Balance Magazine Jan-Feb 2013 by John Clarkson

ED IT IO N

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Your diabetes lifestyle magazine • January – February 2013

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contents January – February 2013 • no 250

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 Sabeha Syed DESIGNER John Clarkson EDITORIAL SECRETARY Rosie Daniel CONTRIBUTOR Sheila Seabrook AD MANAGER Claire Barber, 020 7878 2319 claire.barber@tenalps.com ABC APPLICATION APPROVED 18/04/2012 ARTICLES & ADVERTISEMENTS

Products and services advertised in balance are not necessarily recommended by Diabetes UK. Although the utmost care is taken to ensure products and services advertised are accurately represented, it is only possible to thoroughly check specialist diabetes equipment. Please exercise your own discretion about whether or not an item or service advertised is likely to help you personally and, where appropriate, take professional advice from your medical advisor. Please note also that prices are applicable only to British buyers and may vary for overseas purchases. Paid adverts do not necessarily represent the views of Diabetes UK. Complaints regarding advertised services or products should be addressed to: Claire Barber, Advertisements Manager, Ten Alps Publishing, One New Oxford Street, London WC1A 1NU. Articles in balance written by freelance contributors do not necessarily represent the views of Diabetes UK. Diabetes UK policy statements are always clearly identified as such. ©Diabetes UK 2013 A charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136).

regulars 4 6

THIS IS DIABETES UK NEWS

features

22 T RIATHLON MAN

Getting off a bus stop early didn’t cut it for 60-year-old Type 2 John Nicholson. So he took up triathlons and found himself in Team GB!

Diabetes round-up

14 OPINION & LETTERS 18 RESEARCH MATTERS 50 RECIPES Healthy takes on comfort food classics

26 BACK TO THE FUTURE It’s our 250th issue – so what have been our biggest research stories?

54 BITE-SIZED For foodies

56 WALK

Walk on the wild side

58 TRAVEL

Paradise found. Tropical exploration in Borneo

life&health

Forget about any past diabetes setbacks and read our guide to concentrate on your healthy future; could you be B12 deficient?; Ways to keep your heart healthy; How to be ID savvy; & more

45 ASK THE EXPERTS

29 MEDALS OF HONOUR The Bupa Great Run Series

41 HEALTH NOTES

2012 has been a great fundraising year. We meet some of our most challenging runners

A look at your concerns, including transplants, sharps disposal and salt substitutes

47 SPOTLIGHT ON...

Celebrating your achievements 30 “I WAS LUCKY TO HAVE FATHER and upcoming events

Annual review. As we enter a new year, we explain all about your diabetes annual review – a vital appointment to help you manage your condition

Win £100 John Lewis vouchers with our prize crossword

expert, Barbara Currie

60 FUNDRAISING FOCUS 64 FUN & GAMES

66 DIFFERENT TYPES Arthur Smith and Mari Wilson tell it like it is

TO SHARE MY 48 BASIC CARE EXPERIENCES” Renewable energy: Three key Bridget Wilkins explains how yoga moves from leading

her life with Type 1 diabetes has been shaped by her own father’s experience and guidance

in our great giveaways!

34 BALANCE BONANZA Roll up, roll up, and take part 37 THE WAY WE WERE... A look back and a celebration of balance over the years

January – February 2013 balance 2-3 ContentsAC.indd 3

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this is Diabetes UK FROM THE CHIEF EXECUTIVE

