique as well as help you stick at it. Nordic walking organisations can put you in touch with groups and classes in your local area and give you information about events too.

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life&health

»»»ON««« »TARGET«

Filling the gaps

Everyone with diabetes should have access to the 15 Healthcare Essentials. So what can you do if you’re not getting the service you’re entitled to?

he 15 Healthcare Essentials include having annual blood tests, urine tests and eye screening to check for any of the long-term complications of diabetes; seeing specialist diabetes healthcare professionals; attending an education course and having access to emotional and psychological support. While they may not all be appropriate for everyone (for example, some don’t apply to children), it’s important that, if you have diabetes, you know that this is the basic level of care that you should be receiving.

Not getting everything you need? Be proactive. At your annual review, take along an early-morning urine sample and, if your blood is being tested, check the nurse has taken enough blood for all the checks needed. Make sure you take the checklist to your diabetes healthcare team and discuss it with them. Work in partnership with your healthcare team by discussing your concerns and agree goals that will help you manage your diabetes day to day. These goals will be part of your written care plan

Making the most out of appointments • Before you go, write down the points you want to raise and take along your blood glucose meter and a record of your results (if you test). • During your appointment it’s important to listen actively. Ask for them to explain anything you don’t understand and make notes that you can refer back to. • Afterwards, review what has been said and agreed, and make a note of anything you need to do before your next appointment. If you don’t feel like your care is improving and you have tried to resolve your issues with your diabetes healthcare team, you can take your complaint further. How you do that depends on which part of the UK you live in. For details on this, visit www.diabetes.org. uk/complaints or call Diabetes UK Careline on 0845 120 2960. i Visit www.diabetes.org.uk/15-essentials for the checklist. Communicating with healthcare professionals is not always easy. Don’t be afraid to ask questions – it’s your health and your diabetes healthcare team is there to help you. If you are elderly or disabled and depend on someone to care for you, it might be helpful if this person goes along to appointments with you.

You and your diabetes healthcare team should agree your individual blood glucose level target range. These targets are to be used as a guide only.

» Adults with Type 1 Aim for 4–7mmol/l before meals, and no more than 9mmol/l by two hours after meals.

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

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

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

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

» HbA1c

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

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Health matter on your mind?

Karen Therapist & counsellor

Deepa Dietitian

Cathy Diabetes specialist nurse

Libby Paediatric diabetes specialist nurse

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

WILL MY IGT BECOME TYPE 2? I was diagnosed with Impaired Glucose Tolerance (IGT) two years ago. I followed all the advice (with a few ups and downs!) and I’ve lost weight. I run and cycle regularly and eat a low GI diet and I must admit, I feel fantastic! However, I recently read that people with IGT are at a high risk of going on to develop Type 2. Should I be getting regular tests from my GP? I haven’t been checked since my diagnosis and I’m a bit worried. Mark, Chesterfield Cathy says… Firstly, congratulations on your new lifestyle, it sounds like you’re really enjoying it! Unfortunately, you’re right. People diagnosed with prediabetes (including Impaired Glucose Tolerance and Impaired Fasting Glycaemia) are at greater risk of going on to develop Type 2. The National Institute for Health and Clinical Excellence (NICE) has updated guidelines on preventing Type 2 diabetes. They recommend that those with a moderate risk of developing Type 2 should have a follow up every three years and that those with a high risk should have an annual check-up. Talk to your GP who can schedule a follow-up test. i See page 43 for information on insulin resistance.

THE ROAD AHEAD I’ve recently been diagnosed with Type 1. My brother says the DVLA won’t renew my Group 1 licence if I’ve had more than two serious hypos in a year. Is this true? Sue, Tunbridge Wells Karen says… The application form for Group 1 licences has changed recently and now asks if you’ve had ‘more than one episode of severe hypoglycaemia’ in the last 12 months. The term ‘severe hypo’ is defined as an episode

of hypoglycaemia where you need the assistance of another person to help you treat it. (Don’t include instances where someone helped you but you could have treated your hypo yourself.) If you have more than one severe episode of hypoglycaemia in 12 months the DVLA won’t renew your licence until you have a 12-month period with less than two severe hypos, ie one or none at all. The DVLA has issued guidelines to help people with their application. i Download it at www.diabetes.org.uk/driving.

A REAL PAIN My blood glucose is usually well-managed, however, recently it’s been between 10–20mmol/l. I suffer with painful joints, which have been particularly troublesome of late – could this be the reason? Jamie, Paisley Cathy says… Pain can raise blood glucose levels (along with other factors eg, stress or infection), so this may be why you are finding your levels are higher than usual. As they are so raised, it is important see your GP. Diabetes can cause muscle and skeletal changes that lead to symptoms such as joint pain; swelling; trigger finger; carpal tunnel syndrome; painful shoulders; and severely affected feet. After having diabetes for several years, joint damage – or diabetic arthropathy – can occur. It is thought that one third of people with diabetes have some degree of limited joint mobility. Good blood glucose control will help guard against it and aid recovery if it has already developed. Your healthcare team can recommend exercises to help restore some flexibility and your GP can also refer you for specialist treatment.

ask the experts Sometimes people are given steroid injections, though there is a risk that they can raise blood glucose levels, so this would have to be monitored. i Find out more at www.diabetes.org.uk/ Musculoskeletal-Conditions.

PERIOD WOES I’ve had Type 1 for two years – I’m 28 and on a basal-bolus regimen. My blood glucose levels are all over the place before and during my period, and I also have a problem with hypos. I’m not eating or exercising differently – is this common? Anne-Marie, Bedford Cathy says… Many women report that hormonal changes around the time of their menstrual cycle can affect their blood glucose levels. Generally, women seem to find they need more insulin a few days before they start their period – it’s thought that the hormone levels create some insulin resistance. Once your period starts and your hormone levels drop, the amount of insulin you need goes down as blood glucose levels stabilise, which poses the risk of hypos. The best way to manage insulin levels is to test blood glucose more often before, during and after your period for a few months to find your pattern. You can adjust your insulin doses and carbohydrate intake as required – ask your diabetes specialist nurse to help you with this.

DIABETES UK

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

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46-47 SpotlightAC.indd 46

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life&health

Spotlight on...

Necrobiosis What is it?

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

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

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

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

Who does it affect? NLD is extremely rare. It is reported to affect only 0.3 per cent of all people with diabetes, usually appearing some years after diabetes has been diagnosed. It can occur at any age, but most commonly starts between the ages of 30 and 40. It is three times more common in women than men and it can happen no matter how well diabetes is controlled.

What are the symptoms? NLD appears as a rash initially, most commonly on the lower legs, but some people might notice it on their face, torso, scalp or arms. In the beginning, the rash might appear reddish-brown with fairly well-defined borders. Over time, the lesions might grow larger, turning shiny and red, sometimes developing a yellow centre. Eventually, the lesion develops into a purplish depression in the skin.

