Balance Magazine May-June 2012

balance Your diabetes lifestyle magazine • May–June 2012

“WE PLAY THINGS DOWN”

MEN: LISTEN UP Get symptomsavvy with our revealing guide

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

SCIENCE & SOCIETY

STEEL MAGNOLIAS

Social and psychological diabetes research

Playwright Robert Harling’s touching true story

SIBERIAN STUNTS

Injecting at -40°C

PLUS

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

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

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Mrs Stocks returned to Diabetes UK Insurance Services for travel insurance, having taken out policies with us in the past, and feeling more secure with a service endorsed by and in partnership with the charity. ‘I had gone elsewhere for a couple of quotations, but one company turned me down and the other quoted more than I was willing to pay. So I didn’t hesitate to return to Diabetes UK. Not only was it a cheaper price, but your team are very helpful and I just cannot fault your service at all.’

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contents May – June 2012 • no 246

balance

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

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

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

Angela Coffey DEPUTY EDITOR

Kate Flagg DESIGNER

John Clarkson EDITORIAL SECRETARY

Melanie Aldridge CONTRIBUTORS

Sheila Seabrook, Sabeha Syed COVER IMAGE

ITV/Rex Features AD MANAGER

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

Pindar plc 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).

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regulars

features

life&health

4 This is Diabetes UK 6 News Diabetes news round-up 14 Columnists 16 Your views 20 Research matters 46 Recipes Celebrate with gluten-free treats 52 Bite-sized For foodies 54 T ravel We take a tour around Euro 2012 hotspots: Poland and Ukraine 58 Walk Lovely pub walks 60 Fundraising focus Celebrating achievements and events coming up 64 Fun & games Win: a Morphy Richards Induction Hob, and get your free tickets to the Allergy & Free-From Show 66 Different types Arthur Smith and Mari Wilson tell it like it is

22 Science & society Dr Richard Elliot looks at social and psychological diabetes research 26 Steel Magnolias As the play, set more than 25 years ago, goes on tour, how far have we come with diabetes and pregnancy?

29 Make a splash British breaststroke champion Kate Hayward is backing Diabetes UK’s Swim 22 challenge 30 In the family Denis Healey’s nephew, Robin, ponders over his family’s Type 2 trait 32 Make a connection As Diabetes Week approaches, we look at ways to get involved – however big or small 34 The Adventurist Thrill-seeking Olly Rowland on managing Type 1 in the Arctic 51 Gluten free, not taste free!

Phil Vickery’s gluten-free recipes are hot property

37 Health notes Avoiding generations of Type 2; the importance of injection site rotation; understanding sun creams; MODY; & fish pedicures 41 Ask the experts Blood transfusions & HbA1c; reusable injection pens & IVF and diabetes 43 Spotlight on...

Gastroparesis 44 Basic care Man up: In preparation for Men’s Health Week, we shine a light on some typically male health problems and the symptoms to look out for

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

GET INVOLVED

D

iabetes UK couldn’t exist without its volunteers. Our army provides support It will be a great to people with diabetes, influences the NHS locally and nationally, raises the day out with profile of diabetes and the charity, and raises demonstrations, vital funds for our work and research.

Volunteers are involved in almost every area talks, opportunities of work; some in the public eye and others quietly to hear about the behind the scenes. People run, walk and bog latest research... snorkel, they speak on behalf of Diabetes UK, run voluntary groups, help us with the media, become a Diabetes Voice to help influence the NHS, and they do important volunteer jobs like stuffing envelopes and rattling cans – all to help the vital work of supporting people with diabetes and those at risk. I have met a volunteer who speaks to schools across a whole county about diabetes. Our Professional Conference in Glasgow, which in March brought together 3,000 diabetes professionals from the UK and beyond to explore the latest research and practice, was admirably supported by a big team of helpful and smiling (sometimes in the face of adversity!) Scottish volunteers. Some people give us a few hours a year, others seem to live for Diabetes UK and involve their whole family (not sure if they are volunteering!). Whatever time you can give us, we will value it.

To celebrate excellence in volunteering at Diabetes UK, we have launched the Inspire Awards, our new annual awards scheme. We want to recognise the hard work and commitment of the people who dedicate their time and efforts to people with diabetes and Diabetes UK without expecting anything in return. Nominations close on 29 June, so if you know a tireless or inspiring volunteer, let us have your nomination. There are a number of categories and I look forward to congratulating the ‘supreme volunteer’ of 2012 later in the year.

I hope we will see you at Diabetes UK’s Big Event, our new gathering for all supporters and anyone interested in diabetes, to be held at the University of Warwick on 14 July. It will be a great day out with demonstrations, talks, opportunities to hear about the latest research, an exhibition of products and services, group sessions on exercise and diet, and a chance to meet other people living with diabetes and share experiences. There will be a parallel kids’ event so that parents can join in the main event. We hope to build this over the years into the must-be-there event in the diabetes calendar. Think meeting old friends, sharing ideas, hearing what’s new and getting help with living with diabetes. See you there.

Baroness Young, Chief Executive, Diabetes UK i To find out more about volunteering for Diabetes UK, visit www.diabetes.org.uk/volunteer or call the Volunteer Development Team on 020 7424 1000.

• To sign up for the Big Event, visit www.diabetes.org.uk/thebigevent.

4

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 working 10 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: 12–3pm; Friday: 9–12pm; or Sunday: 7–10pm. 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. Join 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 May – June 2012

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news Reducing the rise in potentially avoidable complications Rates of stroke and kidney failure in people with diabetes have reached record levels in England, according to a new analysis by Diabetes UK. This once again highlights the importance of people with diabetes receiving all their annual checks, as listed in Diabetes UK’s 15 Healthcare Essentials, to identify potential complications and help prevent them from developing.

Figures from the 2009–2010 National Diabetes Audit (NDA) show a 57 per cent rise in stroke in people with diabetes since 2006/07. Taking these figures as being representative of the rate across England means that more than 16,000 people with diabetes had a stroke in 2009/10.

For kidney failure, the rate is 31 per cent higher than in 2006/07, which means more than 8,800 people with diabetes had kidney failure in 2009/10.

A recent Diabetes UK survey of patient experiences revealed that almost a quarter (22 per cent) of people with diabetes were unaware of having had their kidney function checked in the previous year. And while 91 per cent had their blood pressure checked, NDA figures reveal that just 50.7 per cent of people with diabetes met their blood pressure target in 2009/10.

Diabetes UK has warned that once people with high blood pressure have been identified, not enough is being done to help them bring it under control to help prevent complications

6

Diabetes UK warns that not enough is being done to treat high blood pressure developing. This could include, where necessary, medication and support with improving diet, losing weight and stopping smoking.

Barbara Young, Chief Executive of Diabetes UK, said: “These appalling figures once again highlight the importance of applying pressure on the Government and the NHS to give everyone with diabetes the basic checks that can help bring the rise in potentially preventable complications to an end.” i Download a 15 Healthcare Essentials checklist to find out if you are receiving all the checks that you should be: www.diabetes.org.uk/15-essentials.

POP-UP RISK ASSESSMENTS

MAKING A SPLASH

Diabetes UK North West ran a pop-up risk assessment day in a disused shop on 29 March, in North City Shopping Centre, Manchester. Throughout the day, 103 people had their risk of developing Type 2 diabetes within 10 years assessed, and 57 people were referred on to their GPs for further investigation. There will be more risk assessment days in the north west this summer. i Diabetes UK’s online risk assessment test for Type 2 diabetes: www.diabetes.org.uk/risk-score.

Great British Olympic swimmer Kate Haywood launched Diabetes UK’s Swim22 Channel swim-pool challenge in London on 22 March. i See page 29 for more on Kate Haywood.

• www.diabetes.org. uk/swim22.

Everyone’s talking about...

Improving foot care On 7 March 2012, it was all about feet. While Diabetes UK officially launched the Putting Feet First campaign at the charity’s Professional Conference in Glasgow (7–9 March), broadcast, print and online news across the UK took the issue right into people’s homes.

BBC news bulletins on national TV and radio featured the shocking amputation figures for the country; the fact that about 80 per cent of the 6,000 diabetes-related amputations in England every year could potentially be prevented; and Diabetes UK’s call for action to the NHS to improve foot care for people with diabetes.

Diabetes UK spokespeople – including Chief Executive Barbara Young – became familiar faces in the BBC Glasgow studios, where they recorded more than a dozen radio interviews for stations from Humberside to Somerset.

The media buzz around the campaign not only brought awareness to those who knew little about the dangers of inadequate foot care, but also set the scene for productive discussions between the almost 3,000 healthcare professionals who attended the Diabetes UK Professional Conference. i To find out more, visit www. diabetes.org.uk/putting-feet-first.

• There will be further updates on the campaign in future issues of balance.

balance May – June 2012

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SCOTLAND’S PUMPED UP After many years of campaigning, Diabetes UK Scotland has welcomed a Scottish Government announcement to invest more than £1m in delivering insulin pumps.

All eligible under-18s with Type 1 diabetes will now have access to insulin pumps under plans announced on 27 February by Scottish Health Secretary Nicola Sturgeon, pictured with 5-year-old Daisy Slatter – the youngest person in Scotland to receive a pump.

Nicola Sturgeon said: “By the end of March 2013, this treatment will be made available to the 480 children and teens struggling with Type 1 diabetes who could benefit from it.

“Over the next three years, NHS Boards will also increase the number of insulin pumps available to all Scots to 2,000, tripling the current amount.”

Daisy Slatter (who featured in ‘Coming up Daisies’, May/June 2008 balance) was diagnosed with Type 1 aged 18 months.

Daisy’s dad, Tim Slatter, remembers: “After 11 months of blood sugar highs and lows, we finally embarked on insulin pump therapy in September 2008. It really helped to stabilise Daisy’s blood sugar levels within hours of fitting it.” i For more information on pump eligibility, visit www.diabetes.org.uk/pumps.

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NHS Shake-up The Health and Social Care Bill reached Royal Assent (the final stage of the Bill) at the end of March and is now The Health & Social Care Act. The Act follows around 50 days of heated debate in Parliament and almost 2,000 amendments to the Bill. The final days of debate in the House of Lords included Baroness Finlay of Llandaff raising Diabetes UK’s concerns about the balance between competition and providing seamless care for people with diabetes, with the

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Government responding that this responsibility is now on commissioners and their acting transparently in the best interest of patients.

Diabetes UK will now work to understand and influence the new organisations that have been set up by the Act (and which will be responsible for the NHS budget from April 2013), to make sure that diabetes care is a priority at all levels and that the new organisations are acting in the best interest of people with diabetes.

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news

THEY SAY, WE SAY

Healthy living advice ‘failing to reach patients’ Clinicians think they are giving much more healthy living advice to people with diabetes than patients think they are getting, according to research.

The study, funded by Diabetes UK and led by Newcastle University, found that almost all clinicians (99.6 per cent) say they routinely talk about physical activity with people with diabetes who are overweight, while 88 per cent said they advise them about their diet. Yet less than half of overweight people with diabetes (45 per cent) said a doctor had talked to them about physical activity during the previous year, while for dietary advice the figure was 57 per cent.

Could white rice increase risk of Type 2 diabetes?

On the same wavelength? Healthy living advice needs to reach people with diabetes Simon O’Neill, Director of Care, Policy and Intelligence at Diabetes UK, said: “We hope this research highlights the importance of doctors making sure that their advice is clear and jargon free.”

Diabetes UK has recently confirmed funding for the Newcastle team to further investigate the factors that influence the quality of care received by people with Type 2 diabetes.

CUMBRIA DIABETES AWARENESS MONTH Diabetes UK North West is launching Cumbria Diabetes Awareness Month in June, to tackle the fact that an estimated 11,000 people in the county are unaware that they have Type 2 diabetes.

It will start on 7 June with a two-day Diabetes UK Healthy Lifestyle Roadshow in Barrow, and will culminate on 10 July in Carlilse with a further Roadshow. i North West office: 01925 653 281; www.diabetes.org.uk/north_west

Thank you, volunteers National Volunteers’ Week runs from 1–7 June, and Diabetes UK would like to thank all the charity’s volunteers for their support.

Volunteers are at the heart of Diabetes UK and their support means that the charity can care for, connect with and campaign on behalf of all people affected by and at risk of diabetes. All volunteers bring skills, experience, enthusiasm and commitment to Diabetes UK, helping the charity to have a real impact in local communities. i To find out more about volunteering at Diabetes UK, visit www.diabetes.org.uk/volunteer or call the Volunteer Development team on 020 7424 1000.

8

INSPIRE AWARDS

2012 WHO INSPIRES YOU? Diabetes UK has launched The Inspire Awards to thank the volunteers who deserve recognition for the activities they undertake on behalf of Diabetes UK, and is now welcoming nominations for several categories of awards. i For further details, visit www. diabetes.org.uk/inspire-awards.

Regularly eating white rice can significantly increase the risk of Type 2 diabetes, according to a study published in the British Medical Journal.

This claim was picked up by BBC News, the Daily Express, The Daily Mail and other national newspapers in April.

The authors from the Harvard School of Public Health analysed previous studies that looked at the association between eating white rice and risk of Type 2 diabetes. Four studies were analysed: two in Asian countries (China and Japan) and two in Western countries (USA and Australia). The participants did not have diabetes at the start of the study.

Based on their analysis, the authors claim that a high intake of white rice is associated with a significant increased risk of Type 2 diabetes, especially among Asian populations.

DIABETES UK SAYS Dr Iain Frame, Director of Research at Diabetes UK, said: “This new study is a review of previous research looking at the association between white rice consumption and Type 2 diabetes, but it has not looked at whether eating lots of white rice actually increases the risk of Type 2 diabetes. Previous research in this area has not provided conclusive results.

It’s a difficult area in which to conduct research because no single type of food is directly linked or associated with the development of Type 2 diabetes.

“A person’s risk of Type 2 diabetes is increased by a range of factors, including poor lifestyle choices, so it is important to maintain a healthy weight through being regularly physically active and eating a healthy diet.

“This study does not provide any strong evidence that eating lots of white rice will put people at increased risk of Type 2 diabetes.”

balance May – June 2012

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Improved care for children and young people

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Every child and young person with diabetes in England can expect an improvement in their level of care after a landmark funding agreement for paediatric diabetes services came into force on 2 April.

Set by leading paediatric doctors, nurses and commissioners working in partnership with NHS Diabetes, the ‘Best Practice Tariff for Paediatric Diabetes’ sets out 13 mandatory care standards for paediatric diabetes service teams to meet.

Care providers who can prove they meet these standards will qualify for greater funding. Services unable to achieve these levels of care will be supported to improve but face having their funding withdrawn if they are unable to reach the required level by April 2013.

Barbara Young, Chief Executive at Diabetes UK, said: “We are really pleased by this news because giving incentives for providing excellent health services could help drive the improvements in healthcare that children with diabetes badly need.

“However, it is disappointing that new technology such as insulin pumps is not included.

For some children pumps are extremely useful in helping to of 16–24-year-olds manage blood glucose levels, don’t receive all and many do not currently the recommended have the option to use them. diabetes health checks.

“We are also concerned that the standards only apply Diabetes UK is urging the NHS to to the care of those aged do more to stop young adults with under 19 and do not include diabetes falling through the gap guidance on preparing young between children’s and adults’ people with diabetes for their healthcare services. transition to adult services.

Source: 2009–2010 National The NHS needs to make sure Diabetes Audit (NDA) that the new standards do not ignore the need for a continued level of care throughout this change.”

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news

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SHAKE YOUR BOX

30p saving this per day could add up to £16 by Diabetes Week – and make a real difference to someone facing unfair treatment.

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Diabetes UK is highlighting the importance of people with diabetes connecting with each other and the charity’s many services during Diabetes Week 2012 (10–16 June). An easy way for you to get involved is by popping your spare change into the coin box, provided with this issue of balance. All the money raised by the Coin Box Appeal will support the charity’s much-needed services, such as the Advocacy Service, which supports people who are facing unfair treatment because of their diabetes.

Demand for the service is ever-increasing – over the last year, 40 per cent more people have been in touch about employment or education issues. Your small change can make a big difference.

There will be a return envelope for your donation with the July/August issue of balance – thank you! i If you haven’t received a coin box with this issue of balance and would like one, call 0845 123 2399. • See page 32 for more on Diabetes Week.

Charity shopping Diabetes UK’s spring/summer 2012 catalogue is included with this issue of balance, and it’s packed with a fresh product range. There’s the all-new Diabetes UK-branded T-shirt, lapel badge and pen (pictured), alongside handy kit bags, cases and insulin wallets. There’s also the popular Timesulin – a cap for your insulin pen that shows how long it’s been since your last injection. All profits from catalogue purchases come directly to Diabetes UK. i You can also shop online at www.diabetes.org.uk/shop.

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

iBGStar This teeny meter connects to your iPhone or iPad. With its corresponding app, you can then instantly see all your results (in colour). You can even email them, should you wish to share them, and trends become easily trackable. It’s a sure thing for those with a busy lifestyle and the style conscious. Diabetes has never been so chic. Retails at £48 from www.boots.com. i www.diabetesmatters.co.uk; 08000 35 2525

Medical ID bands In a range of colours and with different messages to choose from, these rubber bands get to the point without coming over all medical. No matter what type of diabetes you have or how you treat it, there’s a band for you. Retails from £5. i www.theidbandco.com; 0845 269 4523

GSF Syrup The new name for Hypo-Fit, GSF stands for glucose, sucrose and fructose – the three sugars in this potent hypo (low blood glucose) treatment. These tablets will bring you out of a hypo, with each sugar kicking in one after the other, so you’re not swamping your system with too much too soon. Available from Arctic Medical at £12.99, or on prescription. i 01303 277751

10 balance

May – June 2012

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BOOK CLUB More reasons to count carbs Diabetes UK has launched a free PDF version of Carbs Count, the charity’s guide to carbohydrate counting and insulin dose adjustment. Carbs Count includes information on the different types of insulin available, how they work and how each one should be adjusted according to what you eat, drink and the amount of physical activity you do. i Download the book for free at www.diabetes.org.uk/carbscount.

Be kind to your kidneys The National Kidney Federation (NKF) has launched Food for Thought, a free cookbook containing more than 30 ‘kidney-kind’ recipes that are low in phosphates, nitrates and potassium for people with chronic kidney disease (CKD).