FALSE ECONOMY

readful accounts are coming about Short-term PCTs rationing the number of blood savings risk glucose test strips for people with Type 1 diabetes. Clearly driven by a wish to long-term health save money, we hear regularly of people with Type 1 who are being limited to three strips a day. Not only is this against National Institute for Health and Clinical Excellence (NICE) guidance, but it also doesn’t make sense. Think of an average day. Testing before meals, testing before bed, testing before driving the car to work or to take the kids to school, testing around the exercise so important to the management of diabetes and to healthy living. Even without any driving for social purposes or heavy duty sport or exercise, that makes a minimum of four strips a day and probably more, eg when ill. Self-monitoring is a personal issue. Some people are confident with less monitoring, some want to manage their glucose levels with precision. Self-monitoring can be an important motivator to effective control. People with Type 1 diabetes need to agree with their healthcare professional about what regime suits them and how often they need to test. One-size-fits-all embargoes leave people in a position where they may be unable to control their diabetes as effectively with short-term dangerous impacts like hypoglycaemia and diabetic ketoacidosis and consequences over time for confidence, control and complications and cost. If people can manage their glucose levels effectively, that will help reduce their risk of developing complications which are not only costly in human terms but expensive for the NHS. Rationing strips for short-term savings is a false economy. Diabetes UK’s Careline advocate told the All-Party Group on Diabetes in Parliament about personal accounts of strip restrictions the helpline has received. The new Parliamentary Under Secretary of State for the Department of Health, Anna Soubry, had fortuitously dropped in to the Group meeting and was astonished. We’re pressing the case further for the NICE guidance to be the norm. We’re urging local health leaders and prescribers to stop issuing blanket restrictions on test strips for people with Type 1 diabetes. We’re working up our advice for those with Type 2 where the issues are different. This is simply one example of the growing number of examples where short-term savings and financial squeeze risk the longer-term health of people with diabetes which in turn will cost the NHS more. Effective education to help people self-manage their diabetes, ensuring everyone gets their 15 healthcare essentials would all help reduce costs in the long term. We know that 80 per cent of NHS spending on diabetes goes on treating complications and many of these could be prevented through investing in helping people to manage their condition properly in the first place. Diabetes UK increasingly needs to marshall economic arguments and evidence to help make the case for good patterns of care for people with diabetes. Baroness Young, Chief Executive, Diabetes UK

GET INVOLVED VOLUNTEER The passion, skills and dedication of Diabetes UK volunteers mean we can do more for people with diabetes. Whether you want to raise awareness, support people with diabetes or help run a local group, by joining our team of exceptional volunteers you will help us have greater impact.

CAMPAIGN Diabetes UK is campaigning hard for people living with diabetes but we can’t do it without your help. Join Diabetes Voices, our network for people who want to influence diabetes care. The more members we have, the more powerful our voice will be.

JOIN US Become a supporting member, or, if you’re a healthcare practitioner, a professional member of Diabetes UK. You’ll receive many benefits, including our magazines and updates on the latest developments in diabetes treatment, care and research.

FUNDRAISE We rely on generous donations to continue our vital work. There are many ways you can raise funds or give to Diabetes UK, and we’ll work hard to make sure your money goes a long way.

LEAVE A GIFT IN YOUR WILL Choosing to remember Diabetes UK in your will is a really special way to support our work and leave a truly lasting legacy for the future.

BECOME A PARTNER Joining forces with Diabetes UK means you’ll be working with us to address the nation’s biggest health threat. We welcome corporate partnerships and are always willing to discuss new opportunities to work together.

0845 123 2399 INFO@DIABETES.ORG.UK WWW.DIABETES.ORG.UK

balance January – February 2013

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news Number 10 supports 4 Ts campaign Diabetes UK thanks everyone who’s been supporting Diabetes UK’s Children and Young Person’s campaign by raising awareness of the most common signs and symptoms of Type 1 – the 4 Ts: Toilet, Thirsty, Tired and Thinner. The charity wants every parent, grandparent and carer, and anyone looking after children, to know the 4 Ts and what to do if they spot any of these, so that more children can be diagnosed before they become seriously ill with diabetic ketoacidosis (DKA). The charity is also working to influence health services to make sure that the right test is carried out to diagnose Type 1 and the right care is given straight away. The 4 Ts were featured in newspapers and on TV across the UK when the campaign launched on World Diabetes Day (14 November). The 4 Ts video was even shared on Prime Minister David Cameron’s Facebook page! A special reception was also held for MPs, children with Type 1 and their families at Speaker’s House – the official Westminster residence of John Bercow MP, Speaker of the House of Commons. Diabetes UK’s Chief Executive Barbara

Diabetes UK’s Richard Lane and Barbara Young, with Today presenter, Justin Webb (centre) Young welcomed Today programme presenter Justin Webb, who spoke of his experience as a parent of a child with Type 1, and Jamie Reed MP, who shared his personal story of living with the condition. The star of the show was 17-year-old Ross Edwards, who talked about his diagnosis and how living with Type 1 has never held him back; so much so that he’s busy

preparing to climb Mount Kilimanjaro later this year – wearing his insulin pump. In the next issue of balance we’ll update you on the next phase of the campaign, which will focus on improving the quality of care that children and young people with Type 1 receive. i To order free copies of the 4 Ts poster and flyer, please call 0800 585 088.