What to do during a flare-up

Camouflaging the condition, using specialised make-up, is extremely effective Sometimes, NLD itches and hurts, but many people report no symptoms other than the rash.

Can it be treated? As long as the lesions of the rash don’t break open, NLD doesn’t usually require treatment. Your GP might ask you to rest your legs occasionally and protect them from injury to reduce the risk of ulceration. A padded dressing, elastic support stockings or shin guards can help with this. During a flare-up, some people find relief using a topical steroid cream and covering the area with a sterile dressing. Others find that steroid injections help. Trauma to the affected area might cause ulcers to form and these need treatment. If this is the case seek help from your healthcare team. Some researchers have found that treating the area with ultraviolet light can control NLD during flare-ups.

Many people with NLD (both men and women) find that camouflaging the condition, using specialised make-up, is one way of living with it. The make-up is extremely effective, can last up to four days, is waterproof and also contains sunscreen. Colour matching and skilful application is important for camouflaging to be successful and professional help is available. The charity Changing Faces teaches people how to apply specialist cover creams to improve the appearance of affected areas. This service is provided free of charge (but donations are welcomed) on referral from your GP or consultant, while camouflage creams are available on prescription. If a lump, persistent scab or ulcer develops in an area of NLD, consult your GP as soon as possible. i www.changingfaces.org.uk Do you have necrobiosis? How do you manage it? Email your tips to balance@diabetes.org.uk or write to us at balance, Diabetes UK, 10 Parkway, London NW1 7AA.

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Take control We take a look at the pros and cons of the various contraceptions available and its impact on diabetes

aving diabetes should not affect your desire for or ability to have sex, but it is really important to avoid an unplanned pregnancy. This is because high blood glucose levels at the time of conception can affect the foetus, causing damage to the developing heart and blood vessels, and a lack of folic acid could lead to neural tube defects such as spina bifida.

Concerns Some women are concerned that having diabetes means they are unable to take the oral contraceptive pill. Any form of contraception that releases either of the hormones oestrogen or progesterone carry the risk of raising blood pressure or causing a blood clot (thrombosis). Women may be diagnosed with Type 2 diabetes after they think that they are too old to have children, but sometimes taking metformin can make women more fertile. So even those who think they are nearing menopause should be aware of the need for contraception if sexually active.

balance

Women with diabetes are susceptible to the same – but no higher – risks than any other woman who uses these forms of contraception, but if they have any diabetes complications they should be

Some women do experience a slight deterioration in blood glucose control when they first start using homonecontaining contraception advised to avoid hormone-releasing contraceptives. Another concern is that contraception will affect diabetes control. Some women do experience a slight deterioration in control when they first start using a form of contraception that contains hormones. But this can be easily monitored and controlled by a slight change in diabetes medication. Used correctly, most contraception has more than 90 per cent effectiveness, but some forms need more care than others, eg remembering to take a pill at the same time every day.

Your GP or a family planning clinic will help to ensure that the best choice of contraception is prescribed for you, but see our basic guide, right.

When you want to conceive • If you want to have a baby, it is important to start planning as soon as possible. Some forms of contraception such as the Depo-Provera injection can delay a return to fertility. Ask to be referred to your local pre-conception clinic where the diabetes specialist nurse and/or midwife will be able to help you. • Start taking 5mg folic acid. This is a higher dose than women without diabetes need to take and is only available on prescription. • Good blood glucose control is vital at conception to help your baby to develop normally. If your HbA1c is more than 86mmol/mol (10 per cent) then you should delay becoming pregnant and talk to your diabetes healthcare team about how to improve your blood glucose control. i For Diabetes UK’s pregnancy and preconception information, visit www. diabetes.org.uk/pregnancy.

September – October 2012

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basic care THE COMBINED PILL

CONDOMS

HOW IT WORKS There are several

HOW IT WORKS Covers the penis,

HOW IT WORKS

types, but they all prevent the ovaries from releasing eggs and thickens the mucus at the neck of the womb, which makes it harder for sperm to enter. ADVANTAGES Can make periods lighter and less painful. DISADVANTAGES May cause weight changes, breast tenderness and headaches. Antibiotics can make it less effective so extra precaution is needed. Women who have had diabetes for more than 20 years should avoid the combined pill, as well as those who smoke or are aged over 35. DIABETES EFFECTS? The hormones may affect blood glucose levels.

prevent sperm from entering the womb. ADVANTAGES Protects from sexually transmitted infections. Only needs to be used when you have sex DISADVANTAGES Can interrupt sex. May break. Some people are sensitive to the chemicals in latex or spermicide. DIABETES EFFECTS? No.

The hormone progestogen is injected into a muscle, and acts on the womb lining in the same way as the combined pill.

PROGESTOGEN ONLY PILL (POP) HOW IT WORKS Thickens the mucus

in the neck of the womb, making it harder for sperm to enter the womb. It also thins the lining of the womb so that there is less chance of a fertilised egg implanting. ADVANTAGES Providing there are no medical problems, such as heart disease or stroke, it can be taken until menopause or the age of 55. DISADVANTAGES Periods may be irregular. Side effects at first can include spotty skin, breast tenderness, weight change and headaches. It has to be taken at the same time every day or it will not protect against pregnancy. DIABETES EFFECTS? The hormone may affect blood glucose levels.

VASECTOMY / TUBAL LIGATION HOW IT WORKS A vasectomy (for men)

cuts the tubes that deliver sperm, and a tubal ligation (for women) blocks the fallopian tubes so a fertilised egg can’t reach the womb. ADVANTAGES Very reliable. DISADVANTAGES Involves surgical procedure. DIABETES EFFECTS? No.

CAP/DIAPHRAGM HOW IT WORKS Fits inside the vagina

and covers the cervix, which prevents sperm from entering the womb. A spermicide (a chemical that kills sperm) is also used. ADVANTAGES Only has to be used when you have sex. DISADVANTAGES Can interrupt sex. Spermicide can be messy. Can take time to learn how to use it. Cystitis can be a problem for some women. Some people are sensitive to the chemicals in latex or spermicide. All types of diaphragm and cap need to be kept in place for at least six hours after intercourse and no longer than 30 hours (latex) or 48 hours (silicone). High failure rate if used incorrectly or they burst. DIABETES EFFECTS? No.

INJECTIONS

ADVANTAGES

Depending on which type you are given, it lasts for eight or 12 weeks. DISADVANTAGES Fertility may take a long time to return. If you have any side effects you have to put up with them for a long time. May cause thinning of your bones and shouldn’t be given to those under the age of 18. Can cause weight gain. DIABETES EFFECTS? The hormone may affect blood glucose levels.