Fiona Loud, Chair of the Kidney Alliance, who has lived with CKD for 20 years, said: “A renal diet is vital for helping to preserve kidney function for as long as possible – and it doesn’t have to be bland and tasteless.” i Download the cookbook at www.kidney.org.uk. For a hard copy, call the NKF on 01909 544999 or email nkf@kidney.org.uk.

Celebrating RD Lawrence An insightful biography about the life of RD Lawrence, who co-founded Diabetes UK (the then British Diabetic Association) in 1934, has been written by his daughter-in-law, Jane Lawrence.

Diabetes, Insulin and the Life of RD Lawrence chronicles RD’s diabetes diagnosis and his extraordinary career, which was devoted to treating patients with diabetes. i The book, published by The Royal Society of Medicine, will be available from mid June, priced at £25. There will be a discount for members of Diabetes UK. • balance will feature more on Jane and the book in a future issue.

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INSULCHECK A device has been launched to help insulin-users avoid the dangers of accidental double injections.

InsulCheck is a device that clips onto insulin pens and automatically displays the time since last the injection. It was developed by balance reader John Hughes, who has Type 1, after he double injected by mistake and experienced a hypoglycaemic coma. i See page 19 for an exclusive 20 per cent discount on the device.

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Date of preparation: January 2012

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columnists Truly inspirational

What they carry

Richard Lane OBE

Patricia Debney (

As it is Volunteers’ Week 1–7 June, it is a good time to reflect on the outstanding work of our volunteers, so many of whom I have met.

Not all are people who themselves have diabetes, but are individuals who have been touched by the condition in a number of different ways.

The inspirational Sue Braeger, who sadly died last year, did not have diabetes but her husband does. She looked after him and chaired the very successful Havering family diabetes group, without a word of complaint about her own health problems (including cancer). What a lady!

I also want to highlight the work of a large number of healthcare professionals who give their time so generously in so many different ways, whether it is by helping with our Children’s events, by manning our growing

number of Roadshows, or by serving on the committees of, or even chairing, some of our voluntary groups. Their support is astonishing!

Finally, we are fortunate to have the services of so many young people who give their time and energy so selflessly, despite their own health conditions.

Two examples are Jenny Guy from York parents’ and children’s group, who encourages others to volunteer, and Ashley Spires, who was a member of the Stockport tadpoles’ group, run by his parents, before becoming an Events Volunteer, a Risk Assessor and, most recently, a Volunteer Ambassador.

Both Jenny and Ashley have Type 1 themselves.

These people are just a few of the thousands of volunteers who make Diabetes UK what it is. i Richard Lane OBE is President of Diabetes UK and has Type 1.

Follow his blog for Diabetes UK at www.diabetes.org.uk/bloggers.

@PatriciaDebney)

Recently I was treated to a surprise birthday weekend away with the whole family. Travel with Eliot now feels routine: after packing spares of everything and shifting some insulin into a cooler pack, we head out.

Night-testing after restaurant meals is also routine for us. However, at 3am during the first night, Eliot is 16mmol/l.

The second night, he is 15mmol/l. Both mornings, despite over-correcting in the early hours, he is still high. Argh. For us, the confident management of carbohydrate and glucose index levels feels routine. But this weekend, in Belgium – the land of chocolate and chips – we understand once and for all why we don’t have chips at home anymore: they are a nightmare, whatever we think we know!

Worse, back home, Eliot’s typical ‘vacation

highs’ (indicating growth and relaxation) hit.

On Easter Saturday we received our daughter’s blood test results from the research study I wrote about in my last column (March/April 2012 balance): negative for all four antibodies, which means that she is very unlikely to develop Type 1 diabetes.

The root of my heartbreak for Eliot lies in what he must do alone, hour after day, after week after month.

And the corresponding root of my relief for our daughter is that she is very unlikely ever to have to convince herself – exhausted after battling soaring highs or debilitating lows – that everything’s alright really. That her chances of complications haven’t increased. That she can do this. i Patricia is an author and senior lecturer in Creative Writing at the University of Kent. Her son, Eliot, 15, has Type 1. Visit her blog: www. wavingdrowning.wordpress.com.

listen to on your MP3 player whenever you want. You can download BBC classics such as Desert Island Discs, Mark Kermode and Simon Mayo’s Film Reviews or Fighting Talk, a funny sporting panel game. Then there are specialist podcasts like The Skeptics’ Guide to the Universe. And, best

of all, they are all free on iTunes. Rather than seeing the gym as a chore, I now see it as a chance to spend an intimate hour with a programme I enjoy. The gym becomes the perfect excuse for an hour of ‘me time’ in a busy day. i Andy Kliman has Type 2 diabetes. Follow his blog at http://t2dkidding.blogspot.com.

Hello to Jason Isaaks Andy Kliman (

@andykliman)

Since being diagnosed with Type 2 in May 2009, I have changed two huge parts of my life: diet and exercise.

Both are difficult to do and I can’t say I am an expert or a saint with either of them, but I do try and I have had some success.

14 balance

I thought I’d share one particular way in which I’ve managed to take some control over my health: podcasts. I joined a gym but I wouldn’t have been able to keep it up if it hadn’t been for podcasts keeping me entertained while I’m there.

Podcasts are like radio programmes that you can

May – June 2012

14-15 Columnists_b&w.indd 14

16/04/2012 13:43

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your views

balance Your diabetes lifestyle magazine • March – April 2012

STEP TO IT Why diabetes is important to Steps star Lee Latchford Evans

CAN YOU PROVE THAT? Lifting the lid on diabetes ‘remedies’

WAY OUT WEST

Family fun in the Rockies

PUT YOUR FOOT DOWN

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

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

STAR LETTER

After Chloe, our 8-year-old daughter, was diagnosed with Type 1 diabetes in October 2011, we were devastated. Chloe became terrified of needles. A few months later, she was diagnosed with coeliac disease too.

Chloe has been very brave and is mostly cheerful, even though she can’t watch the injections. After reading Mari Wilson’s column (‘Health & handbags’, March/April 2012 balance), I remembered the early days when it was all so overwhelming and felt reassured again that we really are not alone. Imagine this – Chloe then did her own blood glucose test for the first time. She didn’t tell anyone what she was doing, she just showed me the reading and said she turned the machine back to front so she couldn’t see the blood get sucked up onto the test strip. She did it! In her own time.

Heartfelt thanks to the diabetes team at Leicester Royal Infirmary, and everyone who has been so kind.

Liz Abell, via email

I wholeheartedly support the changes to driving licence application forms (‘Licence forms to be redrafted’, News, Jan/Feb 2012 balance).

I have Type 2, controlled with insulin. When filling in the form recently to renew my three-year licence it was unclear whether I needed to supply a new photo so I did, just in case. The DVLA sent my form back two weeks later, asking whether I wanted a new photo for my licence and, if I did, to fill in extra information. I sent it back saying my old photo would do as time was moving on.

A few weeks later I received another query. Apparently I hadn’t filled in the section on hypos properly as I hadn’t answered questions three and four. On my original form the instruction was

16 balance

DIABETES DOWNSIZE

Slimmer and healthier after Type 2 diagnosis

PLUS

Walk an Olympic route, favourite recipes, carb counting for cooks & great giveaways

Lights, camera, action!

Filmmaker Tom Craig takes us behind the scenes of his latest diabetes movie

01 Cover 2.indd 1

22/02/2012 14:16

Good job Banting knew Best

Small step, big leap

Red tape frustration

Get the foot care you deserve

PERFECT FIGURES?

What to do when you’re off target

to miss out these questions if I had answered ‘no’ to question two, which I had. An accompanying letter threatened to refuse or revoke my licence if I didn’t fully fill in and return the form within 21 days. I filled in the ‘missing’ information and returned it immediately. My licence arrived one week after my old one had expired, during which time I was not able to drive.

The whole thing left me utterly frustrated and very angry. The sooner these forms are simplified the better – for us and DVLA staff.

I have just ‘celebrated’ 56 years on insulin, and my 84th birthday.

I was fascinated by Dr Richard Elliott’s article ‘Science or snake oil?’

(March/April 2012 balance). I have a copy of the 1856 Every Man His Own Doctor by Nicholas Culpeper. His ‘cure’ suggests rice as a suitable vegetable, and oysters and crabs as particularly effective. ‘Thirst may be quenched by vinegar and Bristol water, a course of which has done wonders. If this is not available, a preparation of oak bark infusion should be used.’

If it had not been for Banting and Best, think what your prescription might be today!

Neill (the notorious) Evans, via email

Carbs count

We have been carb counting since my husband was diagnosed with Type 1 30 years ago. We follow the same system as Autumn Barlow (‘Number crunching’, March/April 2012 balance) and have always cooked from basic ingredients. In the beginning, carb counting was very controlling of portion sizes and total carbs per meal. It taught us how much food was sufficient to keep to a healthy weight, which is the one positive thing that came from having diabetes in the family!

Our copy of The Complete Peter Blades, via email Carbohydrate Counter, is falling apart but it is now out of print, and Editor’s note: You will be pleased ingredients available have changed. to hear that Diabetes UK’s work with the DVLA has resulted in a The only new book we’ve found gives much improved form, which will the carb content of manufactured soon be in use. The charity is also goods only. Is there an alternative? working with the DVLA on guidance Fran Dutson, via email for completing the form, which Editor’s note: See page 11 for details should provide further clarity. of Diabetes UK’s Carbs Count PDF.

May – June 2012

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16/04/2012 16:20

your views

THE BIG

QUESTION Different types…

Thanks to Arthur Smith (‘Confessions’, March/April 2012 balance), at last I can hold my hand up and admit that I am just as guilty, but not for exactly the same reasons.

I do not test my blood sugar morning and night, just mornings. I do not have a bath but a shower, and I hate to get out of it. I eat things that I should not, all the time. I can’t afford grapes. Because of my strokes I do forget to change needles. I use cream on my hands, I’ve never thought about my feet, but I do have them checked regularly.

At last I can say the use of semi-skimmed milk gets a tick. I don’t bother marking plates – should I? I have never read all of balance (print rather small in large doses). I have never pretended to have a hypo; they are bad enough without faking them. People do not ask me to run anywhere, I can hardly walk.

I am not busy also, but do work for a charity. And last, I am not as funny as Arthur Smith.

David Heap, via email I offer my full support to Arthur Smith for his use of full-fat milk. I find it extremely annoying that this, at 4 per cent fat, is frowned upon when companies promote products with fat contents of 5 per cent as ‘diet’ or ‘good for you’.

Geoff Noddings, via email What an excellent writer Arthur Smith is – writing essentially serious scripts but with a delicious sting in the tale. So mischievous, in fact, that they are easily understood. I laughed, inwardly of course, at his ‘confessions’, but the whole ethos was quickly lost by the ‘Health and Safety Executives’ insisting on reality in the paragraph below his article. What a shame.

Surely those who read balance are interested in good diabetic welfare and largely note the advice from the professionals, who write clearly and succinctly about our condition. Please, balance, don’t spoil our childish enjoyment with the truth!

Editor’s note: Consider us told!

John, Bury

What’s the best diabetes-related advice you’ve received?

Make diabetes fit into your life, don’t fit your life into diabetes.

Phil Knott, via email Eat what you want BUT (she said it in capitals too) everything in moderation.

Lisa Cook, via the balance Facebook group As my daughter is on an insulin pump I was told to put Cavilon cream under the canula sites to stop them getting sore. It works a treat, no more sore lumps.

Kellie Hartley, via the balance Facebook group Test don’t guess!

Patricia Bason, via the balance Facebook group My diabetes specialist nurse said “one bad day doesn’t mean complications, it just means we need to work a little harder to work out the problem.” The best thing in the quote? The word “we”.

Gemma Ralston, via the balance Facebook group “You’re allowed treats” – this advice makes the diet I find I have to follow to control my Type 2 do-able!

I love my...

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

I love my fiancè, Steven Morrow, because he is always there for me when I am down about my diabetes. I’ve had Type 1 since I was 13 and am on an insulin pump. Steven always knows exactly what to do when I have a hypo – he has saved my life a few times now. Thank you, Steven, for always staying calm, even when I’m not, and for being there when I need you.

Kayleigh McKimm, via email

20-23 Your ViewsAC.indd 17

Sue Lewins, via the balance Facebook group

NEXT BIG

QUESTION What are your top exercise tips?

Email balance@diabetes.org.uk or post on the balance Facebook group wall. A selection of answers will be printed next time.

May – June 2012 balance 17 16/04/2012 16:20

your views Vitamin vitals

I’ve had diabetes for 32 years I’m 67 and have Type 2. I was and my sight began to be shocked to hear that I needed affected three years ago. I was vitamin B12 injections. given Lucentis injections but According to the internet, one eye was beyond saving. I taking metformin six times a have now only got one eye with day could have brought about sight and, to date, the treatment this deficiency. Has anyone else has been effective. Without experienced this?

Lucentis I would be blind by Mrs Harrington, Edgware now. I’d also be a drain on the support systems, and no doubt A warning cost the state a lot of money.

The article ‘Put your feet first’ Perhaps a compromise could (March/April 2012 balance) be found that those patients comes a bit late for some of us. who have sight in only one eye In 2001 I developed an ulcer on could be treated. Also, most the ball of my right foot. I saw of the people needing Lucentis six doctors over three months treatment are older and at my local practice. Not one of probably on a pension, so they them considered diabetes, and could find it difficult to pay.

I didn’t have symptoms apart Sheila Farley-Sutton, via email from my foot ulcer. I was sent Editor’s note: Diabetes UK has to the fracture clinic but they called on the manufacturer couldn’t find what was wrong (Novartis), the Department with my foot. Finally, another of Health and NICE to agree doctor diagnosed diabetes. a Patient Access Scheme.

I have been in and out of Balance will report on any hospital since 2002. My left progress in a future issue. foot is completely dead, though the right foot has a small Budget over health amount of movement. Because I’m 72 and control my Type 2 I didn’t get the right treatment with medication, and by I’m wondering how long my testing and adjusting my diet legs and feet are going to last. accordingly. But my nurse told Mr M Nicholls, Doncaster me I shouldn’t test as much due to the expense and that there’s An eye on Lucentis not much you can do about the I’m concerned that NICE has results. She’s more concerned turned down the appeal for with the practice budget than Lucentis to be made available my health. I suppose they on the NHS (‘Lucentis update’, would save money if I got ill.

News, Jan/Feb 2012 balance).

Leonard Hobsbaum, via email

Chatroom Hi, I’m 80 and have had Type 2 diabetes for five years. I am still quite active and enjoy going on holidays. I like dancing, having meals in pubs, etc. Is there anyone in the Hertfordshire area who would like to correspond for friendship and socialising?

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

18 balance

Blogs, tweets & posts www.facebook.com/diabetesuk http://twitter.com/diabetesuk @DiabetesUK Just been on phone to Careline. Excellent service. So happy.

Never called before. Type 1 for six years.

Ian Clowes, via Twitter My son in his spare time goes bowling and works on go-karts, so you can adapt and live life to the full. In a couple of weeks he is going hill climbing with his friends. Diabetes does not have to interfere with your life!

Sue Murray, via the Diabetes UK Facebook page After a week or so here and there under canvas with a bit of walking thrown in, I decided it was time to do it properly – 10 days walking through the Himalayas spending every night in a tent.

Helen May covers the highs and lows of her Himalyan adventure in her latest Diabetes UK blog post ‘Diabetes in high places’: www.diabetes.org.uk/bloggers.

Me & my balance It’s a first for balance, after Carol Barraclough, from North Yorkshire, took her copy to the southernmost tip of Africa, Cape Agulhas, which is the official meeting place of the Indian and Atlantic Oceans. Carol, who travelled to South Africa with her husband in February, said: “To quote my godson (who travelled overland from Dorset to Cape Town in 2005), Cape Agulhas was ‘rocky and barren, protruding out from the land around it, with large crashing seas all around’.

“I’ve found balance an excellent source of interest and information ever since I was diagnosed with Type 1 more than 33 years ago.”

Keep your photos coming to the usual address (see top of page 16), marked ‘Me and my balance’. Every photo printed wins a Diabetes UK scraggy bear.

May – June 2012

20-23 Your ViewsAC.indd 18

16/04/2012 16:20

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16/04/2012 16:20

research matters A new direction for diabetes research?

One of three molecules essential for all forms of life is Ribonucleic acid (RNA), along with DNA and protein. Since the early 2000s, scientists have realised that short RNA molecules, known as microRNAs, play a role in most biological processes by blocking the production of certain proteins.

Recent studies, carried out in Austria, have started to explore the role of microRNAs in Type 2 diabetes and obesity. The new research suggests that two specific microRNAs (microRNA-27b and microRNA30c) block the production of proteins that are key to the storage of fats within the body. When fats cannot be properly stored they begin to build up in organs such as the liver, where they can cause damage that contributes to conditions such as Type 2 diabetes. The researchers believe that developing new drugs to target and regulate these two microRNAs might help to improve fat storage and open up new ways of fighting Type 2, without the side effects of existing medicines.

Research teams funded by Diabetes UK are also studying the role of microRNAs in

Fat cells with red-coloured fat drops relation to other aspects of diabetes.

For example, Professor Manuel Mayr and researchers at King’s College London recently completed a study of microRNAs in the blood of people with Type 2.

They have been using them as markers to see which are effective at predicting cardiovascular problems, such as heart attack and stroke. They hope that within 10 years, microRNA ‘fingerprints’ might

enable the design of a new blood test to identify those people with diabetes who require more intensive management and more frequent screening for cardiovascular complications.

Another study, at the University of Bristol, is looking at the role of microRNA in diabetes-related complications of the blood vessels that can lead to restricted blood flow to the arms and legs. Dr Costanza Emanueli and his team have found that levels of another microRNA (microRNA-24) are higher in cells lining blocked arteries and in legs that have to be amputated as a result of diabetesrelated complications. With funds from Diabetes UK, they are now studying whether bringing levels of microRNA-24 back to normal can promote the growth of new blood vessels in the legs and enable the blood supply to be recovered. If this research can provide insights on whether microRNA-24 is a suitable target for new therapies, it could have significant implications for the treatment of diabetesrelated complications.