BOOTS UK TO OFFER IN-STORE DIABETES RISK ASSESSMENTS Boots UK has teamed up with Diabetes UK to offer in-store diabetes risk assessments. Launching in January, the risk assessments will be available at all Boots Pharmacy stores, close to 2,500 stores nationwide. They will be carried out by trained Boots Pharmacy colleagues and will be offered free of charge to customers who may be concerned that they are at risk of developing Type 2 diabetes. The diabetes risk assessment consists of a series of questions based on the risk factors of Type 2 diabetes. Customers will also have their waist circumference measured and their

trained in diabetes, on how to manage their risk, as well as a letter explaining this to take to their GP practice, and will be advised to make an appointment for further tests. The Diabetes Risk Score was developed by Diabetes UK, the University of Leicester and the University Hospitals of Leicester NHS BMI calculated. A risk score will be Trust. This association, which will help calculated, based on the answers, and customers to identify their risk of the final score will determine their risk developing Type 2 diabetes, highlights as low, increased, moderate or high. If Boots UK’s commitment to enhance customers score a moderate or high pharmacy services. i Visit www.diabetes.org.uk/riskscore for risk, they will be offered personalised Diabetes UK’s online risk score. advice from a pharmacist, specially

balance January – February 2013

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balance rounds up all the latest diabetes news

Peers criticise state of diabetes healthcare

Everyone’s talking about

The poor state of care for people with diabetes was highlighted in a two-hour debate in the House of Lords about the management of the condition in the health service. The debate was initiated by Lord Harrison of Chester, who criticised the NHS for failing to deliver the recommended standards of care and for not doing enough to hold commissioners of diabetes services to account for poor performance. Lord Harrison, who has Type 1 diabetes, also called for urgent action from the Government. During the debate, many agreed for the need to improve diabetes care and many peers called for greater improvements to diabetes foot care services and a reduction in the soaring rate of diabetes-related amputations. There was also praise for Diabetes UK’s work around this as part of its Putting Feet First campaign. Diabetes UK’s recently launched 4 Ts campaign was also singled out for praise by Earl Howe, Health Quality Minister, who responded on behalf of the Coalition Government. Bridget Turner, Diabetes UK Director of Policy and Care Improvement, said: “We hope that the debate will send a clear message to the Government and the NHS that they need to make prevention and management of diabetes a priority and ensure that people with diabetes have access to the healthcare they deserve and we look forward to seeing how this will be translated into action.” Other aspects discussed included care for children with Type 1 in schools, cuts to diabetes specialist nurses and the importance of early diagnosis. The debate follows the recent Public Accounts Committee report on diabetes healthcare in England, which criticised the NHS approach taken to diabetes care. The Government response to this report is due in the new year.

The next steps for Putting Feet First Diabetes UK, The College of Podiatry and NHS Diabetes jointly hosted a policy think tank and parliamentary reception on 22 October to launch the Putting Feet First campaign to parliamentarians and to explore the future priorities for the campaign. People with diabetes, vascular surgeons, podiatrists, diabetologists, GPs and a health economist spent the day exploring how Diabetes UK can ensure that the integrated foot care pathway – which will deliver the best foot care for people with diabetes – is commissioned by every clinical commissioning group (CCG) and delivered everywhere. Key issues for taking forward the campaign included ensuring that there is a foot protection team and multidisciplinary foot care team in every area and that people with diabetes know when and how to access them. It was also recognised that there is a need for local community champions to

The policy think tank in action ensure foot care for people with diabetes is a priority, as well as making sure that it is also a priority for those responsible for commissioning healthcare, who should also set and publish local targets for reducing amputations. The campaign aims to reduce amputations by 50 per cent in five years and will continue to be rolled out in 2013. i www.diabetes.org.uk/Putting-feet-first

Diabetes UK calls for action over new heart attack figures Diabetes UK is calling for urgent action as new figures reveal that people with diabetes are 48 per cent more likely to have heart attacks than the rest of the population. According to the new National Diabetes Audit report, 14,476 of those included in the audit had a heart attack during 2010/11, which is 4,694 more than expected. The real number of diabetes-related heart attacks will be even higher, as more than 10 per cent of people with the condition are not included in the audit, and the figures only cover people in England and Wales. Diabetes UK is urging the NHS to respond to the report by focusing more on providing the education and care to

prevent diabetes-related heart disease. At the moment, just 40.7 per cent of people with diabetes are meeting the recommended cholesterol levels, and 10 per cent aren’t getting the annual cholesterol check recommended by the National Institute of Health and Clinical Excellence. Many people with the condition also have high blood pressure and blood glucose levels, which also increase the risk of heart disease. Barbara Young, Diabetes UK’s Chief Executive, told balance: “We hope this report spurs the NHS into action to improve the current situation. i Check you are getting all your recommended health checks and services at www.diabetes.org.uk/15-essentials. • Turn to p43 for ways to keep your heart healthy.