INTRAUTERINE DEVICE (IUD) HOW IT WORKS A small plastic and

copper device that does not contain any hormone but works by stopping sperm reaching an egg due to the release of copper. May also work by stopping a fertilised egg from implanting in the uterus. ADVANTAGES It’s effective as soon as it is inserted and can last between five and 10 years, depending on the type (although it can be removed sooner). DISADVANTAGES Can be painful

to insert.

IMPLANTS

DIABETES EFFECTS? No.

HOW IT WORKS A small flexible rod is

placed just under the skin in the upper arm, which releases a progestogen hormone that acts in the same way as the combined pill. ADVANTAGES Lasts for three years so you don’t have to think about it very often and may reduce painful, heavy periods. DISADVANTAGES Requires a small procedure to have it fitted and removed. Side effects may include headaches, breast tenderness and mood changes. May also cause weight gain and increase blood pressure. DIABETES EFFECTS? The hormone may affect blood glucose levels.

INTRAUTERINE SYSTEM (IUS) HOW IT WORKS A hormone-releasing

version of the IUD (above), which acts on the womb lining in the same way as the combined pill. ADVANTAGES It’s effective as soon as it is inserted and can last between five and 10 years, depending on the type (although it can be removed sooner). DISADVANTAGES Can be painful to insert. DIABETES EFFECTS? The hormone may affect blood glucose levels.

September – October 2012 balance 49 46-47 Basic Care AC2.indd 49

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recipes 47p per serving

The

supper club

50 balance

With autumn on its way, top chef Michael Moore cooks up some inspiring and creative dishes that will make a perfect, healthy alternative to comfort eating

September â&#x20AC;&#x201C; October 2012

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recipes

Spicy sweet potato & pumpkin soup Serves 6 • vegetarian • 1 portion of fruit & veg per serving

• • • • • • • •

800g sweet potato, peeled 490g pumpkin, peeled 1 tbsp harissa paste 2 tsp ground cumin 1 clove of garlic, crushed 2 tbsp extra virgin olive oil 600ml vegetable stock 125g low-fat unsweetened yogurt • sea salt* and freshly ground black pepper • fresh chives, chopped, to serve

1 2

Preheat oven to 180°C/350°F/gas mark 4. Cut sweet potato and pumpkin into large dice. Place into a bowl with the harissa, cumin, garlic and oil. Toss to coat evenly and oven roast in a tray for 50 minutes, or until cooked and tender. Transfer into a large pan and cover with stock. Bring to the boil and simmer for 30 minutes. Purée with a stick blender until smooth. Blend in yogurt. Adjust seasoning to taste with a little salt and freshly ground black pepper. Serve hot, topped with chopped chives.

3 4 5

Per serving (411g) 182Kcal 3.8g protein – 32.1g carbs 5.6g ( 10.2g sugars) – fat ( 1g saturates) – 1.2g salt *Salt not included in analysis. –

•• •

•

66p per serving

Mushroom, pea & bocconcini omelette Serves 4 • gluten free • ½ portion of fruit & veg per serving

• • • • • • • •

1 tbsp olive oil 1 clove of garlic, crushed 120g mushrooms, quartered 90g fresh peas 3 egg whites, lightly beaten 2 egg yolks, lightly beaten sea salt* and freshly ground black pepper 4 baby bocconcini or (mozzarella balls)

Heat oil in a small non-stick frying pan and cook garlic and mushrooms for 2–3 minutes. Add peas and cook for a further 2 minutes. Carefully fold beaten egg whites and yolks together. Season with salt and

pepper. Pour over the mushrooms and peas and allow to set for 15 seconds on the bottom of the pan. Drop bocconcini or mozzarella balls over the top and place directly under a hot grill for 2 minutes, or until puffed up and cooked through. Serve wedges with crusty sourdough or linseed bread.

Per serving (97g) 108Kcal – 7.2g protein – 2.8g

• •

•

carbs – ( 0.6g sugars) – 7.6g fat 2.4g saturates) – 0.2g salt *Salt not included in analysis.

•

–(

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recipes 95p per serving

‘One pot’ chicken & rice Serves 4 • Dairy free • 2 portions of fruit & veg per serving

• 2 tbsp olive oil • 4 chicken Marylands or free-range chicken legs, skin removed • salt*and freshly ground black pepper • 1 onion, sliced • 2 cloves of garlic, crushed • 2 celery sticks, sliced • 1 red pepper, cut into strips • 1 yellow pepper, cut into strips • 1 x 425g can red kidney beans, drained • 200g long-grain or brown rice • sprig of fresh thyme • 750ml chicken/vegetable stock

1 2

Preheat oven to 200°C/400°F/ gas mark 6. Warm oil in a non-stick frying pan. Season chicken with salt and pepper and sear until golden brown, but not cooked through. Remove and set aside.

£3.42 per serving

Add onion, garlic, celery and peppers to the same pan and cook for 5 minutes. Tip into a large, deep roasting dish, along with kidney beans and rice. Mix well and smooth out into an even layer. Place chicken and thyme over the top of rice and pour in hot stock; cover with a lid or foil. Roast in oven for 25 minutes. Serve chicken on the bone with the rice or pull the chicken meat from the bone and mix through the rice. Adjust the seasoning to taste.

4 5

Per serving (610g) 457Kcal – 41.6g

protein – 62.3g carbs 10g sugars) – 9.6g fat 1.6g saturates) – 2.1g salt *Salt not included in analysis.

••

( (

••

Corn & crab soup Serves 6

• • • • • • • • •

2 fresh corn cobs 1 clove of garlic, sliced 1 bay leaf 1 litre vegetable stock (2 cubes) 1 tsp vegetable oil 3 spring onions, finely sliced 180g cooked crabmeat 2 egg whites sea salt* and white pepper

Cut kernels off cobs and set aside. Place cob, husks, garlic and bay leaf into a large saucepan with the vegetable stock; bring to the boil. Reduce heat and simmer for 45 minutes. Heat vegetable oil in a second pan. Cook the corn kernels and spring onions for 15 minutes, or until softened. Strain the hot stock over the corn and bring back to the simmer. Cook for 15 minutes. Add the crabmeat and stir through lightly whisked egg whites until egg ribbons form. Season to taste. Serve topped with extra finely chopped spring onions.

2 3

Per serving (241g) 94Kcal – 8.7g protein – 7.7g carbs ( 1g sugars) – 3.3g fat 1.4g salt ( 0.4g saturates) – *Salt not included in analysis.

•

Traffic light symbols:

• • high

medium

low

These delicious recipes are taken from Blood Sugar by Michael Moore, published by New Holland, priced £24.99.