UK BIOBANK OPENS TO RESEARCHERS After more than 10 years of preparation – UK Biobank, a secure database of health information on half a million anonymous volunteers, opened its doors at the end of March to scientific and medical researchers.

The bank began recruiting participants four years ago and has collated 20 terabytes of information (the equivalent of 30,000 CDs), on people aged 40–69, including 26,000 people with diabetes, 11,000 who have had heart attacks and 50,000 with joint disorders.

Each participant underwent measurements including height, weight, blood pressure and body fat; had their sight, hearing and fitness tested; supplied details of their lifestyle and medical history; and donated samples of urine saliva and blood for genetic testing.

The hope is that this anonymous data will help researchers at home and abroad

20 balance

to improve the prevention, diagnosis and treatment of conditions such as diabetes, cancer and heart disease.

“UK Biobank is a globally unique resource that places the UK at the forefront of the quest to understand why some people develop life-threatening or debilitating conditions,” said Professor Dame Sally Davies, England’s Chief Medical Officer.

“It has huge potential for future generations and will help us understand how our children and our grandchildren can live longer, healthier lives.”

Dr Iain Frame, Director of Research at Diabetes UK, said: “I anticipate that Diabetes UK will fund many projects that will use the bank to uncover information, increasing our chances of developing new approaches to prevention and treatment.”

Inside the automated urine freezer samples are kept at a frosty -80˚C

May – June 2012

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16/04/2012 17:04

Conference rewards Diabetes UK’s Professional Conference 2012 took place 7–9 March in Glasgow. Among the many research projects highlighted were the following two, focussing on Type 2 diabetes:

BMI and diabetes

CHEEK CELLS KEEP IMMUNE SYSTEM IN CHECK Researchers at Cardiff University have demonstrated that cells from the lining of the cheek have a powerful ability to suppress the action of the immune system and could potentially be used in therapies to prevent immune disorders, such as Type 1 diabetes.

Typically, the body’s immune system protects against infection and disease. However, when it malfunctions it can be harmful, for example in Type 1 diabetes white blood cells destroy insulinproducing cells in the pancreas.

Existing attempts to control the immune system have focused on

adult stem cells (such as those from the bone marrow) but now, a team led by Professor Phil Stephens has shown that cells obtained from the cheek are far more potent at inhibiting unwanted immune responses, even in low doses.

Dr Lindsay Davies, a member of the team, said: “At this stage, these are only laboratory results. We have yet to recreate the effect outside the laboratory and any treatments will be many years away. However, these cells are extremely powerful and offer promise for combating a number of diseases.”

TAKE PART IN RESEARCH Diabetes UK-funded researchers at Northumbria University are recruiting men with Type 1 diabetes aged 18–50 who are physically active and able to run on a treadmill for 45 minutes at a moderate pace. The researchers are studying the ways that blood glucose levels respond to reduced doses of insulin after exercise. Their work might help people with Type 1 to manage their blood glucose more effectively and reduce the risk of hypos [low blood glucose] after exercise.

Contact Matthew Campbell: 0742 9016 669; matthew.campbell@northumbria.ac.uk.

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

Contact Ian Boffey: 0797 711 9904; i.j.boffey@ncl.ac.uk.

A study for the Scottish Diabetes Research Network presented by Jennifer Logue of the University of Glasgow shed new light on the relationship between body mass index (BMI – a marker of body fat) and mortality rates among people with Type 2 diabetes.

Previous research has shown conflicting results on whether BMI is important in determining the life expectancy of a person with Type 2. Researchers on this study recorded the BMI of over 100,000 people at their time of diagnosis with Type 2 and linked this to overall mortality rates and mortality rates associated with specific causes. Overall, the mortality risk was higher among those with a BMI of 20–25 or 45–50 and lowest among those with a BMI of 30 (five points higher than that of the general public). These findings suggest that further research focussing on people with Type 2 who are underweight is needed.

Marker of mental decline

Markéta Keller, a PhD student at the University of Edinburgh, reported that interleukin-6 (IL-6, a molecule involved in inflammation) may act as a marker of the decline in cognitive function that sometimes occurs among older adults with Type 2. Her work derives from the Edinburgh Type 2 Diabetes Study, which is investigating the effects of various risk factors on cognitive impairment in this population.

IL-6 was measured in more than 1,000 adults aged 60–75, who were also assessed on seven measures of cognitive function, including memory and fluency of speech. The tests were repeated four years later. Raised levels of IL-6 were associated with a decline in non-verbal reasoning, which reduces a person’s ability to problem solve and therefore has an impact on their day-to-day life. Ms Keller said: “Further research is needed to see whether IL-6 causes cognitive decline or is merely associated with it. Analysis of a number of other inflammatory markers measured in the Edinburgh study is ongoing.”

May – June 2012 balance 21 20-21 Research Matters.indd 21

16/04/2012 17:04

Science and society Discoveries of diabetes genes and medical treatments may grab the headlines, but social and psychological research can be just as important for health and wellbeing, argues Dr Richard Elliott

T

he mainstream media often describe diabetes as if it were a single health condition, caused by one gene or one social problem (such as obesity) that might easily be cured with a single scientific ‘breakthrough’. But, as many people with the condition are aware, the truth is more complicated. There are various types of diabetes (Type 1 and Type 2, gestational, Maturity Onset Diabetes of the Young and others), and

22 balance

while raised levels of blood glucose defines them all, they each have somewhat different causes, contributing factors and complications. It’s therefore no surprise that the research targeting diabetes is as diverse as the condition itself.

Three Diabetes UK researchers discuss their research into the social, psychological and behavioural issues that people with diabetes experience, and explain what they hope to achieve…

May – June 2012

26-29 FEAT Science and Soc Colour.indd 22

16/04/2012 16:06

feature

Home or hospital for kids with Type 1?

Often when a child is diagnosed with Type 1 diabetes, they are admitted to hospital for anything from a few days to a few weeks in order to receive initial treatment for the condition. However, over the last 25 years this has started to change, with some studies suggesting that it might be better for children who are healthy (apart from their diabetes) to receive initial care and support in their own homes after visiting hospital as outpatients. Accordingly, initial care can be variable, with some units admitting all children diagnosed with Type 1 and others trying to keep them out of hospital. As yet, there is limited evidence to suggest that home care is the best strategy, and further research is needed to ensure that parents and healthcare professionals can make informed decisions.

To fill this gap, Dr Lesley Lowes and Professor John Gregory at Cardiff University are using a randomised controlled trial (the ‘gold standard’ for evaluating care) to see whether a home or hospital approach is better for children in the long term. Dr Lowes, who became a diabetes specialist nurse in 1995, explains her involvement and the need to support parents and children, allowing them time to come to terms with diabetes: “I’m a mother and I saw how distressed parents were at diagnosis,” she says. “I wondered over time whether we were doing the right thing by treating children at home.

Was this the right thing for parents?

“In all those parents, although they were quite scared to go home, most of them appreciated the fact that they had gone home. They were not left on their

own to get on with it because we were at the end of the phone, and I would visit them at home 2–4 times a day for the first three days. As a result, they felt that they were able to take control of their child’s condition – it made them feel able to cope.”

The study began in 2007 and, so far, the researchers have recruited 203 children over the age of 8 who have Type 1 diabetes (plus their parents) to receive either home or hospital care following diagnosis. The best approach

higher among Black people than in people of White European origin.

However, the exact reasons for these differences are unclear. Dr Emily Williams is using a four-year Diabetes UK Moffat Charitable Trust Travelling Fellowship to study these variances with experts at Monash University and the Baker International Diabetes Institute in Melbourne, Australia. Using data from AusDiab, one of the world’s largest studies of the natural history of diabetes in a large population,

By identifying the risk factors that promote social and ethnic inequalities in diabetes, such variances can be reduced will be determined by exploring the children’s experiences and comparing their diabetes knowledge, psychological adjustment, satisfaction with the care provided, and their health and wellbeing two years down the line. The costeffectiveness of the two approaches will also be assessed, which could impact decisions made by the National Institute for Health and Clinical Excellence (NICE), the regulator of treatments used in the NHS. “It is a very important study that will inform practice and policy,” says Dr Lowes. “Currently, recommendations such as the NICE guidelines say children should be treated at home wherever possible, but they’ve got no evidence to back that up. For example, if we find that parents and children have found hospital better and their outcomes are not significantly different after two years, then that’s what NICE would hopefully take into account. That would be evidence based, whereas I think a lot of the work we currently do in diabetes care is not.”

Dr Williams’ work explores risk factors for Type 2 diabetes such as diet, an inactive lifestyle, stress, smoking and alcohol use, which vary according to ethnicity and levels of social deprivation.

Dr Williams emphasises the importance of learning about social, economic and psychological factors associated with Type 2 in order to help people who have or are at risk of developing the condition. She hopes that by identifying the risk factors that promote social and ethnic inequalities in Type 2, such variances can be reduced.

“It tends to be that people living in more deprived areas have reduced access to safe areas to walk, fewer physical activity facilities, perhaps a higher prevalence and density of fast-food outlets,” says Dr Williams.

“These are structural aspects of our

»

Inequalities in Type 2 risk Around the world there are social, economic and ethnic inequalities in rates of Type 2 diabetes. In the UK, for example, the risk of developing the condition is 4–6 times higher among South Asian people and 2–3 times

May – June 2012 balance 23 26-29 FEAT Science and Soc Colour.indd 23

16/04/2012 16:06

H3684 C

feature environment that really predispose people to an increased risk of abnormal glucose metabolism.

“It is really important that we study people’s experiences of diabetes because that’s what really matters to people with the condition. Perhaps clinicians focus a little bit too much on the management of diabetes symptoms and blood glucose, rather than actually thinking about how people have to manage it on a day-to-day basis.

“I think that if GPs and diabetes specialists develop a greater awareness of other aspects of our social and emotional health, they will become more in tune with picking up risk factors either for Type 2 or diabetesrelated complications in those who already have the condition.

“It would be great if healthcare professionals were able to allocate a little more time to listening to the person talk about their experience.

That might not be something that’s just around the corner, particularly in the current economic climate, but I think it is something that hopefully will start to become part of the support system for people with Type 2 and those at risk.”

A pre-pregnancy tool for diabetes Most women with Type 1 and Type 2 diabetes are able to have healthy babies as long as they can achieve good control of their blood glucose before they become pregnant and during early pregnancy. Accordingly, if they have diabetes, women are advised to plan and prepare for pregnancies in advance.

24 balance

Unfortunately, only a third of women currently receive the recommended pre-pregnancy care – a lack of awareness about reproductive health and the importance of planning for pregnancy may be one reason why.

Dr Valerie Holmes and her team at Queen’s University Belfast are currently in the third year of a five-year project

into a website to make it accessible to as many women as possible.

Dr Holmes concludes that “this kind of research is very important as it brings basic science closer to healthcare professionals. We can give them information and, more importantly, evidence so that they can use new treatment tools within their everyday

Perhaps clinicians focus a little bit too much on the management of diabetes symptoms and blood glucose, rather than actually thinking about how people have to manage it on a day-to-day basis to design, test and evaluate a novel way of engaging with women with diabetes who are planning to become pregnant.

Their aim is to provide women with guidance about pre-conception care and to help raise awareness of the importance of reproductive health issues for all women with diabetes.

Dr Holmes and her team used discussion groups to explore the knowledge, needs and experiences of women with diabetes related to preconception care. “While women with diabetes were aware that they needed to plan for pregnancy, they often didn’t understand why it was important,” says Dr Holmes. “Perhaps this lack of understanding resulted in the poor uptake of planning. We also found that women wanted to receive guidance about pregnancy in a motivated, positive and supporting manner.”

To achieve this, the team put together an interactive DVD to enable women to manage their condition more effectively and seek advice on planning pregnancy.

“With the DVD we’ve been able to use a ‘real lives’ approach, where women with diabetes appear in a documentary style,” says Dr Holmes. “They tell of their experiences and we follow some of them through their pregnancies.

It’s been a very useful medium to allow women to have peer support, if you like, from others in a similar situation.”

The DVD is now being used by diabetes consultants in Northern Ireland and the researchers want to evaluate its impact on diabetes care.

They have also converted the DVD

roles and provide better care. It’s also essential to evaluate these new tools in the community for which they are intended, to assess their effectiveness.

I feel that this sort of research can extend from smaller projects to even the reorganisation of diabetes care, ultimately improving things for patients.”

Ba

R

The value of diversity Many Diabetes UK research projects explore a similar range of social issues to those outlined here and the charity is committed to incorporating the experiences of people with diabetes at all stages of the research process.

Dr Iain Frame, Director of Research, says: “We are proud of the diversity of our research programme and recognise that there are many different approaches by which research can help to improve the lives of people with diabetes. Studies that look for ways to prevent or even cure diabetes with new drugs or devices are important but can take a long time to reach patients and are only one part of the solution. Studies that focus on the social, educational and psychological issues that people with diabetes experience every day are a vital component of our aim to achieve a future without diabetes and its complications.” i For more on Diabetes UK’s research programme, visit www.diabetes.org.uk/research.

• To find out more about Dr Holmes’ internet resource for women with diabetes, visit http://go.qub.ac.uk/womenwithdiabetes.

• For Diabetes UK’s pre-conception and pregnancy information, visit www.diabetes.org.uk/pregnancy.

May – June 2012

26-29 FEAT Science and Soc Colour.indd 24

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16/04/2012 16:06

Steel going strong M

ovies rarely represent people with diabetes, but when the condition is built into the plotline, the line between what is an accurate portrayal of diabetes and what is exaggerated for dramatic effect can sometimes become blurred.

But it’s the movies – isn’t that meant to happen? The trouble is, diabetes, in all its forms, is often misunderstood, which can be frustrating when it’s thrust into the limelight and misinterpreted.

So, should we be concerned about the portrayal of diabetes in Steel Magnolias?

Released in 1989, it is perhaps one of the most memorable films in which diabetes is portrayed. It is a story about the lives and friendships of six women in a small town in Louisiana, USA, which revolves around Shelby, who has Type 1 diabetes and suffers devastating consequences after the birth of her child.

Despite her mother worrying that her diabetes would give her problems when carrying a child, Shelby becomes pregnant.

26 balance

Photos: Paul Coltas

As Steel Magnolias tours theatres, Angela Coffey meets playwright Robert Harling to find out the true story behind the 1980s script, and looks at how diabetes care has since come a long way

She gives birth to a baby boy but, a year later and after receiving a kidney donated by her mother, she dies.

While this can make for uncomfortable viewing, it’s important to remember the advances in diabetes care since then.

The story is primarily about the strength and unbreakable bonds between the characters, which is told with humour and witty dialogue. And the diabetes plot isn’t there to create drama – the events are real.

A way of coping Robert Harling, then an aspiring actor, penned Steel Magnolias as a short story in 1986, as a way of coping with the death of his 32-year-old sister, Susan, who had Type 1 diabetes. It developed into a play in 1987 and has since been performed worldwide in 25 different languages.

The hit movie adaptation starring Julia Roberts and Dolly Parton came two years later, and Robert was keen

to include humour to cope with the seriousness of the storyline. He also insisted that viewers were given a real insight into what his family went through, and even cast some of the hospital staff who treated Susan to play their real-life roles.

While the film involves many characters and locations, the play takes place with just the six females (see box, above right) and is set solely in Truvy’s beauty salon, where the women regularly meet.

So are all the characters based on real people?

“Everyone is based on someone I knew in my youth. The great joy is finding that every woman in town thinks one of the characters is based on them. But I’ll never tell…”, says Robert.

“And, being theatre, every new production, every new cast makes it a fresh experience. It’s always exciting to see a new interpretation.”

May – June 2012

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16/04/2012 16:07

feature Getting it right Before the current British version opened in Bath on 3 April, Diabetes UK’s Clinical Advisor Libby Dowling was invited to rehearsals. The cast and crew were keen to make sure that they were correctly portraying Shelby’s severe hypo [low blood glucose] at the start of the play, which she recovers from after drinking some orange juice provided by the others. Had they got the scene right?

“Obviously, everyone’s experiences of a hypo are different,” says Libby.

“But Sadie Pickering (Shelby) had, along with the rest of the crew, clearly done her research.”

Hypos aside, should we be concerned that people could think that women with diabetes can’t cope with pregnancy?

“It’s important to remember that the play is set more than 25 years ago – the set is a clear reminder – and we’ve seen massive changes in this time,” says Libby. There have been significant advances in diabetes knowledge and treatments, and with the right care and planning, thousands of women with diabetes go on to have children with no devastating consequences.”

So, what’s changed? “We now understand the importance of prepregnancy care. National Institute for Health and Clinical Excellence (NICE) guidelines for women with diabetes were only introduced in 2008. They state that before conception, or as soon as a woman becomes pregnant, she should have renal (kidney) and retinopathy (eye) screening to check for any potential problems.

Pregnancy Maternity units are working with diabetes centres to provide the best care possible. If you have diabetes and are thinking of becoming pregnant, it is vital that you ask your diabetes care team for pregnancy planning advice. i For more on pregnancy, including preconception video, Rebel, rebel, visit www.diabetes.org.uk/pregnancy.

Meet the cast Anelle: Truvy’s eager new assistant (Kacey Ainsworth) M’Lynn: social leader and mother to Shelby (Isla Blair) Ouiser: the rich curmudgeon (Cheryl Campbell) Clairee: an eccentric millionaire (Cherie Lunghi) Shelby: preparing for her wedding and has Type 1 (Sadie Pickering) Truvy: owns the beauty salon (Denise Welch) Main picture: Steel Magnolias is currently touring theatres and opened to a packed audience in Bath at the beginning of April; Top: Clairee and Truvy; Bottom: Anelle “Women who are planning a pregnancy will also be prescribed higher-than-normal-strength folic acid and certain medications may be stopped. We also now know that high blood glucose levels can damage the developing foetus. Back then there weren’t any blood glucose meters or insulin pumps and the main insulin used was animal insulin – we now have such a wider choice in terms of monitoring and treatment.

“Essentially, it’s all about planning a pregnancy. Maternity units are working with diabetes centres to provide the best integrated care possible.”

Robert agrees: “There have been tremendous strides in treatment. My hopes and prayers are that people are spared the fate of my sister. But all cases are different. My sister’s situation was particularly fragile.”

More to be told “It’s every playwright’s hope that one’s work touches and informs the audience,” says Robert. “Reactions over the years have made me realise this happens with

this play. I’ve heard so many personal stories from people with diabetes.”