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news

Lead researcher, Phillip Holland, Clinical Paediatric diabetologist at Leeds Children’s Hospital, holding his award, with Professor Parveen Kumar, Chairman of the Bupa Foundation, Dr Andrew Vallance-Owen, Bupa Group Medical Director, and Gio Allen.

UPBETE WEBSITE IS WINNER A team from Leeds Teaching Hospitals NHS Trust has won the Bupa Foundation Patients as Partners prize in recognition of their development of UpBete, an online support service for young people who have Type 1 diabetes and their families. Designed and built by families in the Leeds area, the Leeds Children’s Diabetes Team, Leeds Institute of Medical Education and MyKnowledgeMap, UpBete helps young people with Type 1 and their families, to manage the condition by

providing advice, information and online tools. The Bupa Foundation annual research prizes, of which Patients as Partners is one, recognise the very best completed research projects. The Patients as Partners prize is awarded to a project which helps to improve care by developing ways for patients to play a more active role in decisions. The winning projects in each of four categories receive a £15,000 prize. i www.upbete.co.uk

South Asian communities need culturally-specific education With South Asian people facing an increased risk of developing diabetes, the South Asian Health Foundation (SAHF) highlighted the urgent need to educate this community about the risk and symptoms of diabetes. This was the message that the SAHF took to the House of Lords in November. People from South Asian communities are up to six times more likely to develop diabetes than the white European population, and the SAHF is urging funding to be provided for prevention, and for local authorities to consider providing culturally and linguistically sensitive education sessions in high-risk South Asian communities to tackle the growing threat posed by diabetes to their health. The need to educate South Asian communities was highlighted earlier this year when the SAHF conducted a series of education sessions targeted at people in this community. More than 800 people attended these sessions and the SAHF found that many were unknowingly at high risk of developing Type 2 diabetes, with 75 per cent of South Asian people who underwent checks to assess their diabetes risk at one of these courses being referred to their GP. The SAHF is calling for ongoing funding to be provided for NHS Health Checks and for local authorities to replicate these highly successful diabetes educational sessions. i www.diabetes.org.uk/15-essentials

Lucentis approved for use in Scotland As balance went to press, it was announced that the Scottish Medical Consortium has approved Lucentis (ranibizumab), for restricted use within NHS Scotland in the treatment of diabetic macular oedema (DMO). Currently, Lucentis is not licensed for use in the rest of the UK. Lucentis is an injectable drug already used in the treatment of patients with wet age-related macular degeneration (wet AMD). Novartis, the manufacturers of Lucentis, estimate that, as a result of this decision, approximately 4,000

people in Scotland who have DMO will have access to this treatment. Jane-Claire Judson, National Director of Diabetes UK Scotland, said: “We are pleased that the decision from the Scottish Medicines Consortium to accept the revised submission for Lucentis will mean more people with diabetes will have a better opportunity to preserve and possibly improve their vision. We particularly welcome this decision as it will help to improve management of diabetes and decrease the risk of other diabetes complications.”

Dr Wasim Hanif, diabetologist and Chair of the South Asian Health Foundation diabetes working group, Mr Peter Meeus, Vice President of Novo Nordisk UK & Ireland, Baroness Barbara Young, Chief Executive of Diabetes UK, Dr Rowan Hillson, National Clinical Director for Diabetes, Lord Naren Patel KT, Patron of the South Asian Health Foundation, Dr Kiran Patel, Chair of Trustees, South Asian Health Foundation

balance January – February 2013

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2012 was ‘lost year’ of diabetes care

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THE CARE

YOU SHOULD RECEIVE

15 HEALTHCARE ESSENTIALS Having the right care is essential for the wellbeing of all people with diabetes. There is a minimum level of healthcare that every person with diabetes deserves and should expect. Here are the 15 essential checks and services you should receive. If you aren’t getting all the care you need, take this checklist to your diabetes healthcare team and discuss it with them. Checks and services for children. Children should receive more frequent HbA1c measurements and regular weight, height and general health checks from their healthcare team. Formal screening for complications generally begin at age 12. *If you live in Northern Ireland, care planning is different. Talk to your diabetes healthcare team.