52 balance

September – October 2012

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recipes

Roasted salmon Niçoise salad Serves 6 • 1 portion of fruit & veg per serving You can reduce the amount of fat in this recipe by using less oil in the dressing or simply using less dressing

£2.81 per serving

• 720g salmon fillet, skin on and pin boned • splash of extra virgin olive oil • salt* and pepper, to taste For the dressing

• • • • • • • • • •

1 tsp Dijon mustard 2 tbsp sherry vinegar 90ml extra virgin olive oil 1 egg white (optional) 150g small potatoes, cooked and halved 150g baby green beans, cooked and chilled 130g cherry tomatoes, halved and roasted 60g black olives 3 hard-boiled eggs, peeled and quartered ½ bunch basil, leaves picked

1 2

Preheat oven to 180°C/350°F/ gas mark 4. Place salmon fillet, skin side down, onto a lined baking sheet. Brush with a little olive oil and season with salt and pepper. Bake for 7 minutes.

Meanwhile, whisk mustard, vinegar and oil together with egg white, if using. Season and adjust consistency with water. Place potatoes, green beans, tomatoes, olives and boiled eggs in a bowl with the basil leaves. Season and mix together. To serve, spoon the salad onto the salmon and drizzle with the dressing.

4 5

Per serving (258g) 438Kcal – 29.6g protein

• • •

– 6g carbs ( 1.5g sugars) – 32.9g fat ( 5.6g saturates) – 1g salt *Salt not included in analysis.

•

September – October 2012 balance 53 50-53 RecipeAC.indd 53

16/08/2012 14:52

bite-sized

In season

Flaming tasty

September Mussels are in abundance but don’t carry the hefty price tag of oysters, which are also in season. Try them in a tomato and chilli pasta sauce or add to haddock and salmon for a luxury fish pie. It’s also the time of year for butternut squash, pears, apples and plums. Hold back some of the harvest by freezing stewed apples and plums.

We’ve had an unpredictable season, but there’s always the prospect of balmy Indian summer days and nights to pin your barbecue hopes on. So, if you get the chance to fire up the barbecue, serving a variety of breads, such as ciabatta, focaccia, walnut and olive bread, plus interesting salads, alongside barbecued food goes down well with guests. Salads needn’t take time – just adding a few ingredients can jazz up some lettuce. Try artichoke hearts, toasted pine nuts, sunflower and pumpkin seeds, and roasted vegetables. Serve a carbohydratebased salad like rice, potato, pasta or couscous, too. You can also create some simple, yet tasty, dips, sauces and dressings: • Spicy tomato sauce Stir a chopped green chilli, a handful of fresh coriander, 2 chopped spring onions and ½ a teaspoon of caster sugar into a tin of chopped tomatoes. • Avocado salsa Combine 2 chopped avocados with the juice of 1 lime, 2 sliced spring onions and 1 tablespoon of chopped chives. • Low-fat dressing Whisk together 150ml (¼ pint) of apple juice with a heaped teaspoon of grainy mustard, 2 teaspoons of runny PERFECT honey and 2 tablespoons of light Greek yogurt. FOR BBQS

Twix twin bar (58g) (288 Kcal, 14g fat)

Frylight’s low-fat Smokey BBQ & Grill Cooking Spray. Tesco and Sainsburys (£2.49)

SWAP ’N’SAVE 76Kcal & 11.1g fat

October As you turn your attention to warming autumn fare, kale and celeriac make an appearance. Celeriac is delicious roasted in wedges with olive oil, while kale works well in rustic Italian soup. And with names like Hedgehog and Chicken of the Woods, who can resist wild mushrooms? Cook with garlic, parsley, lemon juice and zest in a pan with a little olive oil.

Chocolate crackle skinny popcorn (55g) (212 Kcal, 2.9g fat)

Gourmet on the go

Aldo Zilli’s spaghetti with broccoli

Recipe kindly provided by www.tenderstem.co.uk

Serves 4 • Gluten free (if GF pasta is used)

48p per serving

Cook & drain 400g of spaghetti. Heat 60ml oil in a pan and add 3 crushed garlic gloves, 100g Tenderstem broccoli, 2 anchovies (finely chopped) and 2 red chillies (finely chopped and deseeded). Sauté on a low heat until the garlic is soft, but not burnt. When the broccoli is cooked, add the spaghetti and 100g grated Parmesan to the pan. Toss to combine and season. Serve with fresh basil and parsley. 6.8g fat ( 1.9g saturates) / 0.3g salt Per serving (146g) 410Kcal / 16.1g protein / 70.5g carbs ( 4g sugars) /

•

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September – October 2012

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per ing

bite-sized

Veg out Want to grow your own veg, but don’t know where to start? Gardener Stephen Rayner points you in the right direction It’s been just about the worst spring and summer for gardeners, but things can only get better, so don’t be put off if you are new to growing your own. There’s no time like the present, so follow the tips below to put your gardening plans into action: There is still time to sow radish seed – French Breakfast is a quick variety to mature, but cover it with a plastic cloche if the weather turns cold. You can also sow carrots – opt for variety Autumn King, covering with fleece if required. It is also an ideal time to plant garlic, but opt for a variety suited to our climate. Split bulbs into cloves and plant 150mm apart with only the tips showing for harvesting next July. As the soil is still warm, put in strawberry plants now for strawberries and cream next June.

Eton Mess (77g) 205kal

40 minutes of golf

» » »

READY STEADY

SHOP!

A selection of items available from Diabetes UK. All funds raised come to the charity.

ADULT T-SHIRTS

CHILDREN’S WRISTBAND Bright blue wristband embossed with the words “I have diabetes”. It is 17cm in length and fastens with two press studs. Non-toxic and 100 per cent hypo-allergenic. £4.49+p&p (code 6032)

Show your support with these 100 per cent cotton blue T-shirts with the Diabetes UK logo on the front and back. They come in six sizes – please quote the correct code when ordering: Small: 4221, Medium: 4209, Large: 4210 XLarge: 4211 XXLarge: 4220 XXXLarge: 4240 £6.95+p&p

DRAWSTRING BAGS Perfect for sports gear and shopping, these blue bags with the Diabetes UK logo are strong and durable. (Approximate size when flat: 40 x 37cm.) £3.50+p&p (code 4353)

Order these and other Diabetes UK items at www.diabetes.org.uk/shop or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote B157 when placing your order. (Postage is charged on some items.)

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15/08/2012 19:07

Beyond the Royal Mile

The stunning view of Edinburgh from Calton Hill

dinburgh,’ said Robert Louis Stevenson, is ‘a profusion of eccentricities, a dream in masonry and living rock.’ You can see what he means: the formal New Town below the precipice of the Old; a maze of closes and vennels (alleyways with dead ends and passageways) and snug howffs (taverns) just a few minutes’ walk from the wild volcanic outcrop of Arthur’s Seat; palace and parliament just opposite each other; water, crags and distant mountains all within view. For centuries in the Old Town, rich and poor rubbed shoulders. Following the filling in of Nor’ Loch, which had been drained by the 1760s and is now Princes Street Gardens, the rich built their New Town to the north and bridges were built to the Old Town. Long before then in the Old Town, new streets were laid on top of old and the city’s poorest went underground to live in vaults. New and Old, above and below – Edinburgh truly is a city for walking.