Steel Magnolias celebrates the value of friendship and love, which makes the play truly touching. And with a film remake in production – this time with a cast of African-American women, starring Queen Latifah – it’s a story that’s set to be told for some time.

“For me and my family, Steel Magnolias exists as a celebration of an extraordinary woman’s life. The fact that Susan lives on through the telling of her tale thrills us. It was so wonderful to be reminded of that while watching the production now touring the UK. It was my idea to do [the remake] with an AfricanAmerican cast. But I’ve only been involved as an enthusiastic fan and can’t wait to see it!” i If you have been affected by diabetes and pregnancy, and would like to talk to a trained counsellor, call Diabetes UK Careline on 0845 120 2960 or email careline@diabetes.org.uk.

• All people with diabetes should receive the annual checks and services they are entitled to – visit www.diabetes.org.uk/15-essentials.

May – June 2012 balance 27 26-27 FEAT Steel Magnolias.indd 27

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16/04/2012 12:14

splash

Diabetes UK has Olympic approval as British Breastroke champion Kate Haywood (right) backs the charity’s latest sporting challenge

I

Photo: © SWpix.com

Make a

f you haven’t already heard about Swim 22, it’s Diabetes UK’s fundraising challenge that requires people to swim the length of the English Channel (22 miles/35km) in the comfort of their local swimming pool, individually or as part of a team, any time between 22 April and 22 July.

At the launch event on 22 March, volunteers and staff took to the local baths to complete the distance in one day – and Kate Haywood, 24, who’s preparing to compete in the women’s 100m Breaststroke in the London 2012 Olympics, got the team off to a sure start by swimming the first 50 lengths.

She talks to balance about why Swim 22 is one to champion.

When did you realise your Olympic potential?

It’s great you’re supporting Swim 22 – why did you get involved?

at the age of 15, picking up a silver medal for the 4x100m Medley, and then went on to the 2008 Olympics in Beijing, which was a life-long dream.

Swimming is such a good way to stay fit and healthy, and it’s great to be a part of this 22-mile challenge to raise awareness of diabetes. I spend hours in the pool each week and I love it!

e

I was pretty good at swimming from a young age and when I was 7, on holiday with my mum and dad, I joined a swimming club. I was about 12 when I competed at the Youth Olympic Games [Kate won the 100m Breaststroke] and it went on from there. In 2006 I competed in the Commonwealth Games in Melbourne

You don’t have to be an athlete to reap the rewards

What are you most proud of?

In 2003 I won the BBC Young Sports Personality of the Year, aged 16, which was amazing – Wayne Rooney won it the year before! Apart from that it’s qualifying for the Olympics twice – I’m so excited about competing in the London Games!

What’s your training regime?

Channel challenge: Kate (centre) with the volunteers who completed all 22 miles in 4hrs and 45mins. Youngest swimmer 10year-old Zak Maddison-Roberts (bottom left), swam 150 lengths out of a total of 1,160

Every week I do about nine pool sessions, three weight sessions, a pilates class and either a bike ride or a run. As a big event nears, like the Olympics, I’ll probably do up to two hours in the pool every day, but three weeks before I taper off to eat well and rest.

Obviously, you’re very fit – what healthy lifestyle advice would you pass on?

That it’s important to be as active as you can, to eat plenty of fruit and veg, and to not indulge in chocolate and sweets every day! It’s important to be good to yourself most of the time but it’s OK to treat yourself, too – I like a coffee and a piece of cake on a Saturday afternoon.

So, what’s the most and least healthy food in your fridge?

Lots of salad – mainly tomatoes and lettuce. And least healthy has to be chocolate – I love Cadbury’s Dairy Milk!

What advice would you give to people who would like to get into swimming for fitness?

It depends on a person’s age. As a child, join a swimming club. As an adult, find time in the week to go to your local pool and swim on a regular basis. You don’t have to be an athlete to reap the rewards that swimming can offer!

We’ll be cheering you on at the Games, Kate – good luck! i For more on Swim 22, visit www.diabetes.org. uk/swim22. • Find out more about Kate Haywood at www.katehaywood.com.

May – June 2012 balance 29

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16/04/2012 12:14

feature

Author and journalist Robin Healey wasn’t aware that Type 2 diabetes could run in the family until he was diagnosed in 2007.

Then it all made sense.

His uncle, Labour politician Denis Healey, has the condition and so, he suspects, did his late father

M

In the family

embers of my family tend to be deniers. Or at least, we play things down. When my father had his first stroke at the age of 74 in 1994, he announced it calmly over the phone a few minutes after the event, as if it was a bad dose of flu. After his second stroke, not long afterwards, he ended up semi-paralysed and passed away four years later.

Although we are not a very close family, the fact that my uncle Denis had been living with Type 2 diabetes for three years came as a complete surprise when I found out, quite by chance, in 2005 from my cousin. Looking back, it all fits the family dynamics. Health problems were seldom, if ever, discussed.

We kept such things to ourselves, and most of my conversations with Denis revolved around British art, photography, or the poetry of the 1930s. Back then, I knew nothing about diabetes – I didn’t even realise there were different types.

I wasn’t aware that with Type 2 in my family, I was at increased risk of developing it. However, when I was diagnosed with the condition in 2007, aged 55, everything fitted into place.

30 balance

Pieces of the puzzle I began to speculate on the cause of my father’s sudden stroke after a life of pretty good health. Although I was aware that his sedentary lifestyle and incredibly unhealthy diet – he was hooked on pies and lard sandwiches – were strong factors, I never saw his constant thirst, lack of energy and frequent need to pee as indicative of diabetes. Not knowing the first thing about the condition, I was unable to link these symptoms. Had my father been more forthcoming about his health, or had I been a little more curious (I didn’t even question all the tablets he gobbled down), I might have been able to help him with his diet. I could have discovered more about the genetic aspect of Type 2 diabetes and, as a result, could have taken steps to curb my own unhealthy habits. I could have linked the motorcycle tyre developing around my waist with my love of fried food, sweets and biscuits. I could have cut down the three or four cooked breakfasts I ate every week to the one a week that I cook today. Before my diagnosis I had chronic digestive

problems, which coincided with two bouts of kidney stones for which I needed hospital treatment. I was also getting bronchial infections that lasted for weeks, yeast infections, fatigue, and was drinking far too many sugary drinks.

Knowing what I know now, I would have realised that diabetes was the underlying cause.

Today, my digestive problems have disappeared, and although I have since been diagnosed with obstructive sleep apnoea, which my father also had, and which is linked to diabetes, I feel healthier than I did five years ago, and my weight has stabilised to just under 14 stone (89kg); I am 5ft 11in (1.5m).

More significantly, I am aware of the risks to which I am exposing my body when I am tempted to depart from my largely healthy regime.

Denis & diabetes Denis was diagnosed with Type 2 in 2002, aged 84, 22 years after leaving the government. It came quite out of the blue for him: “I had felt ill with a chest complaint and had gone to the clinic at Eastbourne. There the doctor did some

May – June 2012

30–31 FEAT DenisColour.indd 30

16/04/2012 14:47

feature

Childhood memories (main picture): Denis (top left), Robin (top row, second from right) and his father (top right).

Above (from top): Denis in 1945; Robin’s late father, aged 59; and Robin, in 1982, at his first book signing

blood tests and after a while I was told metformin tablets a day, Denis no longer that I had diabetes. At the time this takes any medication. unexpected bad news had quite a big “I know, of course, that diabetes is a impact on me,” he confesses. “I was lifelong condition, but I’ve been told that admitted to hospital at Eastbourne and my blood sugar levels are totally under was given an antibiotic for my chest, control,” he says. “If I do feel a bit unwell and also metformin [for my diabetes].”

I will visit the doctor. I’ve no complaints Denis says he didn’t make any about my treatment but I hardly need changes to his diet after his diabetes any. I’ve had no trouble for four years.” diagnosis, which surprises me, This came as another surprise, though considering that he appeared I am aware that the older you slimmer. Chancellors of the are when diagnosed, the less Exchequer seem prone to By sharing damage diabetes will have putting on weight (one thinks on your body. My information inflicted of the increased girths of father, I suspect, had been on symptoms, suffering from the condition Lawson, Lamont and Brown) – undoubtedly the consequence for a decade or more before his family of frequent functions where stroke at the age of 74. I was members can diagnosed at a younger age, rich food and copious amounts of alcohol are freely available which suggests that good help each – and my uncle, who had been is even more important other to cope control slim until taking up this post in for my own health. Of course, with the 1974, was no exception.

Denis too could have developed Perhaps it’s the exercise diabetes many years before condition he gets that keeps his weight, diagnosis, but I’ll never know and his diabetes, under control. and he’s not saying. What is While he used to explore the certain is that today, with his stunning East Sussex countryside, his 95th birthday only months away, he age has finally caught up with him. But seems to be in respectable health. he has a swimming pool, which he still The more I read about the genetic uses regularly. “I swim every day starting factors of Type 2 diabetes, the stronger in early spring,” he reveals, “but apart I feel that by sharing information on from strolling around my garden, symptoms, family members can help walking is a thing of the past. I don’t suffer each other to cope with the condition. from arthritis, thankfully. It’s more to Diabetes should bring families together; do with a lack of puff. I’m just a clapped too often people are left to cope alone. i Turn to page 37 for ‘Relative risk’, which takes out old fart nowadays,” he laughs.

It’s certain he’s doing something right, a closer look at diabetes in the family. • For more on Type 2, visit www.diabetes.org.uk/type2. because while I gobble down 1,000mg of

A distinguished career Born in 1917, Denis had a brilliant career at Bradford Grammar School and an equally distinguished one at Balliol College, Oxford, where he obtained a double first in Classical Moderations.

He was offered a fellowship in philosophy at Merton College, which he declined in favour of fighting Hitler. He saw action in North Africa, was beach-master at Anzio (for which he received an MBE), and retired with the rank of Major.

After marriage in 1945 to fellow Oxford graduate Edna Edmunds, he spent seven years in the International Department of the Labour Party, ending up as Secretary, before being elected

as member for Leeds SE in 1952. In the cabinet of Harold Wilson he served as Secretary of State for Defence and in 1973 became Chancellor of the Exchequer.

In the era of Margaret Thatcher, Denis served as Shadow Foreign Secretary, and narrowly missed being elected Leader of the Opposition. He left the Commons for the House of Lords in 1990, assuming the title Baron Riddlesden, after his childhood home in Yorkshire. In the same year he published his autobiography, The Time of my Life, which was widely admired. The death in 2010 of his devoted wife Edna was a savage blow. He still lives in East Sussex, surrounded by 16,000 books, and is still avidly sought after as a commentator on foreign and economic policy.

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16/04/2012 14:47

DIABETES

WEEK

2012

MAKE A CONNECTION

MAKE A CONNECTION

10–16 June

SOM EONE WHO GETS WHAT HE’S

This year’s Diabetes Week is shaping up to be bigger and better than ever before. And there are plenty of ways for you to get involved…

W

hen you have diabetes, making a connection with the right person can be a life-changing moment.

Finding someone who can give you a clear answer, someone who’ll put you in touch with others, someone who can advise you on what to eat or just someone who knows what you’re going through can make all the difference when living with diabetes.

This year, Diabetes Week – Diabetes UK’s annual awareness and fundraising campaign – is highlighting these connections and helping people to find that ‘someone’. With the theme ‘make a diabetes connection’, the campaign runs from 10–16 June and aims to connect more people affected by diabetes both with each other and with the support that Diabetes UK provides. The charity is also calling on parents, families, carers, colleagues and the general public to get connected and get involved with the campaign.

One person who is already right behind Diabetes Week is Coronation Street’s Sue Cleaver, who plays Eileen Grimshaw. The soap star said: “I understand the seriousness of diabetes, and know how important it is to let people know that Diabetes UK is here to provide support along the way.

“So, for Diabetes Week, I’ll be hosting my own tea party to raise funds and awareness, with my friends and family and maybe some colleagues from the cobbles. I hope you’ll join me in doing the same!” So, how can you get involved?

32 balance

GOING THROUGH Diabetes UK offers a range of services to support young people living with diabetes. To join today, call 0845 123 2399, or learn more about our support services at diabetes.org.uk

Time to party By throwing a party with family, friends, neighbours or colleagues, you’ll raise both awareness of diabetes in your area and valuable funds to support Diabetes UK’s work.

Whether it’s inviting friends for an afternoon tea party with cucumber sandwiches and scones, or organising a kids’ party with jelly and ice cream, the main thing is that you’re bringing people together. By charging for entry, or selling treats to eat, you’ll help to make a difference to millions of people affected by diabetes.

DIABETES

WEEK

2012

EONE SOM WHO’LL PUT ME IN

Small change, big difference A fun and easy way to support Diabetes UK, you simply fill the coin box with spare change in the run up to and during Diabetes Week.

You can also get creative with how you choose to collect the coins – see box, right, for the balance team’s ideas.

A coin box is included with this issue of balance, and you can return your donation with the reply form included with the July/August 2012 edition.

Raise awareness Displaying posters (pictured) in your local community in the run up to and during Diabetes Week is a fantastic opportunity to raise awareness about diabetes and the services Diabetes UK provides. There are 2.9 million people in the UK already diagnosed with diabetes and an estimated 850,000 people living with Type 2 who don’t yet know it – and we can help them.

A MAKE CONNECTION

TOUCH WITH OTHERS

Diabetes UK offers a range of services to support people affected by, and at risk of, diabetes. To join today, call 0845 123 2399, or get to know about our voluntary groups at diabetes.org.uk

Top coin box tips

1 2 3

Don’t use public transport for a day – walk or cycle if you can – and drop your bus fare into the coin box instead.

Every time you utter a swear word (if prone to doing so!), pay a fine.

Give that sofa a well-earned vacuum and rehouse the lost pennies in your coin box. i Any better ideas? Tell us at balance@ diabetes.org.uk. • Don’t forget that to qualify your coin box donation for Gift Aid, all the money must come from your own pocket.

May – June 2012

32-33 FEAT DUK WEEK Colour.indd 32

16/04/2012 11:33

feature Add to that a further 7 million people who are at high risk of Type 2 diabetes and you can see why it’s so important to raise awareness.

Attend an event Diabetes UK has volunteers and voluntary groups across the UK, and many will be holding a Diabetes Week fundraising event. So you can either find an event in your area, or organise your own (see end info).

Add a Twibbon Show your support on Twitter. Add a small icon (a Twibbon), to your Twitter avatar (profile picture) to help promote Diabetes Week 2012 to your followers.

Simply follow @DiabetesUK to find out how to take part.

on providing the Advocacy Service to help people understand their rights relating to all aspects of living with diabetes, and further develop its Peer Support scheme, which is a support network for people affected by diabetes.

The money raised will help Diabetes UK continue to run a programme of events for children and families, where people living with diabetes can connect with one another and receive advice and support from healthcare professionals.

Your support will also give people with diabetes the opportunity to influence the provision of health services in their area through the Diabetes Voices programme, and fund pioneering research worth more than £20m in the next five years.

There are 2.9 million people in the UK already diagnosed with diabetes and an estimated 850,000 people living with Type 2 who don’t yet know it – we can help them Barbara Young, Chief Executive of Diabetes UK, said: “2012 is proving to be an exciting year for the charity as we continue to put Diabetes UK on the map and push the issue of diabetes onto the national agenda.

Diabetes Week is another great way to show your support and really wake the nation up to the big health challenge we all face.”

YOUR LOCAL OFFICES CONTACT DETAILS

DIABETES

Northern & Yorkshire

Sterling House, 22 Cuthbert’s Way, Darlington DL1 1GB Tel 01325 488606 Email northyorks@diabetes.org.uk

WEEK

North West

First Floor, The Boultings, Winwick Street, Warrington WA2 7TT Tel 01925 653281 Email n.west@diabetes.org.uk

How will my support help?

South East

Blenheim House, 1Blenheim Road, Longmead Business Park, Epsom KT19 9AP Tel 01372 720148 Email south.east@diabetes.org.uk

i To order a Diabetes Week pack, which includes everything you need to raise

Victoria House, Victoria Street, Taunton TA1 3FA Tel 01823 448260 Email south.west@diabetes.org.uk

Eastern

Ground Floor, 8 Atlantic Square, Station Road, Witham CM8 2TL Tel 01376 501390 Email eastern@diabetes.org.uk

money and awareness, visit www.diabetes.org.uk/diabetesweek or call 0800 585 088 and quote reference number 5692. • Don’t forget to let Diabetes UK know what you’re up to during Diabetes Week – email diabetesweek@diabetes.org.uk.

Midlands

1 Eldon Court, Eldon Street, Walsall WS1 2JP Tel 01922 614500 Email midlands@diabetes.org.uk

London

Macleod House, 10 Parkway, london NW1 7AA Tel 020 7424 1116 Email london@diabetes.org.uk

Scotland

The Venlaw, 349 Bath Street, Glasgow G2 4AA Tel 0141 245 6380 Email scotland@diabetes.org.uk

Northern Ireland

Bridgewood House, Newforge Business Park, Newforge Lane, Belfast BT9 5NW Tel 028 9066 6646 Email n.ireland@diabetes.org.uk

Cymru

Argyle House, Castlebridge, Cowbridge Road East, Cardiff CF11 9AB Tel 029 2066 8276 Email wales@diabetes.org.uk

Code: 5692

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

Diabetes UK will be able to continue to make more connections through its work. For example, the charity will be able to continue to run its free and confidential helpline, Careline, carry

PACK

South West

www.diabetes.org.uk

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16/04/2012 11:33

Photos: Matthew Jones

Photos: The Adventurists

running head

The

Adventurist Thrill-seeking stuntman Olly Rowland (right), 23, loves an adventure. But how did he manage his Type 1 in -40°C, while racing an old motorbike in the Arctic? Fresh from the challenge, Olly explains how his diabetes was the thing that caused the least trouble...

M

y general approach to life is to get on with it. If bad things happen, you just need to crack on as best you can. This was my outlook when I was diagnosed with Type 1 diabetes, aged 17. And when the hospital doctor said I should give up my dream of becoming a stuntman, as it wasn’t ‘a feasible career for someone with diabetes’, I was determined to prove him wrong. Thankfully, I had the diabetes specialist nurses on my side – they said diabetes doesn’t need to stop anyone from doing anything as long as they keep on top of it. They were right. I adapted my lifestyle to deal with diabetes by testing and injecting accordingly – nothing else in my life changed.