Get your blood glucose levels measured at least once a year. An HbA1c blood test will measure your overall blood glucose control and help you and your diabetes healthcare team set your own target.

Have your blood pressure measured and recorded at least once a year, and set a personal target that is right for you.

Have your eyes screened for signs of retinopathy every year. Using a specialised digital camera, a photo of each eye will be taken and examined by a specialist who will look for any changes to your retina (the seeing part at the back of your eye).

Have your feet checked – the skin, circulation and nerve supply of your feet should be examined annually. You should be told if you have any risk of foot problems, how serious they are and if you will be referred to a specialist podiatrist or specialist foot clinic.

Attend an education course to help you understand and manage your diabetes. You should be offered and have the opportunity to attend courses in your local area.

Get information and specialist care if you are planning to have a baby as your diabetes control has to be a lot tighter and monitored very closely. You should expect care and support from specialist healthcare professionals at every stage from preconception to post-natal care.

Get support if you are a smoker, including advice and support on how to quit. Having diabetes already puts people at increased risk of heart disease and stroke, and smoking further increases this risk.

Receive paediatric care if you are a child or young person. You should receive care from specialist diabetes paediatric healthcare professionals. When the time comes to leave paediatric care, you should know exactly what to expect so you have a smooth change over to adult health services.

See specialist diabetes healthcare professionals to help you manage your diabetes. Diabetes affects different parts of the body and you should have the opportunity to see specialist professionals, such as an ophthalmologist, podiatrist or dietitian.

Have your kidney function monitored annually. You should have two tests for your kidneys: urine test for protein (a sign of possible kidney problems) and a blood test to measure kidney function.

10038586-UK-en/V01 OmniPod is a registered trademark of Insulet Corporation.

Have your weight checked and have your waist measured to see if you need to lose weight.

Have your blood fats (cholesterol) measured every year. Like blood glucose levels and blood pressure, you should have your own target that is realistic and achievable.

Receive care planning to meet your individual needs – you live with diabetes every day so you should have a say in every aspect of your care. Your yearly care plan should be agreed as a result of a discussion between you and your diabetes healthcare team, where you talk about your individual needs and set targets.*

Receive high quality care if admitted to hospital. If you have to stay in hospital, you should still continue to receive high-quality diabetes care from specialist diabetes healthcare professionals, regardless of whether you have been admitted due to your diabetes or not.

Get emotional and psychological support. Being diagnosed with diabetes and living with a long-term condition can be difficult. You should be able to talk about your issues and concerns with specialist healthcare professionals.

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ago, the Department of Health responded to criticism of diabetes healthcare by telling the NHS to improve the service it is offering people with the condition. But this survey shows that people with diabetes are not noticing things getting better and this means 2012 has been a lost year and a missed opportunity to make the kind of changes that are so badly needed. “It is true that there are some positive signs in this survey, such as the increase in the proportion of people getting an annual foot check, which can help prevent amputations by identifying problems at an early stage. But looked at as a whole, it is clear that we are still a long way from consistently delivering good quality integrated healthcare.” i For more information on the survey, visit www.diabetes.org. uk/15-essentials for more details.

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Diabetes UK has branded 2012 a ‘lost year’ for diabetes healthcare after results of the charity’s 15 healthcare essentials online survey suggested that there has been almost no improvement to people’s standard of care over the past 12 months. Of the 6,310 people who took part in the survey, 85 per cent said their healthcare had either stayed the same or got worse over the last year, while just 11 per cent said it had improved. In light of these findings, the charity views this failure to deliver significant improvements means 2012 has been a missed opportunity to reduce the risk of devastating health complications, such as amputation, blindness, kidney failure and stroke, and ultimately to reduce the number of people with the condition who die early. This lack of improvement is even more disappointing, given that there is now widespread agreement from organisations, such as the National Audit Office and the Public Accounts Committee, that diabetes healthcare is not good enough. There was some good news in the survey, however, with 79 per cent of respondents saying that they had had a leg and foot check in the past year – a rise of four percentage points on last year. Barbara Young, Diabetes UK’s Chief Executive, said: “A year

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20/12/2012 16:35

news

Improving Local Services

Brian and Pamela Quigley, of Redhill, chat to Lucy Curtis from Diabetes UK

Roadshows show the way

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Diabetes UK thanks everyone who helped make 2012’s roadshows the most successful yet – it wouldn’t be possible without the hard work of dedicated volunteers. With more than 90 roadshows planned for 2013, Diabetes UK’s buses hope to be in a town near you soon. i Email roadshow@diabetes.org.uk for more details.