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Start at the Scottish National Gallery and pop in to see some of the works of the permanent collection, by some of history’s most important artists from native Scotland and around the world. From the Gallery, cross Princes Street (with the Castle behind you) and walk north into Hanover Street, which before 1790 was a boggy wasteland. Turn right into Queen Street – the longest stretch of New Town architecture in the city, designed to complement Princes Street. Princes Street was commercial before it was finished, but Queen Street was residential and much superior. At the end, in Picardy Place, look for a giant foot by Sir Eduardo Paolozzi, the Leith-born sculptor. Turn left onto Leith Walk and right into London Road then look for a path on the right up through trees. Cross the road at the top (Royal Terrace) and carry on up the path to the left side of Greenside Parish Church. Zig-zag up Calton Hill, which boasts one of the best panoramic views of Edinburgh, to see a collection of monuments and buildings. The National Monument commemorates the

A version of this article was first published in Walk, the Ramblers magazine

From the Scottish National Gallery to the famous Castle on the Royal Mile, Stephen Morris takes you on a circular walking tour of Edinburgh — a city steeped in history

dead of the Napoleonic Wars. Funds for its construction ran out, and this half-finished replica of the Parthenon in Athens became known as ‘Scotland’s Disgrace’. The Old City Observatory here is worth a visit and at the Nelson Monument, which resembles a tall stone telescope, a timeball is dropped at one o’clock – marking time for ships on the Firth. Pay £3 and climb 143 steps to the top for an amazing view. From the Nelson Monument, take the steps downhill towards the Old Town and, at the bottom, turn left along Regent Road. After passing over the railway, in a couple of minutes there are steps going off to the right, downhill to Calton Road. Turn left (east) and

‘Scotland’s Disgrace’ – The National Monument

September – October 2012 15/08/2012 19:04

A version of this article was first published in Walk, the Ramblers magazine

figures. No one knows what they were for. From here, turn north and descend on a path back to Holyrood. The Scottish Parliament building is at the foot of the Royal Mile, which finishes at the castle. Architect Enric Palace of Holyroodhouse Miralles built something so unassuming – the Parliament building flows gently you’ll come to the Palace of towards the crags of Arthur’s Seat – Holyroodhouse, the Queen’s residence that only the price seems monumental. in Scotland. It was here that Mary, Tours are excellent. Meetings of the Queen of Scots reigned briefly and full Parliament are usually held on saw Rizzio – her deformed, loyal and Wednesdays and Thursdays. probably innocent secretary – murdered Leave Parliament and walk up by her husband, Lord Darnley. Canongate – the Royal Mile. On Leave Holyrood on your left, cross each side arched pends (entrances) lead the road from the car park and walk to wynds (alleyways) and courts. An up some steps into what was once royal overhanging clock marks Canongate hunting ground. Turn right onto the Tolbooth on Canongate. Dating from Radical Road (a path) for Salisbury Crags 1591, it is now The People’s Story (172m/567ft) and then up to Arthur’s Museum. Further up, overhanging Seat (251m/823ft) to see the Lothian gables and stairs mark John Knox coast, Lammermuir and Pentland Hills, House. Now you’ll pass South Bridge. the Firth of Forth and the Fife coast. Here, underground tours explore the In 1836, 17 miniature coffins were dug Old Town’s once-inhabited vaults. up here, containing carved wooden Legend has it that along one such

DISTANCE 9.5km/6 miles TIME 3hrs+ WHERE Circular tour of Edinburgh city centre. START National Gallery, The Mound FINISH The Castle TERRAIN Mostly level pavements throughout but with rough footpaths on two ascents. MAPS OS Explorer 350; Landranger 66 GETTING THERE Regular trains from all over Britain arrive at nearby Edinburgh Waverley (0845 748 4950, www.thetrainline.co.uk). EATING AND DRINKING There are many excellent places, but a favourite is the Elephant House on George IV Bridge (0131 220 5355, www.elephanthouse.biz) with its great view of the castle. VISITOR INFORMATION The VisitScotland Centre is located at 3 Princes Street, Edinburgh EH2 2QP (beside Edinburgh Waverley train station and the Balmoral Hotel): 0845 225 5121, visit www.visitscotland.com.

The Scottish Parliament

tunnel Burke and Hare carried corpses to the dissection rooms of a medical school on Nicolson Street. Situated close to the west end of the Cathedral is a statue of John Knox, spitting protestant fire from a building shorn of decoration. Rebels’ blood flowed when Charles I declared St Giles’ a cathedral, not a kirk, once more. Turn left onto George IV Bridge, past the National Library of Scotland to the beautiful modern National Museum of Scotland and – opposite – Greyfriars Kirk and Kirkyard where, in 1679,

St Giles’ Cathedral

1,200 Covenanters (the Scottish church rebels) were imprisoned in terrible conditions. The National Museum of Scotland has now merged with its neighbour, the newly refurbished Royal Museum, which reopened in July 2011, and has quickly become one of the most popular attractions in Edinburgh. Retrace your steps and turn left into the last bit of the Royal Mile. Look for a little wall fountain – a plaque on the entrance to the Castle esplanade, on the west wall of the Tartan Weaving Mill, commemorates the location of the burning of hundreds of women as witches, a gruesome practice that began in the late 15th century and lasted nearly 250 years. Finish at the castle. In 1296, Edward I, the Hammer of the Scots, lay siege to it and it has seen action ever since. The great hall is terrific and the Stone of Destiny, used in coronations past and present, was returned here in 1996 and is now on display in the castle, having been taken to England by Edward 1 in 1296.