34 balance

Action man I’d decided I wanted to be a stuntman when I was 14, and so, as all my mates got ready for university in 2008, I arranged to spend a day with the stunt team on the set of Wolfman, to see what goes on. I was hooked. After that, I helped out the stunt and horse department on the set of Robin Hood, where I learnt sword fighting and appeared in large stunt scenes, and in 2010 I worked on Warhorse and then Captain America, which got me my first stunt credit – I was hit in the face with Captain America’s shield and sent flying into a wall.

Last year, I worked on Snow White and the Huntsman, which involved sword fighting on horseback – it was amazing. It was just as filming was

coming to an end that Tom, who runs The Adventurists – a company that organises new adventures ‘to make the world a little less boring’ – asked if I wanted to test his latest idea. I had first met Tom in 2009, when I drove from London to Mongolia in a 1972 Hillman Imp for The Adventurists’ Mongol Rally. His new adventure involved riding a classic Russian Ural motorbike (with side car, see above) some 2,500km (1,533 miles) up frozen ice roads from Irbit, in Siberia, to Salekhard, the only town sitting on the Arctic Circle. I couldn’t say no, nor could my friend Rob Mills, and so we formed ‘Team Numb Nuts’.

Along with 10 other teams of two, we were taking on a challenge that we weren’t even sure was possible

May – June 2012

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16/04/2012 14:41

Photos: The Adventurists

feature – we had two weeks to find out. It would be cold, dangerous and tough, but we weren’t just doing it for the thrill – Rob and I were aiming to raise at least £2,000 for Diabetes UK and Cancer Research UK, two charities that mean a lot to us.

Getting ready

During the Ice Run we would be battling temperatures as low as -40°C and could subtract another 40°C for wind chill. I put a lot of research into the clothing and equipment we needed, but I didn’t do much cold-weather training, unlike some of the others who jumped into freezing lakes. But I did go to Moscow, where it was -15°C, a few days before the trip started, to help me acclimatise.

My main concerns were bear or wolf attacks, falling through the ice, my insulin freezing, my insulin pens or cartridges cracking and the needles either snapping or, as they would be cold metal, getting stuck to, or in, my skin. I decided to take plenty of pens and cartridges just in case. My girlfriend wrapped each one in bubble wrap to help insulate and protect them. I then put them in the inside pocket of my inner coat — most of the time I’d be wearing three.

Off to a rocky start On arrival in Irbit, I was so excited.

We picked up our bikes, supplied

by The Adventurists, and practised riding on ice and snow. I’ve ridden a motocross bike since I was 17, but this was completely different. We named our bike ‘Battersea’ as she was an ‘old dog’. The bikes weren’t fit for the task, which made it even more of an adventure.

Our friends Nick and Mark formed team ‘Guinea Pig’. We decided, at the last minute, to stick together so if one bike broke down the other could tow it.

And so team ‘Numb Guinea Pig Nuts’ was born.

The first four days were the most eventful as things went horribly wrong.

Battersea broke down just 5 miles (8km) from the start line, and while

we finally got her going again, it was a taste of things to come.

On day two we took a wrong turn and headed into a life or death situation without even knowing it.

We were on a forest track that, we later learnt, has been out of action for 20 years. We hardly covered any ground for three days as the road was so bad. By day four, both bikes had broken down and we were nearly out of fuel and food – each bike had half a tank of petrol left and we had two camp meals between us. With no phone signal, we were worried.

Then, as if our wishes had been answered, a truck appeared and three Russians jumped out. They were engineers and had been fixing a telephone mast (I think that’s what they said). We explained our problem as best we could and they whipped out their battery – they jumped Guinea Pig’s bike with ease but couldn’t get Battersea going.

As the Russians were going in our direction, we cheekily persuaded them to tow us to the next town, 18 miles (30km) away. Rob and Nick got in the truck; Mark jumped on his bike to follow; and I was towed on Battersea.

By day four, both bikes had broken down and we were nearly out of fuel and food...

With no phone signal, we were getting worried The road was horrendous and Mark got stuck, again and again.

Eventually, one of the Russians who owned a Ural took over. He was amazing, ploughing down the track as if he was on a regular motocross bike. We were making good progress when I suddenly saw the truck lean to the side at a 60° angle, and almost roll. It was the angle of the track. I held on and tried to steer through, but the bike flipped with the side car going over the top of me. I couldn’t bail easily due to the jagged rocks on my left. And when the bike

Opposite: Olly (right) and Rob with ‘Battersea’; Top: The Adventurists; Below: Olly (right) with Mark, camping landed on top of me, my boot got stuck between the engine and the shin guard. I was dragged under the bike (it was still being towed), for several metres before I kicked my foot free. My leg got quite smashed up but I was lucky that my ankle didn’t snap. After that, Mark took over being towed. It wasn’t the most enjoyable part of the trip!

On the right track Once back on the right route, our days went by relatively smoothly.

We would set off about 9am and stop riding about 7pm, although a few times we rode until midnight to make more progress. Off-road riding for up to 12 hours a day was a fair challenge. At night we couldn’t see the road 10m ahead so would often fly several feet in the air and land with a slam, which really took its toll.

We had two nights in hotels but otherwise camped. The inside of the tent would freeze solid – but once we were in our sleeping bags it wasn’t too bad. Getting out of them the next morning was the hardest part – it was like jumping into a frozen lake.

Rob and I took it in turns to sit in the side car, which wasn’t too bad

»

May – June 2012 balance 35 34-36 FEAT Arctic_Final.indd 35

16/04/2012 14:41

running head feature wise. The scenery was » comfort incredible – vast stretches of open nothingness or thick, snow-covered woodland. There were bears and wolves around but we didn’t see any.

Everyone we met on our trip was so helpful, stopping to help if our bikes broke down. It’s a way of life there – if you don’t stop and help someone, they will most likely die.

Sub-zero diabetes

A typically beautiful Siberian sunset

early like some teams, and that we got lost for three days, otherwise we We crossed the finish line in Salekhard wouldn’t have so many stories to tell. at 2.30am on 23 February, tired and Now back home, I’m looking at a weary but glad to have finished what few new adventures: competing in had almost seemed impossible 10 the world’s longest horse race across days ago, when broken down just Mongolia, swimming the Channel, outside the start line. rowing the Atlantic and hiking to the The Ice Run was an ‘endurance Everest base camp. Work-wise I’m challenge’ rather than a race, as some currently riding on Les Mis alongside of it took place on public highways.

Russell Crowe, and will start on the Like most teams, we had initially new Sleeping Beauty and Thor 2 later wanted to finish first but had this year – so, thankfully, there’s lots stopped caring by half way – we more action coming up. wanted to keep going for as long as • As told to Kate Flagg possible. We finished fifth overall, i It’s not too late to sponsor Olly and Rob, visit two days earlier than expected. I’m www.justgiving.com/numbnuts-diabetesuk. glad that we didn’t finish a week • www.theadventurists.com

Action keeps going

Before I set off for the Arctic, I asked Diabetes UK about managing my diabetes in sub-zero temperatures. I was told that before I injected, I needed to make sure that my body was really warm to stop the metal sticking to my skin (my three coats helped with this). I also needed to be quick with my injections – bare skin can start to freeze (in the first stage of frostbite) after about three minutes of exposure so I didn’t mess around, although it was quite fiddly with gloves on!

My girlfriend’s system of wrapping up my diabetes breakables worked brilliantly – not once did I find a frozen or broken pen or cartridge.

I was warned by Diabetes UK that my blood glucose monitor might not work in the extreme cold, which was right. So I just had to listen to what my body was telling me. I checked my blood sugar every time we were inside – a local’s house, a shop or a hotel – when my monitor would work. At the end of the trip it had been five days since I’d last checked my blood, but it seems like I’d been listening pretty well to my body as my blood sugar was 5.7mmol/l.

I beg anyone with diabetes, old or young, who wants to go out adventuring to do it – don’t let diabetes get in your way!

SENSING YOUR WAY • • • •

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LBL-011187 Rev01

16/04/2012 14:42

life&health

Relative risk Type 2 diabetes is known to run in the family, but there are ways that family members can reduce their risk…

I

f you have Type 2 diabetes, chances are that you’re not the only one in your family. This is because people who have a close family member (a parent or a sibling) with Type 2 are 2–6 times more likely to develop the condition themselves. While genetics plays a part, there are also other risk factors for Type 2 that your family should be aware of: BEING OVERWEIGHT – find out your body mass index (BMI) to check whether you are a healthy weight for your height. Visit www.diabetes.org.uk/ overweight-criteria for how to work it out and what it means.

HAVING A LARGE WAIST SIZE – this means 80cm (31.5in) or over for women; 90cm (35in) or over for South Asian men and 94cm (37in) or over for White and Black men.

AGE – Type 2 diabetes usually appears in people over the age of 40, though in South Asian and Black people it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities.

People from South Asian origin are six times more likely to develop Type 2 diabetes and those from Black-African or Caribbean origin are three times more likely to develop the condition than people from White European communities.

Can the risk be reduced?

The good news is that there are a number of steps that people can take to help reduce their risk of developing Type 2. These include: losing weight,

»

May – June 2012 balance 37 37-40 Life and HealthFinal.indd 37

01/05/2012 14:37

life&health necessary; following a healthy, balanced » ifdiet; and increasing physical activity levels.

This is the same as what’s required for the good management of Type 2, so don’t go it alone, your whole family can benefit from a healthy lifestyle.

Doing activities with your family such as walking or cycling, or even kicking a ball around with the younger ones, are fun ways to get everyone active.

Do other types of diabetes have a family link, too?

Yes. Although 85 per cent of Type 1 diabetes occurs in people who don’t have a close family member with the condition, the risk among close family is about 15 times higher than the general population.

However, this increased risk is genetic and cannot be affected by environmental factors such as lifestyle changes.

If a parent has Maturity Onset Diabetes of the Young (MODY), which is caused by a gene mutation (see ‘What is… MODY, page 40), there is a 50 per cent chance that their child will inherit the mutation and go on to develop MODY before they’re 25, whatever their weight, lifestyle, ethnic group, etc.

What symptoms can I tell my family to look out for?

You might not have had all of these before you were diagnosed, but raise awareness among your family members that the main symptoms of diabetes are:

• feeling very thirsty • urinating more frequently, especially at night • blurred vision • slow healing of wounds • genital itching.

If anyone in your family thinks they could have diabetes, it is very important that they see their doctor as soon as possible for further investigation. Remember that being diagnosed early is vital to reduce the risk of diabetes-related complications.

If your family members would like to find out their risk of developing Type 2, they can take Diabetes UK’s online risk score test. i www.diabetes.org.uk/riskscore

How to… understand sun creams UVA STAR RATING Sun creams have a rating of 0–5 stars for the level of protection they offer against UVA rays, which are the dominant tanning rays.

A tan is actually the result of injury to the skin’s DNA – the skin darkens in an imperfect attempt to prevent further DNA damage. UVA rays are present during daylight hours all year round and can penetrate clouds and glass. They play a major part in skin ageing and wrinkling, and also contribute to, and may even cause, the development of skin cancers.

Always choose a sun cream with four stars or more.

sun cream UVA

30SPF UVB

SUN PROTECTION FACTOR (SPF) This rating is measured by timing how long skin that is covered with sun cream takes to burn compared with unprotected skin.

For example, SPF15 means it should take 15 times longer to burn when wearing the sun cream. The higher the SPF the better, but you should at least apply an SPF15 sun cream. This filters out 93 per cent of UVB rays, which are the chief cause of skin reddening and sunburn.

UVB rays play a key part in the development of skin cancer and a contributory role in tanning and wrinkling.

WATERPROOF? Sun creams only work if you use enough, so apply plenty and reapply regularly, as it’s easily rubbed, washed or sweated off. Even sun creams that claim to be ‘water resistant’ should be reapplied after you’ve been in the water. It’s also safer to reapply sun creams that claim to provide protection after just one application, as you might accidentally miss areas that may then get burnt.

i Going on holiday?

Make sure you’ve got travel insurance – visit www.diabetes.org.uk/ insurance for a free quote.

38 balance May – June 2012 37-40 Life and HealthFinal.indd 38

01/05/2012 14:37

life&health

A time and a place Is it important to change injection sites? How often? Is there a ‘best place’ to inject? balance finds out

L

Which site is ‘best’?

Everyone is different. You may find it easier to use your abdomen, while someone else will prefer their thigh. Insulin is absorbed at different speeds from different parts of the body, so this might help you decide where to inject: • fastest from the abdomen • a little slower from the arms • even slower from the legs • slowest from the bottom.

You may choose to give your fast-acting insulin in your abdomen and your longacting insulin in your leg or bottom.

Exercise can increase insulin absorption rates so you may want to choose a site other than your leg if, for example, you are going to run, cycle or play football.

If you prefer to inject near a part of your body that you’ll be using when exercising, wait at least 45 minutes after injecting before starting your activity.

{ 60%

of people have not changed their needle length since diagnosis Source: Forum for Injection Technique (FIT) survey, 2009.

Reduce injection pain by choosing the right needle length and gauge.

Should I inject in the same site area around the same time each day?

To ensure good site rotation, you could inject in your right thigh one evening and your left the next. Some people imagine a clock face on their abdomen (below the belly button) and give their insulin at ‘1 o’clock’, ‘2 o’clock’, etc (see image, above).

Some insulin manufacturers provide an injection template with holes in it, which you can place on your thigh or tummy.

What about non-insulin injection sites?

Although there is little data available about lipohypertrophy related to non-insulin injections such as Byetta, Victoza or Bydureon, you should follow the same advice to reduce the risk of developing lipohypertrophy.

{

egs? Bum? Tum? Everyone has a preferred place to inject their insulin or insert their pump cannula, but wherever you choose, it is important to change injection sites every week or two to get the most out of your insulin.

If you choose the same place each time, hard lumps will develop under the skin, which is known as lipohypertrophy. Not only are these lumps unsightly, they can also affect the way insulin is absorbed, making it more difficult to keep your blood glucose on target.

There are a few rules to remember when injecting or inserting a cannula: 1 Don’t choose a site close to your belly button, moles or scars. The tissue there is tougher, so the insulin absorption will not be consistent.

2 Move to a new site every week or two. Move around within that area with each injection, ensuring at least one finger’s width from the previous injection.

3 If you find a spot that doesn’t hurt, don’t be tempted to inject/insert there all the time. It could cause swelling and lumps.

4 Don’t re-use needles. In the long term it won’t save the NHS money and could damage injection sites and so lead to poor blood glucose control.

37-40 Life and HealthFinal.indd 39

May – June 2012 balance 39 01/05/2012 14:37

life&health

What is…

MODY? Maturity Onset Diabetes of the Young (MODY) is a rare form of diabetes caused by a mutation (change) in a single gene. It is estimated that 20,000–40,000 people (1–2 per cent of people with diabetes) in the UK have MODY. But the actual figure is probably higher – many doctors may not be aware of it as it’s so rare, so it could be misdiagnosed as Type 1 or Type 2 diabetes.

The key features are: • being diagnosed with diabetes under the age of 25 • having a parent with diabetes, with the condition in two or more generations • having diabetes that may be treated by diet or tablets and does not necessarily need insulin.

There are several different forms of MODY, and treatment depends on which form you have. If you think you might have MODY, ask your diabetes healthcare team about blood testing. i For more on MODY, and the different types, visit www.diabetes.org.uk/mody.

HOLIDAY CHECKLIST Don’t forget to pack...

• passport • EHIC (for European destinations) and travel insurance identity • some form of medical identity • medication and medical equipment, including spare test strips, lancets, batteries, pump supplies, etc • needle clipper and sharps disposal container • carbohydrate snacks, including fast-acting if at risk of hypos (eg glucose tablets) • ketone strips • simple first aid kit, eg plasters, painkillers oral rehydration sachets • doctor’s letter for air travel security • list of all medicines (generic names) • local currency, in case you need to buy food or drink as soon as you arrive • phone number for the British Embassy in case of an emergency (visit www.fco.gov.uk or call 020 7008 1500).

Can I… have a fish pedicure?

A ‘fish pedicure’ is a popular spa treatment during which tiny scavenger fish, called garra rufa, are used to clean and exfoliate the skin. The fish are toothless and suck and gently nibble away at dry and dead skin.

In 2011, the Health Protection Agency (HPA) produced guidance for this spa treatment, to address growing concerns that it could transmit infection. The guidance states that while the overall risk of infection is very low for the general population (if appropriate hygiene standards are adhered to), fish pedicures are not recommended for people with diabetes: ‘Those with weakened immune systems or underlying medical conditions, including diabetes and psoriasis, are likely to be at increased risk of infection and so fish pedicures are not recommended for such individuals and pedicurists should not promote treatment to these groups.’ i Health Protection Agency’s fish spa guidance: www.hpa.org.uk/NewsCentre/NationalPressReleases/2011PressRel eases/111018Fishpedicures • For information on taking care of your feet, visit www.diabetes.org.uk/feet.

40 balance

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

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

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

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

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

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

»»» «««

May – June 2012

37-40 Life and HealthFinal.indd 40

01/05/2012 14:37

Health matter on your mind?

Karen Therapist & counsellor

Deepa Dietitian

Cathy Diabetes specialist nurse

Libby Paediatric diabetes specialist

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

WASTE NOT, WANT NOT I have Type 2 and inject insulin (Lantus), once a day. When the OptiClik pen was discontinued last year, my doctor prescribed me the SoloSTAR pre-filled disposable pens for Lantus instead. I’m all for convenience, but I hate waste.

SoloSTAR pens aren’t even recyclable!

John, Chester Karen says...

While many people may prefer the convenience of pre-filled insulin pens, they are not what everyone wants. As you say, these devices cannot be recycled, which for many people is unacceptable.

The good news, however, is that there is still a re-usable pen available for the delivery of Lantus that perhaps your doctor was unaware of. The ClikSTAR is for use with Lantus, Apidra or Insuman insulin.

It is able to deliver between 1 and 80 units, as the SoloSTAR does, but uses a changeable cartridge rather than coming pre-filled.