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With 95 roadshows and 21,000 risk assessments, 2012 was a busy year for the Diabetes UK’s Roadshow team. Come sunshine, wind or rain, volunteer risk assessors have helped in the charity’s quest to assess members of the public for their risk of Type 2 diabetes. Having travelled more than 36,000 miles, the Roadshow buses have visited all corners of the UK.

of the public who were risk assessed were found to be at moderate or high risk of Type 2 and were referred to their GP

Voluntary group is a winner Diabetes UK North Staffs voluntary group has been presented with the Volunteering in Health Award, at the Newcastleunder-Lyme Community and Volunteer Awards Evening, in recognition of their exceptional commitment to the health and wellbeing of an individual or the community. The Volunteer Awards were instigated in order to raise awareness of the brilliant work that volunteers do and to celebrate and thank outstanding commitment or achievement in their

10 balance

volunteer role. All nominations were judged by a panel of professionals. As winners, the group will now be entered in to the next stage, The Volunteer Staffordshire Awards, the countywide award. All at Diabetes UK North Staffs voluntary group are proud to have won this award as it recognises the outstanding work that the group does within the local community and look forward to the next stage.

Diabetes UK has announced a ground-breaking new partnership with 10 NHS organisations. Through the Improving Local Services Together project, Diabetes UK will be supporting the NHS at a local level to involve people living with diabetes, to improve the care that they receive. Among the 10 organisations the charity will be working with this year, Diabetes UK has achieved a strong mix of organisations and, in particular, will be working with seven Clinical Commissioning Groups which provides an exciting opportunity for the charity to work with these organisations as they continue to develop and find their feet within the new NHS arrangements (see balance, November–December 2012). It will also mean that people with diabetes will be able to influence at an early stage of the design and planning of diabetes services. Diabetes UK will also be working with two Hospital Trusts and a Community Healthcare Trust, giving the charity a range of organisations to support. The organisations that Diabetes UK will be working with in the first year are: • Central London Community Healthcare NHS Trust • East Lancashire Hospitals NHS Trust • Hardwick Clinical Commissioning Group • Herts Valleys Clinical Commissioning Group • Islington Clinical Commissioning Group • Mansfield and Ashfield Clinical Commissioning Group • Medway Clinical Commissioning Group • North Hampshire Clinical Commissioning Group • Royal Derby Hospital • Torbay and South Devon Clinical Commissioning Group. i If you would like more information about the project, or ways to get involved in any of these areas, email the Improving Local Services Together Project on ILSTProjectTeam@diabetes.org.uk.

January – February 2013

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Diabetes UK is extremely pleased to be awarded Timesulin Partner of the Year 2012. This annual award, created by Timesulin, recognises the charity’s successful partnership with Timesulin in supporting the innovative new product, which aims to make life easier for people who have diabetes. Timesulin, a replacement cap for your pen to show how long since your last injection, aims to make life easier for people who have diabetes by reducing the risk of double dosing or missing an injection. “The motivation behind awarding Partner of the Year to Diabetes UK was to recognise the leap of faith the charity took with this new product – all in the name of making life for people with diabetes a little easier,” John Sjölund, Chief Executive and Co-founder of Timesulin (pictured above), explained. “We have done quite a bit of learning together and we are very keen to provide recognition for this. We are very appreciative to Diabetes UK and the efforts made to create a successful partnership i Timesulin is available from the Diabetes UK shop, visit https://shop.diabetes.org.uk/store/essentials/timesulin-cap.