Turn to page 64 for your chance to win an Edinburgh walking guide

Edinburgh Castle

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A version of this article was first published in Walk, the Ramblers magazine

The Scottish Parliament

St Giles’ Cathedral

Turn to page 64 for your chance to win an Edinburgh walking guide

Edinburgh Castle

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travel São Gualter is one of the city’s most attractive churches

A tale of two cities Guimarães Portugal

amous for being the first capital of Portugal and home to its first king, Guimarães is a city with a glorious past. It is regarded as the ‘birthplace of the Portuguese nation’ and is one of Portugal’s most important historical destinations. With art galleries and museums, a calendar bursting with festivals, and squares lined with the prettiest of Renaissance and neoclassical timbered mansions, it is also one of the liveliest and most attractive cities in the country. Guimarães came to prominence in the 12th

Castelo de Guimarães was home to King Alfonso 1 (right)

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century when Afonso Henriques drove the Moors out of central Portugal, gave the country its independence and became its first king. Then it was little more Nossa Senhora than a settlement de Oliveira with a monastery and castle, but it gradually grew and a royal college was created. Manufacturing, building techniques and the Portuguese language were developed here, too. The city centre, which was recognised as a UNESCO World Heritage site in 2001, still displays the pioneering building techniques, taipa de rodízo and taipa de fasquio, and local architects’ passion for open arcades and first-floor balconies that continue to characterise traditional Portuguese buildings today. The historic centre of Guimarães is a popular tourist destination. It is still dominated by its magnificent, but somewhat severe, crenellated medieval castle, the Castelo de Guimarães, while the Portuguese Gothic-styled Nossa Senhora da Oliveira church now stands on the site of the original monastery. The city’s most dramatic buildings surround the castle in a necklace-like fashion. A short stroll away is the small Romanesque church of São Miguel do Castelo, which was restored in the 1920s and is a fine example

of the period’s architecture, along with the magnificent 15th-century stone Palace of the Dukes of Bragança. The Old Town and other venues around the city regularly host cultural events and festivals. Two of the most popular annual events are the Festas Gualterianas held over the first weekend of August, featuring the Battle of the Flowers (Batalha das Flores) and the Linen Parade (Cortejo do Linho). In November the Nicolinas Festival is held by the city’s students to honour Saint Nicholas. Guimarães has seen an increasing number of new museums and cultural venues open up in recent years. The Museu de Alberto Sampaio houses a nationally important collection of 14thto 16th-century sculptures and jewellery, and the Centro Cultural Vila Flor, which opened seven years ago, is the city’s largest cultural venue hosting concerts, plays and important exhibitions in its two auditoriums and complex of halls. It has been beautifully created within a 17th-century palace and is among the venues with a programme of events to celebrate Guimarães’ joint status as European Capital of Culture 2012. i www.guimaraes2012.pt

A scene from the 2012 opening ceremony

September – October 2012 15/08/2012 19:03

travel

Guimarães in Portugal and the Slovenian city of Maribor share the title of Capitals of Culture 2012, a prestigious EU accolade that highlights the wealth of culture in Europe. Carole French is our guide to these two vibrant recipients…

Maribor Slovenia

rom street parades and dance festivals to orchestral and operatic performances held in the Slovene National Theatre, alternative music concerts at the Pekarna Cultural Centre, films, new perspectives workshops, lectures, thought-provoking photographic displays and multi-ethnic exhibitions, Maribor is embracing its European Capital of Culture status and is tweeting and blogging its news to the world. This once sleepy market community has seen a transformation that has given it an edgy 21st-century feel. Maribor, Slovenia’s second largest city, is relatively compact and easy to get around. It lies among vineyards and sits majestically along the banks of the Drava River. Its prosperity and its people’s love of the finer things in life might well be attributed to its long-established wine culture. Its cellars produce vintages that attract wine connoisseurs from around the world and Maribor is also home to the world’s oldest vine. According to the Guinness Book of Records, the vine that snakes its way over the facade of

Maribor’s dramatic opening ceremony The town sits on the Drava River

Square, known as Castle Square, next to the Maribor Castle. Lent is the historic heart of Maribor. Here you will find the city’s main sites, as well as its cultural venues. Pavement cafes give you the chance to sit and soak one of its most famous houses, which up the busy atmosphere. Look out is now a museum, the Old Vine for Judgement Tower (Sodni stolp) House (Hiša Stare trte), is said to be and the Water Tower (Vodni stolp), more than 400 years old. which are medieval fortifications A growing number of museums that once formed part of Maribor’s and art galleries, particularly in the city defence walls. Old Town, known as Lent, have A short walk around the lanes brought a new dimension to Maribor’s of Lent will bring you to the city’s cultural identity. The Old Vine House Renaissance-style Town Hall is one of the most visited museums (Mariborski rotovž), its Gothic-style and, as its name cathedral dedicated to John the suggests, celebrates Baptist and monument to the plague the town’s wine victims of 1680 (Kužno znamenje). tradition with Climb to the top of the cathedral’s displays and tastings. bell tower and you will be rewarded The Old Vine Festival, with a fabulous view over the city. is held here every The cathedral stands in one of September. Other the prettiest squares in Maribor, museums include Slomškov Square. Here, too, you’ll the Maribor find the Slovene National Theatre, Regional Museum the venue for many of Maribor’s (Pokrajinski Muzej Capital of Culture 2012 events. Maribor’s pretty main square Maribor), which can i www.maribor2012.eu/en @maribor2012 be found in Grajski

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fundraising focus STANLEY’S TRACTOR TREK Fred Holland meeting the Queen at Worcester Guildhall in July

FRED’S ROYAL APPOINTMENT A charity fundraiser from Kidderminster has said it was an “honour” to meet the Queen. Fred Holland, 75, chairman of Wyre Forest Diabetes UK voluntary group, was nominated in recognition of his fundraising activities for diabetes charities. Fred met Her Majesty during her Diamond Jubilee tour visit to Worcester in July. He shook hands with the Monarch at the city’s Guildhall and later attended a service at the Cathedral. Fred said, “It was a lovely day. She shook my hand and asked my name, and why I was nominated. When I told her she said, ‘how wonderful, on behalf of the people of Britain I thank you’.” Fred is also the first person to receive a Civic Award from the Mayor of Kidderminster. Fred started fundraising 52 years ago and has raised a staggering £150,000 for diabetes charities, including Diabetes UK. Fred started to fundraise after his daughter Vivienne was diagnosed with Type 1 diabetes in 1971, aged 9.

Stanley tries out the Fordson tractor

A father from Brentwood has travelled the length of the country on a tractor to raise money for Diabetes UK. Warren Jopson set off from John O’Groats on 30 July and reached Land’s End in Cornwall a week later – with his wife Hayley and son Stanley not far behind in the family campervan. Stanley, 13, was diagnosed with Type 1 diabetes in March 2011, and his father has been keen to raise money for Diabetes UK ever since. And after purchasing a vintage Fordson tractor, Warren devised the challenge, which he entitled ‘Stanley’s Tractor Run’. Warren said: “Since Stanley was diagnosed we have all found it hard at times, but with the help of family, friends, Diabetes UK and Broomfield Hospital we continue to cope well.” Louise Rout, Acting Regional Fundraising Officer in Diabetes UK’s Eastern Region, said: “Warren has been brilliant throughout his organising of this challenge, and it’s fantastic that he’s managed to complete it alongside Hayley and Stanley.” i www.justgiving.com/warren-jopson

MEMORIAL FUNDRAISER A family from Lowestoft played their local pub team in a charity football match on 5 August to raise money for Diabetes UK. Adam Parnell, 49, and sons Ben, 21, and Jude, 19, assembled a team of friends and family to take on The Old Redhouse in Carlton Colville. The match was initially organised as a memorial to Adam’s youngest son who passed away in 2009, but this year’s event raised money for Diabetes UK as Adam lost his wife to hypoglycaemic brain damage last year.