Have a chat with your doctor and see if it’s possible to have this pen ordered for you, and to have your prescription changed to cartridges of Lantus rather than the pre-filled pen.

contain high glucose levels) and not accurately reflect your glucose control for two to three months.’ It seems that the preservatives used to maintain blood stocks contain glucose and so, in the short term, glucose levels can be higher after a transfusion.

Also bear in mind that the reason for the transfusion, and the type of follow-up care given, can affect your glucose levels. If you were seriously ill when given your blood transfusion, then your glucose levels would presumably be more variable than if you were having treatment for more routine or short-term problems.

The life of a red blood cell is around three months, so three months after the transfusion you should find that your HbA1c test is more accurate. If a test needs to be done sooner, you could talk to your doctor about a fructosamine (glycosylated albumin) test, which reflects blood glucose control over the previous couple of weeks. i Lab Tests Online: http://labtestsonline.org/ understanding/analytes/a1c/tab/test

I’VE A RIGHT TO IVF I’m 28 and have Type 1, which I

TRANSFUSION UPPED MY HBA1C? manage well. My partner and I have I recently had a series of blood transfusions. I expected this to lower my HbA1c (which was taken soon after).

But my HbA1c has gone up. Could the transfusions have caused this?

Melanie, Belfast Cathy says…

An interesting question! According to Lab Tests Online (a public resource on clinical lab testing from the laboratory professionals who do the testing): ‘If you have had a recent transfusion, then your HbA1c will be falsely increased (blood preservative solutions

been trying for a baby for two years.

I recently saw a consultant about IVF treatment and he said he won’t consider me for treatment until I lose 2st (12.7kg) as I’m overweight. I struggle to lose weight so this has really upset me.

Can the NHS discriminate against me in this way?

Hayley, Bristol Karen says…

Trying to have a baby and exploring fertility treatment can be stressful enough in itself, without having to manage blood glucose levels while losing weight at the same time – I

ask the experts understand how difficult it must be to juggle all of these things.

Though it may have sounded like your consultant was being discriminatory, it’s more likely that he was following current recommendations from the National Institute for Health and Clinical Excellence (NICE). Sadly, the reality is that women who are underweight or overweight find it much more difficult to conceive and are also more likely to experience miscarriage – even women who are moderately overweight will be at increased risk of miscarriage.

NICE has a really helpful booklet, Assessment and Treatment for People with Fertility Problems – Understanding NICE Guidance, which is available to read or download from its website (see below). This may contain information about areas of fertility treatment that you haven’t considered.

Don’t give up hope; your GP or diabetes clinic can refer you to a dietitian who will be able to give you detailed advice on managing your weight – it can sometimes be tricky when you are on insulin.

In the meantime, you can contact the Diabetes UK Careline, where a trained counsellor will be able to support you and talk through your situation (see box below). i NICE booklet: www.nice.org.uk/nicemedia/ live/10936/29271/29271.pdf • Diabetes UK preconception care recommendations and video: www.diabetes.org.uk/preconception.

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.

May – June 2012 balance 41 41 ATEColour.indd 41

16/04/2012 13:51

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0800 197 7981 *On Grosvenor and Devon ranges. Free item must be of the same value or less than your chosen item and must be ordered at the same time. Offer applies to orders received and dated no later than 31st May 2012.

“Great British Mobility” is a trading style of The Mobility Rental Group Limited, Suite 1-2, Brinsea Road Farm, Brinsea Road, Congresbury, North Somerset, BS49 5JP

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life&health

Spotlight on...

Gastroparesis What is it?

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.

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.

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.

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 when eating, weight loss, abdominal 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?

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

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 glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, blood glucose levels may be erratic.

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?

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 – your doctor and diabetes healthcare team may try different ones, or combinations, 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.

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16/04/2012 13:44

ANGINA is chest pain that occurs when the heart isn’t getting enough oxygen. It’s a sign of the narrowing of the coronary arteries (the heart’s blood vessels), which is a form of cardiovascular disease (CVD). People with diabetes are at increased risk of CVD because high blood glucose levels can damage blood vessels and cause a build up of fatty deposits in the arteries. People with Type 2 diabetes may also have high LDL cholesterol levels and high blood pressure – risk factors for CVD – that have gone untreated for some time before diagnosis.

Symptoms of angina may vary but are usually described as discomfort, heaviness or tightness in the central chest.

The pain may spread to the neck, jaw, shoulders and one or both arms. These symptoms are usually brought on by exertion and relieved by rest. However, angina can also be brought on by stress and emotional upset, eating a heavy meal or sudden exposure to cold weather. Sometimes there is no apparent cause and it happens at rest.

You may be at increased risk if you have an immediate family member who has had angina or a heart attack. To reduce that risk your doctor may prescribe tablets to lower your cholesterol and blood pressure, if raised. Sometimes very low doses of aspirin are prescribed too. Adapting a healthier lifestyle is also crucial (see below).

Remember that angina is a warning sign of cardiovascular problems – if you think you may have it, see your doctor as soon as possible.

To coincide with Men’s Health Week (11–17 June), balance takes a looks at why ‘real men’ should go to the doctors…

MAN UP M

HIGH BLOOD PRESSURE (or hypertension) is when pressure increases in the arteries (blood vessels that carry blood away from the heart) because they have narrowed or their walls have stiffened.

The danger of high blood pressure is that, over time, your heart may become enlarged, making it beat less effectively, and this could lead to heart failure. High blood pressure also puts a strain on the arteries, which can cause heart attack, stroke, kidney failure and peripheral vascular disease. Having diabetes puts you at greater risk of high blood pressure, and, if you have Type 2, you may have had high blood pressure for some time before you were diagnosed.

Usually there are no obvious symptoms – even with severe cases. This is why you need to have your blood pressure checked at least every year, limit salt and maintain a healthy lifestyle (see ‘Reduce your risk’, below).

en are more likely to smoke, drink alcohol above recommended levels and have a poorer diet than women. They are also more likely to be overweight, have high blood pressure and/ or Type 2 diabetes, all of which increase the risk of heart disease. At the same time, they visit the doctor 20 per cent less frequently than women. But, the fact is, the sooner you recognise any symptoms and visit your GP, the sooner the problem can be treated.

Or, if nothing’s wrong, the sooner you can stop worrying. Here are some common health problems to keep an eye out for...

basic care

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Balance has 10 copies of 5-Minute MOT, Healthy Lifestyle = Stress-free Living to give away. This compact Men’s Health Forum mini-manual, published by Haynes, covers a wide range of men’s health issues. To be in with a chance of winning a copy, send your name and address on a postcard or sealed-down envelope to: ‘balance 5-Minute MOT’ giveaway, Diabetes UK, 10 Parkway, London NW1 7AA, by 1 June. Winners will be chosen at random.

WIN! MINI-MANUAL FOR MEN

ERECTILE DYSFUNCTION or impotence describes the inability in getting and/or keeping an erection for sexual intercourse. Over half of all men with diabetes may be affected and the possibility of problems increases with age. Most men experience difficulties in achieving an erection at some time in their lives, and 10 per cent have continuing erection problems.

Emotional and lifestyle factors can contribute, so you may not get an erection if you are tired, stressed, distracted, or have drunk too much alcohol. In some men ED is caused by low levels of the male hormone testosterone, which can be treated easily.

Over time, high blood glucose levels can damage the nerves or blood vessels supplying the penis, causing ED, so good diabetes control is important. Some medications – such as ACE inhibitors, used to treat high blood pressure – can also cause ED. There are a number of medications available to treat the condition in men with diabetes, so don’t suffer in silence. Erectile dysfunction can also be a symptom of CVD, so tell your doctor as soon as you realise something is wrong.

Eat a balanced diet that includes at least five portions of fruit and vegetables a day, and oily fish like mackerel twice a week. Cut down on harmful fats found in butter, cream, meat products and biscuits. And use less salt.

TESTICULAR CANCER is rare, but it’s important to check yourself because treatment is most successful when started early. Examine yourself once a month after a warm bath or shower, when the scrotal skin is relaxed. Hold your scrotum in the palms of your hands and gently feel each testicle individually with your fingers and thumbs. Any noticeable increase in size or weight may mean something is wrong. You should feel a soft tube at the top and back of the testicle, which is normal.

The testicle itself should be smooth with no lumps or swellings. If you do find something, have it checked by your doctor as soon as possible.

THRUSH is caused by a fungal infection, Candida albicans. In men it can affect the head (glans) of the penis (known as candida balanitis); inside the mouth (known as oral thrush); or the skin (known as a candidal skin infection).

The most common type is balanitis, which is most often found in obese people who have large rolls of skin where the fungus can thrive, and those who have poorly controlled diabetes, as high levels of glucose can encourage fungus growth. Treatment is with anti-fungal creams and ointments.

Aim for at least 30 minutes of physical activity on at least five days a week.

Limit alcohol to recommended levels – that’s 21 units a week (three a day) for men, and 14 units per week (two a day) for women.

Try to keep stress levels to a minimum.

Don’t smoke.

R E D U C E YO U R R I S K Attend your annual diabetes review and make sure you get all the checks you are entitled to – see www. diabetes.org.uk/15essentials.

URINARY TRACT INFECTION describes an infection ranging from cystitis (infection in the bladder) to severe infections of the kidney. Causes include: an enlarged prostate (see above); bladder or kidney problems; and high blood glucose levels, which encourage bacteria to multiply.

Treatment is a course of antibiotics and drinking extra fluids.

THE PROSTATE is a small gland found between the penis and bladder. It is involved in the production of semen. Prostate enlargement affects around 60 per cent of men aged 60 or over to some extent. The exact cause is not known but it is linked to hormonal changes as a man ages.

If the prostate becomes enlarged, it can put pressure on the bladder and urethra (the tube that carries urine from the bladder through the penis). Symptoms include: difficulty starting to urinate, poor urinary flow, dribbling after urinating, traces of blood in the urine and possibly pain. You may also feel like going to the loo frequently – and although you might think this is due to your diabetes, if you aren’t passing much urine it might be because of prostate problems. An enlarged prostate does not mean that you have a higher risk of developing prostate cancer, but the two can have similar symptoms so get checked by your GP.

recipes Buttermilk breakfast muffins

20p per muffin

Frozen blueberries defrost perfectly when cooking, leaving little pockets of brilliantly purple juice. Don’t restrict yourself to blueberries – any frozen berries will work here.

Makes 12 • vegetarian • gluten free

cake!

With the Queen’s Diamond Jubilee four-day weekend coming up, there’s lots of time to celebrate. These delicious recipes from TV chef Phil Vickery make great treats. What’s more, they’re all gluten free!

46 balance

• • • • Seriously Good Gluten-free Baking

Let them eat

• • • • • • •

200g porridge oats 284ml carton buttermilk 125g caster sugar 150ml vegetable oil 1 medium egg, at room temperature 1 tbsp glycerine 200g gluten-free flour mix A (see box, right) 1½ tsp baking powder ½ tsp xanthan gum ½ tsp bicarbonate of soda 75g frozen blueberries

1

Preheat the oven to 200°C/ 392°F/gas mark 6, and place 12 paper muffin cases in a muffin tray.

Place the oats, buttermilk and sugar in a medium mixing bowl and set aside for 20 minutes.

Whisk the oil, egg and glycerine together in a jug and add to the oat mixture. Then stir in the flour, baking powder, xanthan gum and bicarbonate of soda. Finally, add the blueberries and mix well.

Spoon into the muffin cases and cook for 15 minutes or until well browned and risen.

Cool on a wire rack and serve.

2 3

4

Per serving (91g) 300Kcal / 5g protein / 39g carbs 14.7g fat ( 11.8g sugars) / 0.3g salt ( 1.7g saturates) /

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recipes

Gluten-free flour mixes Makes 1kg Flour mix A

• 700g fine white rice flour • 200g potato flour • 100g tapioca flour Flour mix B

Mix all the flours together very thoroughly or put into a food processor and pulse until mixed. Store in an airtight container and use by the soonest best-before date.

Seriously Good Gluten-free Cooking for Kids

• 300g fine gluten-free polenta or chestnut flour • 500g brown rice flour • 200g cornflour

17p per square

Polenta peach squares

SERIOUSLY GOOD OFFER We’ve selected these treats from Phil’s Seriously Good! series: Gluten-free Cooking, Gluten-free Baking and the latest addition, Gluten-free Cooking for Kids – and this is available to balance readers at a reduced price of £11.99 (free p&p, UK mainland only). Call 01903 828503 or email mailorders@lbsltd.co.uk, quoting KC GFK/D. i Published by Kyle Cathie, Phil’s Seriously Good! books are available in bookshops and at www.kylebooks.com.

You can use any ripe, fresh fruit in this cake – cherries in their short summer season would be wonderful. If frozen peaches are not available, substitute another type or use canned fruit.

Makes 16 • vegetarian • gluten free

• • • • • • • • • •

oil, for greasing 175g unsalted butter 225g golden caster sugar 3 medium eggs, beaten finely grated zest of 1 large lemon 1 tsp vanilla extract 3 tsp gluten-free baking powder 250g extra-fine gluten-free polenta 280g frozen peaches, semi-thawed, drained icing sugar, for dusting

1 2

Preheat the oven to 180°C/356°F/ gas mark 4. Oil a 22cm square baking tin.

Place the butter and sugar in a mixing bowl and cream them together using a hand-held electric whisk. Then add the

eggs, half the lemon zest, vanilla extract, baking powder and polenta and mix well.

Carefully fold in the drained fruit.

Spoon the mixture into the prepared tin and then bake for about 30 minutes until well risen, golden and set in the middle. Remove from the oven and leave to cool in the tin.

Transfer to a wire rack to cool completely. Dust with sieved icing sugar and sprinkle with the reserved lemon zest. Cut into 16 squares.

3

4

Per serving (70g) 217Kcal / 3.1g protein 10.7g fat / 27.9g carbs ( 15.4g sugars) / 0.4g salt ( 6g saturates) /

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recipes

Sesame & black pepper lace biscuits These biscuits are very similar to brandy snaps – with a delicious snap and taste when you bite into them. The cracked black pepper adds an extra bite.

Makes 16 • vegetarian • gluten free

Seriously Good Gluten-free Cooking

• • • • • • •

125g icing sugar 25g unsalted butter 3 tbsp clear honey 30g rice flour 1 tsp cracked black pepper 1 tsp xanthan gum 200g sesame seeds

1 11p per biscuit

Preheat the oven to 190°C/374°F/gas mark 5. Line a baking tray with baking parchment.

Place the icing sugar, butter, honey and 2 tbsp water in a medium non-stick pan. Heat gently then bring to the boil, stirring well for 1 minute.

2

3

Remove the pan from the heat, stir in the rice flour, black pepper, xanthan gum and sesame seeds. Mix well and then cool to room temperature.

Use a couple of teaspoons to form the mixture into 4cm-diameter balls and place on the lined baking tray. Flatten slightly with the back of a spoon and leave enough space around them to allow for spreading.

Cook the biscuits for 8–10 minutes or until well spread out and an even colour. Leave to cool on the baking tray.

4 5

Per serving (28g) 137Kcal / 2.4g protein 8.6g fat / 13.3g carbs ( 11.2g sugars) / 0g salt ( 2.1g saturates) /

•

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•

Sweet potato & pecan brownies 77p per brownie

The texture of sweet potato really adds to the squidgyness of the brownie.

1

Preheat the oven to 190°C/ 374°F/gas mark 5, then bake the sweet potatoes in their skins for about 45 minutes.

When soft, slice the potatoes in half and scoop out the flesh.

Weigh out approximately 250g of potato flesh and transfer to a mixing bowl.

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

2 3

48 balance

Line a 20cm square baking tray or dish with baking parchment and oil well.

Place the chocolate and olive oil in a heatproof bowl over a pan of simmering water, or heat it gently in the microwave, until the chocolate melts.

Combine the gluten-free flour, baking powder, gum and pecans together in a bowl.

Beat the warm oil and chocolate into the warm potato, and then add the eggs and sugar.

Finally, add the flour mixture and stir well. Pour into the tin, and bake for about 30 minutes or until set and cooked. Cool slightly, and then cut into squares.

4

Seriously Good Gluten-free Cooking for Kids

• 2 medium sweet potatoes • oil, for greasing • 150g gluten-free dark chocolate, chopped • 100ml light extra virgin olive oil • 125g gluten-free flour mix B (see box, page 47) • 1 tsp gluten-free baking powder • ¼ tsp xanthan gum • 150g pecan nuts, roughly chopped • 2 medium eggs, at room temperature • 150g soft brown sugar

5 6 7

Per serving (78g) 333Kcal / 3.8g protein / 32.3g carbs 21.8g fat ( 20.7g sugars) / 0.2g salt ( 4.3g saturates) /

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••

Traffic light symbols:

• • high

medium

•

low

Treats will obviously have more red and amber lights than other foods, but they’re fine to eat, in moderation, as part of a healthy, balanced diet.

May – June 2012

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Seriously Good Gluten-free Baking

Makes 12 • suitable for freezing • vegetarian • gluten free

recipes

Sweet potato thins The sweet flavour and texture of sweet potato make a great cookie. The end result should be thin and crisp.

15p per cookie

Makes 8–10 • Raw dough suitable for freezing • vegetarian • gluten free

• 1 large sweet potato, approximately 100g • 150g gluten-free flour mix A (see box, page 47) • 1 tsp baking powder • pinch of salt • 40g caster sugar • 50g cooking margarine • 1 medium egg, at room temperature • sieved icing sugar and allspice, for dusting

1

Preheat the oven to 160°C/320°F/ gas mark 3, then bake the sweet potato for 50 minutes until soft. Cool slightly, then peel and mash with a fork.

Set the mash aside to cool completely.

Place the flour, baking powder, salt, sugar and margarine in a medium mixing bowl and gently rub together, or place in a food processor and pulse until you have achieved the consistency of fine breadcrumbs. Add the egg and cold sweet potato and mix well. Then roll the dough into a 15–20cm-long sausage and chill in the fridge for at least 1 hour.

When the dough is chilled, and you are ready to cook the biscuits, line a baking tray with baking parchment (you will need to cook these in batches).

Cut the dough into 5mm slices and place on the tray. Flatten out with your fingers until about 3mm thick, or thinner if possible. Bake for 18–20 minutes, or until lightly browned and crisp, then leave to cool on the tray or on a wire rack. Serve dusted with icing sugar and ground allspice.

3

4

Seriously Good Gluten-free Baking

Seriously Good Gluten-free Cooking for Kids

2

Per serving (40g) 124Kcal / 1.7g protein 4.8g fat / 19g carbs ( 5g sugars) / 0.5g salt ( 0.2g saturates) /

•

• • •

46-49 Recipes–colourAC.indd 49

May – June 2012 balance 49 01/05/2012 14:38

Stevia_Balance_212x267mm_Stevia_Balance_212x267mm 23.01.12 16:14 Seite 1

Sweet, calorie-free and made from the Stevia plant.

Mar ellous!

Hermesetas SteviaSweet – with the calorie free sweetener from the Stevia plant.

Natural sweetness without calories is no longer a dream because Hermesetas SteviaSweet has arrived, containing the extract of Stevia leaves. For hundreds of years, the wild plant Stevia has been known as “honey leaf” to the original inhabitants of South America and used to sweeten foods and drinks. And now you can enjoy Stevia in Europe with Hermesetas SteviaSweet.

Available in tablet, granulated or liquid, you can use it to sweeten tea or coffee, sprinkle on fruits and desserts, or cook and bake delicious low calorie recipes. Enjoy the pure sweetness of Stevia.

For more information on SteviaSweet go to: www.hermesetas.com/steviasweet

50-51 Phil–final.indd 50

16/04/2012 12:22

Photo: Steve Lee, courtesy Kyle Cathie

feature

Gluten free – not taste free!

TV chef Phil Vickery (right) is Food Ambassador for the charity Coeliac UK and author of a series of cookbooks created for people with coeliac disease, so what inspired him?

W

ell-known for his cooking slots on ITV’s This Morning, Phil Vickery, 50, is undoubtedly popular.

Perhaps his popularity has risen further among people with coeliac disease since the release of the first cookbook in his highly acclaimed Seriously Good! range, Gluten-Free Cooking in 2009 – an Amazon number one best seller. A year later, Gluten-Free Baking hit the shelves, and was crowned the Waitrose Specialist Book of the Year 2010. Tipped for equal success is Phil’s third instalment, Gluten-Free Cooking with Kids, published in April.

There’s certainly demand for gluten-free cooking. Coeliac disease is an autoimmune disease, where the body’s immune system attacks its own tissues. It’s triggered by gluten – a type of protein found in wheat, rye and barley – and, as a result, people with the condition need to avoid these foods. According to Coeliac UK, it affects one in 100 people in the UK and around 500,000 people have yet to be diagnosed.

Many balance readers will be aware that coeliac disease is more common in people with Type 1 diabetes (there’s no link with Type 2). This is because both are autoimmune conditions and are genetically linked.

How it all came about With no direct link to coeliac disease or diabetes, why did Phil get involved?

“I started to make Christmas puddings and sell them at a Christmas fayre. The puddings were of very high quality, made

with exceptional ingredients,” he says.

“A lot of people would approach us but when offered a taste they would decline, almost recoiling with horror as they explained: ‘No, I can’t – I’m coeliac.’

Their response when I said they were gluten-free was classic! They would snap up three or four puddings apiece.

“I then wanted to find out more about gluten-free diets and it quickly

I’m passionate about improving knowledge in the food industry became apparent that coeliac disease is a worldwide condition. So, the idea to write a book dedicated to gluten-free cooking seemed like the obvious route to take.”

It snowballed from there, with Coeliac UK announcing him as its Food Ambassador in March 2010. He said at the time: “I’m passionate about improving

knowledge in the food industry and the necessity for more gluten-free cooking.

I have learnt so much and it is essential that chefs understand the importance of gluten-free recipes.”

The series of books include starters, snacks, breakfasts, drinks, main meals, desserts and treats, but it wasn’t an easy task. Phil admits: “It takes an incredible amount of time to create and perfect each recipe. Mostly, it has taken up to three, four, five, six or even seven times to get it right. There have been many challenges to overcome to get the very best results!” i See page 46 for some of Phil’s gluten-free treats and details about his Seriously Good! cookbooks.

• The Seriously Good Gluten-Free Living app for iPhone and iPad includes recipes and tips, and is available from iTunes for £4.99.

• For more on coeliac disease, visit www.diabetes. org.uk/coeliac or www.coeliac.org.uk.

• Coeliac UK helpline: 0845 305 2060

Phil’s tips for gluten-free baking • It’s important to measure ingredients accurately and use the correct tin size – no guess work!

• Make sure your ingredients are at room temperature when you start.

• The amount of liquid needed may differ depending on the brand or type of flours you use. Generally, you tend to need a wetter-than-normal mixture before baking and may have to adjust the amount in the recipe – go by the description of the texture (eg, ‘soft and dropping’, ‘wet’ or ‘for pouring in the tin’).

• If there’s not enough liquid added the result can be disappointing and heavy in texture.

Mixtures can tend to stiffen on standing and soak up the moisture further, so be sure to mix and bake straight away, especially if you have added baking powder.

May – June 2012 balance 51 50-51 Phil–final.indd 51

16/04/2012 12:22

bite-sized

In season

Grow your own

Swap ‘n’ save

Our new resident gardening columnist Stephen Rayner (right) on growing salads

May Get creative with elderflowers – add them to fruit compotes or make a glaze with wine, honey mustard and garlic for a perfect Sunday roast.

Seasonal greens include spinach, watercress, sorrel and radishes.

2 chocolate digestive biscuits (172Kcal, 8.2g fat)

So, what should we all be up to during these coming months?

The simple answer is succession, succession, succession. I’m sure that at one time or another we have all fallen into the trap of sowing or planting too much in one go. The trouble is, when spring first arrives and the lettuce seedlings are growing nicely on the windowsill, it would seem like murder to throw any of them away. So we plant all two dozen only to throw 20 of them away as they go to seed later in the season.

The golden rule with salads in particular is little and often. Try sowing just a couple of feet of your row of lettuces, sow thinly and use the ones you thin out as salad leaves. Then sow the same amount 10 days later and you should have three or four hearty lettuces every fortnight throughout the season. You can, of course, change this plan to suit the needs of your particular family. Another golden rule at this time of year is not to rush into planting out tender crops like courgettes, cucumbers and outdoor tomatoes – remember that a couple of degrees of frost can do a lot of damage, even if it doesn’t actually kill your plants. Try to be patient; in the south wait until mid-May before planting out and, further north, delay until the end of the month.

• Do you have a gardening query? Write to: Grow your own, balance, 10 Parkway, London NW1 7AA or email balance@diabetes.org.uk.

June Tantalise your taste buds and take advantage of summer fruits in full bloom – gooseberries, blackcurrants, raspberries and strawberries make for great sweet snacks or for adding nutrition to jellies and puddings.

Fill up on your veg with broccoli, cucumber, swiss chard and summer squash.

Save 78Kcal & 6.2g fat

2 Jaffa cakes (94 Kcal, 2g fat)

Gourmet on the go

Grilled scallops with asparagus

Recipe kindly provided by British Asparagus: www.british-asparagus.co.uk

+

Serves 4 • ½ portion of fruit & veg per serving • Gluten free (check sauce)

+

=

£1.71 per serving

Sauté 200g British asparagus tips in a frying pan with 1 tbsp olive oil for 3–4mins. Remove from pan, season and keep warm. Return pan to heat and add 1 tbsp olive oil, making sure the pan and oil are very hot but not smoking. Pat 20 fresh scallops dry with kitchen towel, season with sea salt and add to the pan. Cook for 45 seconds on each side and remove from the pan. Divide the asparagus between four plates and place the scallops on top. Spoon some low-fat crème frâiche to the side, and drizzle 1 tbsp sweet chilli sauce.

14.1g fat ( 6.1g sats) / 1.3g salt Add black pepper and serve. Per serving (171g) 214Kcal / 14.6g protein / 7.6g carbs ( 4.9g sugars) /

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52 balance

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May – June 2012

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GET FIT FOR SUMMER!

SNACK ATTACK New goodies when you’ve got the munchies

HFORD EVANS JOIN STEPS STAR LEE LATC ORKOUT FOR AN ALL OVER BODY W

Taste the paste

Say goodbye to bland food and jazz up your dishes with Trees Can’t Dance Chipotle Chilli Paste. It’s ideal for use as a last-minute ingredient to bring spice and flavour to simple snacks and quick suppers, and provides sure-fire chilli joy to marinades, sauces, soups, stir fries, curries and stews. Available at Sainsbury’s (£1.65)

To celebrate its new yogurt range (see left), Rachel’s Organic is giving one balance reader a special kitchen pack of a tea towel, apron and oven gloves, and a hamper containing a selection of yogurts.

For a chance to win, send your name and address on a postcard or sealeddown envelope to: ‘Rachel’s Organic’, balance, Diabetes UK, 10 Parkway, London NW1 7AA by 1 June.

WIN!

Fat-free & fruity Rachel’s Organic has launched its new Fat Free yogurt range with three fruity combinations: Peach and Passionfruit, Strawberry and Rhubarb, and Blackcurrant.

Certified Organic by the Soil Association, there are no colourings, artificial flavourings, preservatives or sweeteners, but the yogurts maintain rich texture and real flavours.

Available at supermarkets (£1.59)

ET FIT, GET… DON’T JUST G A FULL RANGE OF HOME FITNESS EQUIPMENT WITH EXERCISE WALL CHARTS ARE AVAILABLE FROM

WWW.OKFAMOUSLYFIT.CO.UK ALSO AVAILABLE ONLINE FROM

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

Kitbags Keep everything in one place – perfect for travelling or everyday use.

Made with bonded black leather.

Slim: £24.99+p&p (code 4261) Classic: £34.99+p&p (code 4260)

Diabetes UK Pen Show your support with this white pen bearing the Diabetes UK logo. Black ink. £1.25+p&p (code 4200a) Diabetes UK Mug Drink in style with this Diabetes UK-branded mug. £3.95+p&p (code 4232)

Cream tea (jam and cream scone with a cup of tea): 449Kcal

52-53 Bite sized JC.indd 53

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35 minutes of tennis (playing singles)

Order these and other Diabetes UK publications or gifts at www.diabetes.org.uk/shop or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote B155 when placing your order. (Postage is charged on some items.)

16/04/2012 11:35

travel

Opening ceremony for the Donbass Arena, Donetsk

DESTINATION

EURO

2012

This year’s UEFA Euro 2012 football championship will culminate in an exciting final tournament from 8 June to 1 July, hosted for the first time by Eastern European countries Ukraine and Poland.

Carole French is our guide to three of the host cities, Donetsk, Kyiv and Warsaw

From left: Castle Square houses the enormous Royal Castle, which today stands as a heritage museum; former royal residence Wilanow Palace; the National Stadium, Warsaw’s UEFA Euro 2012 venue

Warsaw, Poland

A city of skyscraper offices and contemporary universities that sit surprisingly well with grand palaces and the towering mock17th-century merchants’ town houses of the Old Town quarter, Warsaw is the gritty capital of Poland. It is also one of the most visited cities in Europe, which is no mean feat given that it was almost obliterated during World War II. The UNESCO-listed Old Town is the heart of Warsaw and a great place to begin your tour of the city.

It’s picturesque too, a photographer’s dream. The area is dominated by a market square the size of a football

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pitch, which is surrounded by homes built 60 or so years ago to echo the late-Renaissance architectural style of the 1600s. Once they were occupied by wealthy families; today they house offices and museums, including the Warsaw Historical Museum that chronicles the war years and the Mickiewicz Museum, where the life of one of Poland’s greatest poets Adam Mickiewicz (1798–1855) is celebrated. There’s also the enormous Royal Castle, which was once at the centre of the Polish Royal Court and today houses a heritage museum.

Warsaw is an elegant city awash with tree-lined boulevards and grand buildings, such as the Presidential

Palace and the baroque-style former royal residence Wilanow Palace. It is a green city too, with numerous parks off Ujazdow Avenue. Saxon Garden is the city’s oldest park, while the Royal Baths Park is the largest. In both you can stroll, admire their many statues or take a break with a coffee and a light snack of stew known as flaki.

There’s a good network of trams and underground metro trains, and plenty of buses and taxis. Visitors can choose from a growing number of international-standard hotels, including the Sheraton Warsaw Hotel and the Warsaw Marriott. Both are within easy reach of the city’s UEFA Euro 2012 venue, the National Stadium.

May – June 2012 16/04/2012 17:07

travel Donetsk, Ukraine

With its championship sports amenities, a buzzing cultural scene that centres on the famous Donetsk Opera and Ballet Theatre, and a UNESCO accolade that declared it the cleanest industrial town, Donetsk is one of Ukraine’s best keep secrets. For sports fans, the top attraction is the new Donbass Arena. Opened in 2009, the arena can seat more than 52,000 spectators and is the home ground of one of Ukraine’s top professional football teams, FC Shakhtar Donetsk.

The city centre has a great mix of amenities, with most located in or around its main thoroughfare, Artema Street. Here you’ll find super hotels, such as the five-star Donbass Palace Hotel, along with restaurants and cafes, shopping centres and many of the 250-plus monuments.

Look out for the Statue of Artem, a 6m-tall monument commemorating the life of Fyodor Sergeyev (1883–1921), one of the soviet’s most famous politicians who had links with the city. Nearby, the statue of John Hughes (1814–1889) (see below), is perhaps the most moving of the city’s landmarks. Donetsk can trace its history back to 1869, when it was founded by Hughes, a wealthy businessman from Wales who saw the region’s potential for a thriving steel and coal mining centre of industry. Its community grew and, today, despite Donetsk having been almost destroyed during World War II, it is home to nearly a million people, with the vast majority still working in these industries.

Donetsk has an edgy vibe too. Take a walk in Forged Figure Park, where countless works of art created by blacksmiths are displayed. Then make for Pushkin Boulevard, a walkway of cafés and gardens that snakes out of the city for some 1.2 miles (2km). Here you can see the famous Mertsalov Palm.

Made of steel, it was created in the 19th century and has become an iconic image said to represent the steel-like strength of this glorious city.

Kyiv, Ukraine

Lying at the heart of Ukraine, both in location and importance, Kyiv (or Kiev) is the nation’s capital and its cultural, educational, administrative and commercial hub. It lies on the banks of the Dnipro river. All road and rail networks lead into Kyiv, so travel to the city is easy. Even easier is getting around. It has a highly efficient infrastructure that includes a fast metro system.

Maidan Nezalezhnosti (Independence Square), together with the wide Chestnut tree-lined Khreschatyk Street that splits it in

two, is the main area and makes a good starting point. By day the square bustles with traffic and busy people, and street saxophonists capture the cultural mood effortlessly. From the square you can reach most of the landmarks, including the Opera House and the striking St Sophia Cathedral with its unmissable goldentopped towers. Surrounding the cathedral is a fascinating complex of underground catacombs and chapels, known as Perchera Lavara.

Kyiv can claim to be one of the oldest cities in Eastern Europe, with excavations suggesting it was inhabited by Slavic communities in around the 6th century; it went on to become a major city during the era

of the medieval Khazar Empire, and later the Russian Empire. There are some 40 museums, including the Museum of the Great Patriotic War with its mighty steel Mother Motherland statue that stands as tall as an office block and commemorates the local lives lost in warfare at its entrance. A visit will be an enlightening experience and help you understand what makes Kyiv and its people tick.

While Kyiv, which has an ongoing commitment to restore its 700 or so historic buildings, passionately

Top (from left): Maidan Nezalezhnosti; Perchera Lavara; Olimpiysky National Sports Complex celebrates its heritage, it manages to present itself as a thoroughly modern city. It has contemporary nightclubs, international-standard hotels like the Premier Palace and Opera Hotel, and a whole host of restaurants. Like Donetsk, Kyiv has a large capacity stadium, in fact one of the largest in the world, which was originally used when Russia hosted the 1980 Olympics. The Olimpiysky National Sports Complex has been completely remodelled for the UEFA Euro 2012.

i Download Diabetes and Travelling, a balance guide, at www.diabetes.org.uk/diabetes-andtravelling. • For more on healthcare abroad, visit NHS Choices at www.dh.gov.uk/travellers.

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16/04/2012 17:07

DIABETES

THE

BIG EVENT

SATURDAY 14 JULY 2012, 10.00AM – 5.00PM, ROOTES BUILDING, UNIVERSITY OF WARWICK, COVENTRY Join us for our first national event for everyone affected by diabetes. Choose from 20 interactive seminars, workshops and activities covering all aspects of diabetes and diabetes care.

For programme information: www.diabetes.org.uk/thebigevent To book tel: 020 7324 4330 or visit www.diabetes.org.uk/thebigevent Find us on: www.facebook.com/diabetesuk

www.twitter.com/diabetesuk

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

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13/04/2012 16/04/2012 15:22 17:07

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16/04/2012 17:07

The Shore House Inn

Muddy boots welcome What would a summer walk be without a refreshing drink at a great pub at the end? Neil Coates – pub walks writer and real ale lover – shares his favourite walker-friendly watering holes and the stunning trails that take you there

Square and Compass WHERE Worth Matravers, Purbeck, Dorset PUB TRIVIA As old as the hills, some say – and parts of the hills are inside this timeless little pub (right). Locally collected fossils are strewn in the museum room; one of a clutch of flag-floored,

WHERE Lochgoilhead, Argyll, Scotland PUB TRIVIA This delightful inn is set at the heart of the Argyll Forest Park, with sunsets to die for that illuminate the inspiring Loch Goil (left).

Uninterrupted views of countless peaks demand you locate yourself on the terrace, drinking in the extraordinary vista along these secluded peninsulas in the Cairngorms National Park.

BEST ROUND Challenging terrain and narrow paths make a walk to the summits of Beinn Tharsuinn and Beinn Lochain a demanding day out. Once above the forestry plantation to the west of the loch’s head above Corrow, the undulating way soon morphs into testing, steep walking to gain the craggy ridge, where you’re rewarded with a breathtaking view of the Cowal Peninsula and the Arrochar Alps. Keep an eye out for red deer, black grouse or even a golden eagle. The remote Curra Lochain and a series of falls on Lettermay Burn accompany the homeward leg. [7 miles/11km] TOP TIPPLE The local Fyne Ales microbrewery makes an excellent drop – try an Avalanche. i 01301 703340; www.theshorehouse.net

lived-in, pocket-sized snugs fanning from the corridor servery. Gravity beers straight from the barrel are best sampled at one of the outdoor tables, enjoying the stupendous views to the English Channel while chomping on a home-made pasty or pie.