Downhill all the way Since he was 14, it’s been Ollie Cannon’s ambition to cycle from John O’Groats to Land’s End after his hero Damon Hill completed the same feat in 2000. He achieved his ambition earlier this year when he reached his destination on 4 May, his 25th birthday, all in aid of Diabetes UK. So far he has raised £1,400 and the total is still rising. Ollie’s father Paul, who was diagnosed with Type 1 in 1979, and Ollie’s university mates supported him during his ride, braving the elements as they camped along the way. i www.justgiving.com/olliecannon. Read Ollie’s blog: www.olliejogle2012.wordpress.com.

Hitting the right note Diabetes UK’s Scarborough voluntary group’s main area of fundraising is to pay for young people to go on Diabetes UK Children’s Support Holidays. Since 2007, it has sent five children. Marion Terry (12), who is booked to attend this year, wanted to give other youngsters the same opportunity and, with the help of mum, Sylvia, and school music teacher, staged a concert entitled In a Nutshell, which was a synopsis of music from Phantom of the Opera and Love never Dies. All the cast were aged 12 to 16 and they worked tirelessly for two months before the presentation was staged in June. All those attending agreed it was a great success.

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

TAKING THE PLUNGE

Sally Renny and her husband Hugh took part

Getting the bike bug A fantastic turnout of 300 cyclists took part in the first Stourbug Ride for Diabetes UK on July 15. The Stourbridge-based leisure cycling group took over organising the popular annual charity event for the first time and a record number of bike riders took part, raising around £4,000 for the charity. The event catered for cyclists of all abilities and included an array of different routes ranging from 10 to 100 miles through the South Staffordshire countryside. Tracy Lee, Chairperson of Diabetes UK’s Stourbridge, Dudley and District voluntary group, said: “It was a great event; one of the best yet. Stourbug did a good job of organising it and the weather was fine.”

Entries are flooding in for this year’s Lake Bala Swim run by Diabetes UK Cymru, a once-a-year chance to swim the largest natural body of water in Wales while raising money for Diabetes UK. Now in its third year, the 1-mile swim will take place on Sunday 23 September. Entry is free, but each swimmer is expected to raise more than £150 in sponsorship. Famously deep and clear, Lake Bala abounds in legend and mystery. It has links to Arthurian legend and the Welsh princes and even has its own monster myth – ‘Tegi’. “No one should attempt this swim without a wetsuit and appropriate training,” says Andy Brazier, a volunteer organiser from Llandudno who is swimming this year to mark the tenth year since his son was diagnosed with Type 1 diabetes. “You should be able to swim at least 64 lengths before attempting it.” i For details, visit www.diabetes.org.uk/lake-bala-swim.

CROSSING THE CAPITAL

Sheila Collins’ daughter was diagnosed with Type 1 diabetes in 2004, at the age of 16. She was only diagnosed when she collapsed and was in intensive care on drips, dialysis and a ventilator for four days. Happily she is now well and is managing her blood glucose levels, but the experience made Sheila (pictured) determined to support Diabetes UK. Last year was the second time she signed up for the London Bridges Challenge raising £1,150. The event itself attracted 349 people and raised £30,000. This year’s challenge takes place on 18 November and involves an 8-mile walk across several of London’s most iconic bridges. i Visit www.diabetes.org.uk/bridgeschallenge.

THE BIG TEA PARTY During Diabetes Week in June, Dilys Shepherd hosted a ladies’ tea party for all her friends at her home. They wore their finest tea dresses and enjoyed homemade cakes, tea and elderflower cordial all served using the finest vintage china. Dilys and her friends raised a fantastic £120 for Diabetes UK in just one afternoon.

DIARY 2 SEPTEMBER London to Windsor Cycle Enjoy a late summer’s day cycling from Richmond in London to Alexandra Gardens, Windsor. Choose from a 29or 37-mile road route. i 01372 731361 • www. diabetes.org.uk/cycling-events 22 SEPTEMBER Family Fun Day and Walk for Diabetes Weald Park, Brentwood, Essex This fun-packed day will include bouncy castles, face-painting, local business stalls, great food and diabetes risk assessing. i 01376 501390 • fundraising. eastern@diabetes.org.uk 22–23 SEPTEMBER The Virgin Active London Triathlon Royal Victoria Dock, London Swim in London Docklands, bike past Big Ben and run alongside Canary Wharf. i 020 7424 1867 • ellie. wood@diabetes.org.uk 20–21 OCTOBER Tyne Bridge Zip Slide Tyne Bridge, Newcastle Zip 230m across the River Tyne. i 01325 488606 • www. diabetes.org.uk/tynebridgezip 28 OCTOBER Bupa Great South Run Southsea, Portsmouth 10 mile or 5k. Sign up and join Team Diabetes UK. i www.diabetes.org.uk/ bupa-great-runs 18 NOVEMBER Severn Bridge Walk Join the 4-mile sponsored walk across the iconic bridge to celebrate World Diabetes Day on 14 November. i 01823 448 260 • south. west@ diabetes.org.uk

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fun&games

Win

The Morphy Richards Partition Pot Slow Cooker allows you to create two different meals at the same time, be it a chilli with two different spice levels, two separate dishes or a complete meal such as curry in one side and rice in the other. This really is perfect for every occasion; using both partitions serves eight to 10 people or, if using just one partition, serves three to four people. Not so lucky with the crossword? Then enjoy 25 per cent off at www.morphyrichards.co.uk, quoting DU6226.

Morphy Richards Partition Pot Slow Cooker

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 20 September 2012 will win a Morphy Richards Partition Pot Slow Cooker (see right), worth £39.99. Congratulations to last issue’s winner, Jennifer Walsh from Bolton. 1

www.morphyrichards.co.uk

7 8 9 10 15

27 28

Name Address Postcode

FANCYASTROLL AROUND EDINBURGH?

Discover the city’s hidden sites and secrets on foot with Walking Edinburgh. It has 24 walking tours to help you explore. To enter: send your name and address on a sealed envelope or postcard to: ‘balance book giveaway’, Diabetes UK, 10 Parkway, London NW1 7AA by 20 September 2012.