BEST ROUND Paths meander from the village down pretty Winspit Bottom to gain the westbound coastal footpath to lofty St Alban’s (or Aldhelm’s Head) and its fascinating, tiny Norman chapel (top left). This fabulous Jurassic Coast World Heritage landscape (bottom left) continues until a path cuts inland well before you reach the commanding Swyre Head, drifting along the ridge above secluded Encombe to Kingston, then looping back to Worth Matravers via more dry-valley bottoms and coombes. [8 miles/13km] TOP TIPPLE Former landlord Charlie Newman’s memorable cider, made on the premises. i 01929 439229; www.squareandcompasspub.co.uk

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16/04/2012 12:32

walk

Hiker’s Bar, The Old Dungeon Ghyll WHERE Langdale Valley, Ambleside, Cumbria PUB TRIVIA Decades of dedicated service to generations of grateful ramblers set this renowned Lakeland watering hole apart. Inside are careworn settles, simple plank and bench seats and converted milking stalls; outside the place is stapled to the precipitous cliffs of the jackdaw-haunted Langdale Pikes. What a view from the terrace!

Great food and fabulous beers are the icing on the cake here in one of England’s most memorable corners.

BEST ROUND Lanes and paths creep up to Blea Tarn, between Pike o’ Blisco and shapely Lingmoor, before falling into Little Langdale Valley and its web of miners’ tracks. Crossing the famous Slater Bridge, tracks undulate back into Great Langdale before the Cumbria Way escorts you through the jaws of Langdale to awesome views of the Pikes, Bowfell and Crinkle Crags.

[8.5 miles/14km] TOP TIPPLE Yates Bitter, created by alchemy from Lakeland water. i 015394 37272; www.odg.co.uk

The Pack Horse WHERE Widdop, Hebden Bridge, West Yorkshire PUB TRIVIA Fascinating plans and photos of the local reservoirs and railways being built line the walls of this low-slung, centuries-old, stone-built former drover’s pub way up on the moors between Hebden Bridge and Colne. Huge meals sate the appetite sharpened by walking the nearby Pennine Way or the wooded chasm of Hebden Dale. A cobbled beer garden, ideal for summer afternoons, overlooks the reedy moors.

BEST ROUND Head off along the rim of Graining Water’s sheer-cut clough before entering the National Trust estate at stunning Black Dean, walking the gorge and wooded trails up to Hardcastle Crags (below). Cutting back to remote Walshaw hamlet, a shooter’s track traverses Wadsworth Moor to the lonely reservoirs in Walshaw Dean and a 2-mile (3.2km) stroll back to The Pack Horse. [7 miles/11km] TOP TIPPLE Well over 100 Scottish and Irish malt whiskies are on offer, or sink an ever-reliable Copper Dragon Bitter. i 01422 842803; www.thepackhorse.org

Llanthony Priory Hotel WHERE Llanthony, Monmouthshire, south-east Wales PUB TRIVIA This charming hotel is seamlessly integrated into the stirring ruins of a 12th-century Augustinian priory, situated way off the beaten track up in the Black Mountains in the gorgeous Vale of Ewyas, near the bubbling Afon Honddu. The vaulted bar is the prior’s former wine cellar and is an awesome location in which to cool down and unwind, with the sturdy, gaunt arches framing the ridge of Hatterrall Hill high above the valley.

BEST ROUND Narrow lanes and farm tracks thread along the valley floor to The Vision Farm, central to the Bruce Chatwin novel On the Black Hill, continuing beyond to nearby Capel y Ffin with its memorable, tiny chapel described by the diarist Francis Kilvert as ‘owl-like’. A very steep climb past the waterfalls of Nant Vision leads to the ridge-top Offa’s Dyke Path for an inspiring, high-level traverse along Black Darren and the Wales-England border before dropping back to the fabulous ruins. [9 miles/14½km] TOP TIPPLE Ask for a local farmhouse cider or Brains Bitter. i 01873 890487; www.llanthonyprioryhotel.co.uk i See page 64 for your chance to win a copy of 100 Greatest Walks in Britain.

• A version of this article originally appeared in Walk, the magazine of the Ramblers; www.walkmag.co.uk.

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16/04/2012 12:32

fundraising focus

KWIK-FIT CHAMPIONS Staff from Kwik-Fit Insurance have raised a magnificent £35,000 for Diabetes UK Scotland following a year-long fundraising drive. Staff chose Diabetes UK Scotland as their Charity of the Year 2011, in memory of their fellow employee Tammy Battles, 22, who tragically lost her life to the condition in 2010.

The company’s charity committee encouraged colleagues, friends and family to sign up to some adrenaline-pumping experiences, including white-water rafting and a whiteknuckle zip slide. Staff also volunteered for Diabetes UK Scotland, from carrying out diabetes risk assessments at the charity’s Roadshows to raising awareness at local events. The fantastic amount raised is key to helping Diabetes UK Scotland develop the Making Connections project, which aims to support young people with diabetes to access the right information, emotional support and healthcare in a way that best suits them.

Farewell to veteran fundraisers The founder members of Carmarthen and District Diabetes UK voluntary group, Lt Col Ralph Tucker TD DL and his wife Mary, passed away within a month of each other at the end of 2011. Both Ralph and Mary were in their 90s and had worked tirelessly as joint presidents of the group for more than 30 years. Last year the group raised an impressive £8,000, bringing the cumulative total donated to Diabetes UK Cymru between 1978 and 2011 to £85,500.

“We would like to extend our deepest sympathy to their family and hope that we can continue their outstanding work,” said Group Secretary Wendy Williams.

GLITZ, GLAMOUR & GENEROUS GIVING Diabetes UK Northern Ireland was the chosen charity for this year’s Ulster Chemists Association (UCA) President’s Ball, held on 21 January at the Ramada Hotel, Belfast.

Around 550 people attended the Oscars-style awards ceremony for the pharmacy world. The evening was compered by local TV presenter Alison Fleming, who urged all the guests to dig deep – which they did, raising an amazing £5,022 through a fun casino and a raffle.

Standing ovation Star-in-the-making Raissa Whittaker-Standing (right) put her talents to use by organising, compering and performing in a contemporary music concert at her school on 20 March, raising a fantastic £275 for Diabetes UK. Raissa, who has Type 1, and 19 of her friends at Harris Academy, South Norwood, rehearsed for months to prepare for the event. Raissa sang four songs in the show, while playing guitar or piano. She opened with the Jonas Brothers’ song ‘A little bit longer’, which is about being diagnosed with diabetes. All the children involved gave star performances, making the night a real success.

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16/04/2012 11:38

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.

GOLFERS TEE OFF FOR DIABETES UK Peter Fulford (left) and Stephen Potts from the Ilford group

Group efforts Diabetes UK’s Ilford and District voluntary group is donating a fantastic £5,500 to the charity. The group, chaired by Alan Spink, has raised a staggering £66,635 in total since 1994. Their fundraising activities have included barn dances, balloon races, quiz nights, collections, BBQs, strawberry teas, coffee mornings, etc.

Meanwhile, the Crewe & South Cheshire voluntary group, which has been fundraising for Diabetes UK’s research programme since the 1970s, began to support local people to attend Diabetes UK Care Events three years ago. Since then, they have helped 15 young people and 10 families with partial or full funding, so they can attend an event – a fantastic achievement.

Diabetes UK was chosen as Stamford Golf Club’s Charity of the Year 2011,

by Harry Marshall (pictured centre), then Captain of the Cheshire golf club, and his daughter, Lady Captain Jo Ackers (pictured, with Diabetes UK volunteer Robert Edge).

In total, golfers raised a tremendous £3,700 through a range of fundraising initiatives including collections, raffles, social evenings and donations to the Captain’s whisky bottle on the bar in the 19th hole.

Harry’s son, David Marshall, has had Type 1 since he was 10. Harry says: “We know all about how serious diabetes can be. It’s really important to raise awareness.”

ST DAVID’S DAY FUSION BANQUET Celtic and Indian culture came together on 1 March, St David’s day, when one of Cardiff’s premier restaurants hosted a special charity night of food and entertainment, raising more than £500 for Diabetes UK Cymru.

Shaz Haris’ (pictured) Haveli restaurant created a special menu for the event, featuring leek bhajees, chicken with laverbread and spiced Welsh cakes with saffron custard.

Entertainment came from local band The Petty Thieves and a charity auction hosted by Welsh TV star Boyd Clack.

The event has sparked a longer-term collaboration between Diabetes UK Cymru and Cardiff’s Asian restaurateurs to raise money and awareness of diabetes in local ethnic minority communities.

SIGN UP NOW!

BRITISH 10K LONDON RUN, 8 JULY 2012

This run starts at Hyde Park Corner in London and takes you through some of the capital’s world-famous landmarks before finishing on Whitehall near Downing Street. All money raised by Diabetes UKrunners goes into the charity’s research fund.

Kate Wright explains why she’s taken on the challenge: “I’m running in memory of my dad, John Wright, who died four years ago due to diabetes complications – there was a blood clot at the base of his brain. He was just 60 and it was very sudden. I also have an uncle and two cousins who have diabetes. I chose this race because it’s a 10k – I ran 5k for Diabetes UK a few years ago and wanted to up the ante. I hope Diabetes UK can one day find a cure.” i Sign up at www.diabetes.org.uk/british-10k. • To sponsor Kate, visit www.justgiving.com/dollydanger.

DIARY WALK FOR DIABETES Fun, sponsored walks of various distances across the UK this summer – see the brochure with this issue of balance or visit www.diabetes. org.uk/walk-for-diabetes.

20 MAY Cardiff Fun Run 2012, Bute Park (5k) i 029 2066 8276 • cymru@diabetes.org.uk 25 MAY Yeovil Golf Day, Yeovil Golf Club, Somerset i 01823 448260 • www.diabetes.org.uk/ yeovilgolfday 27 MAY Well Walk, Sunderland, Herrington Country Park (3 miles) i 01325 488606 • www.diabetes.org.uk/ wellwalksunderland 27 MAY The UK’s Longest Zip Wire, near Liskeard, Cornwall i 01823 448260 • www.diabetes.org.uk/ longestzipwire 3 JUNE South West Coast Path Challenge i 01823 448260 • www.diabetes.org.uk/ swcoast 10 JUNE Great Kent Cycle (35 or 60 miles) i 01372 720148 • fundraising.southeast@ diabetes.org.uk 10 JUNE Great Midlands Fun Run, Sutton Coldfield Town Centre i 01922 614500 • midlands@diabetes.org.uk 17 JUNE Swim for All, Pugney’s Country Park, Wakefield – the second Yorkshire swimming festival (50 or 1,500m) i 01922 614500 • midlands@diabetes.org.uk

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16/04/2012 11:38

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Last issue’s solution

2

The Allergy & Free From Show is offering balance readers free tickets to its London event. The show, on 18–20 May at Olympia London, is for those living with allergies, intolerance, coeliac disease, hay fever, chemical sensitivities, asthma, migraines and skin conditions like eczema. It’s also for the healthcare professionals who treat such conditions. Attend the show to find new products, cooking classes, parent workshops, one-to-one consultations and expert seminars.

For unlimited free tickets, visit www. allergyshow. co.uk/go/ diabetes.

Wordworkout How many words can you make from this box of letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word. Names and plurals are not allowed. There is one nine-letter word in the grid.

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

E L A O C H M N E

16/04/2012 12:41

different types

ARTHUR SMITH

MARI WILSON

Out of the woods

66 balance

H

M

y new album, Cover Stories, is finally ready after my six-month Pledge Music campaign, which I’m very happy about. Pledge Music is a great new way for artists to raise enough money for their next release with the help of their fans.

Anyone can pledge to buy the album so that the artist can raise the money they need to record and promote it.

As part of my campaign I auctioned some of my 80s stage dresses, posters, rare CDs, lyric sheets and photos – and a lovely lady pledged for me to come to her house and do a show! It really is the way ahead for artists like myself.

This will be the third release on my own label (Beehive Records), and I like the fact that I own my catalogue and am in control.

I also like to be in control of my blood sugar levels, so I’m a big fan of anything that helps make it that little bit easier. I’m very excited about the new iBGStar blood glucose meter that connects with the iPhone and iPod Touch – how brilliant is that? A tiny attachment and some strips, oh yes, I’m going to be first in line. At last, more space in my handbag – hurrah! Talking of handbags, I had a lovely email from a reader, Sheila, who, after reading my last column (‘Health & handbags’, March/April 2012 balance), recommended some fabulous clutch bags that can hold all of my diabetes kit, so thanks for that! How kind of her to take the time.

I love this time of year, when we’ve moved to British summer time and the days get longer, the sun shines and there’s a feeling of optimism in the air. I was a bit poorly a few weeks ago, though – a week of rising sugars, aching bones and extreme tiredness. I didn’t bother with the doctor because I knew they’d just say “it’s a virus.”

It’s always a virus! I reckon they just say that when they don’t know what it is. Anyway, thankfully, it didn’t last long, and with my sugar levels back under control I returned to the gym for a spin class, a bit of Zumba and some swimming – my favourites. I do love aerobics, but as I’m getting older all that high-impact jumping around isn’t good for my joints, apparently, so I think those classes will have to come to an end soon. Anyway, I’m getting fed up of always being the oldest one in the class.

So, yoga tonight: it’s a really great way to relax, and is especially good for people with diabetes as stress can have an adverse effect on our control. Yoga is physical, mental and spiritual and the benefits are huge. Why not start with some meditation to see how good it makes you feel? i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 diabetes.

Her new album, Cover Stories, is out now; www.mariwilson.co.uk.

B

A

“The unco hesit “Bes Will b Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne

I

t was my first time in Geneva, that grand old town on the lake, but I cannot say I was enjoying myself. Propped up on three pillows, I lay in my hotel room, desperately trying to ignore the pain in my stomach and the thought that this was going to be my last night alive.

Three months earlier I had spent 12 days in hospital (the first three in intensive care) with pancreatitis, or rather, to give it its full title, severe acute necrotizing pancreatitis.

“You’re not out of the woods yet,” the doctors had said when I was discharged, and they advised me to rest a while – another attack could prove fatal. I spent weeks living gently, but as I grew stronger, I began to feel the desire to return to work, particularly to do the Radio 4 programme about France I had been looking forward to so much. The Vosges, I want to go to the Vosges…

From the moment the producer Sara-Jane and I touched down in Annency I knew I was ill again. Stomach cramps crushed my appetite, I felt enfeebled and my urine was the colour of a full-bodied Rioja. Our visits to the former residences of Rousseau and Voltaire were an endurance test. I took no pleasure in the mountains or the lakes and nearly vomited during the section about the strong local cheese. However, I was determined to make it through the recording so that I might not end up in a hospital (or graveyard) in a foreign land.

I made frantic phone calls to my doctor brother, Richard, in search of medical advice. The three days became an ordeal – for Sara-Jane as much as me. Having your presenter die on duty abroad would look bad when she next had to fill in a risk-assessment form. She is my friend; she fretted.

On the last night we crossed the border into Switzerland, where I sat in the hotel writhing and trying to will a postponement of the inevitable collapse – at least until after I had flown back to London. This agony was clearly the sequel to the pancreatitis I had been warned about and, like all sequels – except for The Godfather, of course – it was worse than the original. I wasn’t out of the woods yet. I was near their dangerous centre.

At 3am I went into a coma and died… Well no, obviously, I survived, but I was admitted straight to hospital after I dragged myself home and was not finally discharged until a month later.

Why do I tell you this? Well, because it happened 10 years ago and I want to remind myself on its anniversary that I survived, so that I might enjoy more fully the days I live in now. And to suggest to you that, sometimes, things do get better and that you should cherish the life that you have. i Arthur Smith is a comedian, writer and broadcaster with Type 2.

Back in control

Phon Cum Shad

Call

0

Or o at p

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May – June 2012

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“Just every

16/04/2012 13:02

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Beige

Mottled Mottled Dark Jeans Grey Blue

“Cumfy socks recently purchased are great, everything you said they would be! …I am due to attend a health workshop and will be bringing your products to the attention of others who are there. Thank you for making me so comfortable.”KW

Mottled Beige

Anti-bacterial, inflammation inhibiting socks also available Cumfy Stuff, Reed Medical Ltd., Dept BAL05/12, Thwaites Close, Shadsworth Business Park, Blackburn, Lancs BB1 2QQ Please send me the following items Item 3-pr Pack HALF PLUSH Socks/Black 3-pr Pack HALF PLUSH Socks/Blue 3-pr Pack HALF PLUSH Socks/Beige 4-pr Pack HALF PLUSH Socks/Mottled Dark Grey 4-pr Pack HALF PLUSH Socks/Mottled Jeans Blue 4-pr Pack HALF PLUSH Socks/Mottled Beige I enclose Cheque/P.O. made payable to Reed Medical for £

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Price Size Qty £18 £18 £18 £20 £20 £20 Postage & Packing GRAND TOTAL

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01254 503363

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66-68 A n M-colour.indd 67 MC 2694 267x212 Plush Cotton Socks.indd 1

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BAL05/12

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Cumfy Stuff is a trading style of Reed Medical. Co. Reg. No.2593748

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DIABETES INNOVATION

Confidence and control

C0412

ACCU-CHEK and ACCU-CHEK AVIVA EXPERT are trademarks of Roche. © 2012 Roche Diagnostics Limited. Company registration number: 571546

for people using MDI*

52% of patients reported reduced fear of hypos.1

Accu-Chek® Aviva Expert bolus advisor system.

Speak to your diabetes specialist or visit our website www.accu-chek.co.uk/avivaexpert www.accu-chek.ie/avivaexpert *Suitable for people using Multiple Daily Injection therapy and a long acting insulin analogue.

USE OF AN AUTOMATED BOLUS CALCULATOR REDUCES FEAR OF HYPOGLYCEMIA AND IMPROVES CONFIDENCE IN DOSAGE ACCURACY IN T1DM PATIENTS TREATED WITH MULTIPLE DAILY INSULIN INJECTIONS, Katharine Barnard et al, Journal of Diabetes Science and Technology, January, 2012

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