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Puzzles set by Neil Locker

ACROSS 4 Herbal tea (6) 7 Starchy tuber (6) 8 Gilbert & Sullivan opera, HMS ___ (8) 9 Composition for one (4) 10 Carmen composer (5) 12 So be it (4) 18 Feeling of sickness (6) 19 Spanish rice dish (6) 20 Pace (4) 23 Narrow water channel (5) 27 Point of intersection (4) 28 Wheel projection engaging with chain links (8) 29 Boom (6) 30 Passion (6)

DOWN 1 Bedtime drink (5) 2 Chocolate substitute (5) 3 Yellow gem (5) 4 Principle (5) 5 Bulgarian capital (5) 6 Of medieval Scandinavia (5) 11 Wild goat (4) 13 Steeped barley (4) 14 Bovine animal (archaic) (4) 15 Burden (4) 16 Rough fibre from tropical plant (4) 17 Ointment (4) 21 Hoofed nocturnal mammal (5) 22 Snapshot (5) 23 Hindu ascetic (5) 24 Extremist (5) 25 Foe (5) 26 Grown-up (5) SOLUTION to July/August 2012 ACROSS 1 Circle, 4 Combat, 9 Bacchanal, 10 Retro, 11 Hook, 12 Cause, 14 Gamut, 15 Quire, 17 Genus, 19, Puma, 21 Bagel, 23 Chicanery, 24 Eeyore, 25 Demure DOWN 1 Cleric, 2 Rant, 3 La Boheme, 5 Oche 6 Benjamin, 7 Talent, 8 Ichor, 13 Ubiquity, 14 Gigabyte, 15 Quiche, 16 Julep, 18 Solace, 20 Lair, 22 Guru

LINKLETTER

MU MI

IN AY

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:

SN TR

ER LE

FA PA

EN RY

SE SU

NE LY

ST BL

PE TA A BALANCED LIFE John Byrne

LE ER

Last issue’s solution: METATARSUS

September – October 2012 15/08/2012 19:01

Wordworkout How many words can you make from these letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word. Names and plurals are not allowed. There is one nine-letter word in the grid. Clue: Records official 25 = Average; 30 = Good; 35+ = Excellent. Last issue’s nine-letter word: HEARTBURN

R R I E G R S A T ER FF O

UP TO 35 PER CENT OFF A WEEKEND BREAK

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

SUDOKU Fill the grid so that every column, row and 3x3 box contains the digits 1 to 9. Rating: Intermediate Last issue’s solution 5 8 1 9 4 3 6 2 7

2 6 4 7 8 1 5 9 3

3 7 9 5 2 6 8 1 4

8 5 2 4 9 7 1 3 6

9 3 6 2 1 8 7 4 5

4 1 7 3 6 5 2 8 9

1 2 5 6 3 4 9 7 8

6 9 3 8 7 2 4 5 1

7 4 8 1 5 9 3 6

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

1 6 8 7 4 3 9 8 6 7 8 9 9 3 5 2 4 2 8 7 3 6 7 4 5 1 9

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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3779 Hypurin Patient Ad.indd 1

17/3/11 15:57:19 15/08/2012 19:05

different types

ARTHUR SMITH

MARI WILSON

In praise of the fat

o I hear that at last we’ve had a good run of sun – typical, just as I’m out in Los Angeles for a few weeks! It was becoming quite a challenge earlier in the summer living with the constant rain. I mean, come on, everybody needs a blue sky. Out here, I’m constantly both shocked and fascinated by the American diet. It’s not really surprising that obesity is reaching epidemic proportions. Everything seems to have corn syrup packed into it, including the bread! Back home, we recently had some American friends staying with us and they couldn’t understand why the bread went off so quickly. I had to explain that it’s because bread in the UK is more natural and isn’t full of all those unnecessary additives. There’s also the issue of portion sizes – over here they are absolutely huge by comparison with European standards – my daughter ordered French Toast and there was half a loaf on the plate. No wonder doggy bags are de rigueur here, last night we walked out of the restaurant with a box that had enough food in it for our dinner! I read recently that by 2015, 41 per cent of the American population will be obese, and most European countries are following a similar path, with portion sizes being a major cause. Having Type 1 diabetes for almost 35 years has actually had a positive effect on my life and I suppose that’s why I find it so shocking. Don’t get me wrong, I love cheese and onion crisps as much as the next person, but not all the time. The best thing you can do when you have any medical condition is to educate yourself about it and then take charge. We only have one body so why not make it as fit as you possibly can – the benefits are immense. Sometimes I wonder if we take more care of our cars than our bodies. I still swim, run and go to the gym for the very reason that it makes me feel really good and helps my condition as I burn off so much energy – those endorphins have a very positive effect on your mood. I remember seeing an old film years ago on TV with Ray Milland – The Man With The X-Ray Eyes. He could see through people’s bodies and diagnose their illnesses. It would be rather handy if we could see the inside our bodies and gauge what effect our diet or lifestyle may be having. Hmm… might not be the nicest experience though! i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 and coeliac disease. Her latest album, Cover Stories, is out now; www.mariwilson.co.uk.

Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne

wenty years ago I used to do a routine that imagined future TV shows, including one whose title has proved prescient – Let’s Laugh at Fat People. There isn’t actually a programme called that (yet), but there are numerous that seem to contain that idea. Step forward – if you can manage it – My Big Fat Fetish, Supersize vs Superskinny, The Biggest Loser, I’m a Laughable Lump of Lard (may have made that one up). It can’t be long before we have an entirely new ‘fat channel’. The Americans are, of course, the best at being fat; a statistic I have read states, ‘one out of three Americans weighs as much as the other two…’ Well all right, that is another joke (and if you are going to use it, make sure you pause for a second after the word ‘Americans’), but you only have to see news footage of ordinary US citizens to realise how many chunkies there are out there in the vast windswept concrete plains of Midwestern shopping malls. And now we too, it seems, have ‘an obesity epidemic’. Terrifying hordes of wobbly porkers are lumbering through our island and they must be stopped. In Government offices earnest slim people are staying up late devising ways to rid the nation of excess blubber. I do not pretend that being overweight is a good thing, nor do I deny it can lead to medical problems – including Type 2 diabetes – but I do wonder if the stress and guilt that some plump people, especially women, experience can be nearly as bad for them as the numbers on their scales. The world of fashion is famously obsessed with size and the press meekly follows, producing umpteen glossy pages of diets, pictures of stick women and sensational tales of girls losing 12st in three months for their wedding day. There is always a kind of subtext in these stories that goes: ‘Hey, this lady is gorgeous – not like you, Mrs Tubby’. The language used to describe the overweight has always struck me as unpleasant – ‘obese’ sounds bad enough with its hint of ‘beast’, but ‘morbidly obese’ is even worse. One wonders at the effect of this; there have always been fat people and thin people but it is only recently we have had five year olds fretting about their weight and websites sharing tips on staying unnaturally thin. So, if you are not as svelte as you once were, well you are advised to moderate your calorie intake and do some exercise, but, please, there’s no need to get freaked out by all the hullabaloo. You can only do your best. Here endeth my sermon. Please turn to page 42 of your hymn books and we will now sing All Things Bright and Beautiful. i Arthur Smith is a comedian, writer and broadcaster with Type 2.

Be kind to your body

66 balance September – October 2012 66-68 A n M.indd 66

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