Diabetes impact on loved ones revealed The impact that diabetes can have, not only on those living with the condition, but also their family members, has been revealed in the UK results for one of the largest global studies into the psychosocial aspects of the management of diabetes. The UK results of the survey, Diabetes Attitudes, Wishes and Needs 2 (DAWN2), formed part of a study conducted across 17 countries and four continents, conducted in 2012 with one of the aims being to advance understanding and awareness of the unmet needs of people with diabetes and their families. The UK DAWN2 study surveyed 122 family members, 500 people with diabetes and 281 healthcare professionals. Results confirmed that the physical, financial and emotional impact of diabetes is carried by the entire family. Of the concerns revealed in the survey: • 54 per cent of family members are anxious about the possibility that the person they live with will develop serious complications from the condition. • 70 per cent of family members of insulin-treated people with diabetes fear their loved one will become hypo during the night. • 21 per cent of people with diabetes report their family argues with them about how they manage their diabetes. DAWN2 expands on the original DAWN study from 2001 and involves more than 15,000 people living with or caring for those with diabetes, diabetes healthcare professionals, and patient organisations and diabetes policy experts.

6-15 News AC.indd 11

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Diabetes UK wins Timesulin award

The smallest insulin syringe in the world. Simple and discreet to use Easy to have with you The insulin you use is fresh for the whole day Designed to minimise the risk of underdosing or overdosing A great help for children with diabetes and their parents

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20/12/2012 16:36

news

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Classical Celebration raises diabetes awareness

£45k The amount raised on Diabetes UK’s annual London Bridges Challenge

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• See page 61 to find out more

More than 100 guests attended a ‘Classical Celebration’ on 3 October at Capesthorne Hall Cheshire, home of the Bromley Davenports since 1726. The evening was hosted by Louise Minchin (pictured, with husband David Minchin) from BBC Breakfast and attended by well-known personalities from Cheshire and the North West, including former professional cricketer Luke Sutton (pictured, left, with his wife, Jude). The event, which included a musical recital, featuring Italian pianist Arturo Benedetti Michelangeli, and an auction of two art works donated by world-renowned Salford artist Harold Riley, aimed to raise awareness of diabetes given that prevalence is extremely high in this area. The evening took its inspiration from the artwork donated by Harold and Diabetes UK is immensely grateful for his support. Guests heard from Diabetes UK’s President, Richard Lane, and Chief Executive, Barbara Young, as well as Luke Sutton, father of 3-year-old twins, who both have Type 1 diabetes, and Ashley Spiers. Both Luke and Ashley spoke of their respective challenges. Diabetes UK would like to thank all those who made the event such a huge success.

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

Mendor Discreet

Sharpsafe

Finnish company Mendor has launched an all-in-one blood glucose monitor, the first product of its kind in Europe and granted clinical approval, having undergone extensive testing. It contains all the necessary components: meter, strips and lancing device to be an integrated, all-in-one blood testing device. They call it ‘the MP3 player of blood glucose monitors’. i www.mendordiscreet.co.uk or find them on Facebook.

If you’re using lancets, needles and syringes then you’ll know that part of the pain is the hassle of having to dispose of these items safely after use. Purpose-designed containers for the safe disposal of clinical sharps are generally known as sharps bins and a good bet for one that will suit your needs can be found in the Sharpsafe range. Prices start from around £2.50. i Available on Amazon.

12 balance 6-15 News AC.indd 12

In brief... HELP WITH CHOOSING CARE

If you’re choosing a health or social care service, you can check Care Quality Commission’s (CQC) latest inspection reports. Available from CQC’s website, the reports provide the regulator’s judgement on whether a hospital, care home or homecare agency is meeting national standards of quality and safety. i www.cqc.org.uk

BE FOOD SMART

With January typically being a time for healthy lifestyle changes, Change4Life is calling upon the nation to get ‘Food Smart’ and learn about the hidden nasties in their food. The Be Food Smart campaign will highlight how healthier eating can be tasty, cheap and quick. For inspiration on healthier eating, such as tips on cutting back fat and for exclusive family recipes, sign up to Change4Life at www.nhs.uk/ change4life and see the recipe pack included with this issue of balance.

January – February 2013 20/12/2012 17:12

Sickly sweet syrup High fructose corn syrup (HFCS) made the papers again in November, with the Daily Mail declaring, “Syrup found in biscuits, ice cream and energy drinks is fuelling diabetes on a ‘global scale’”. The story revealed that countries where large amounts of HFCS are used have diabetes rates that are “20 per cent higher” than countries where HFCS is less common. This stemmed from a study looking at the link between diabetes levels and the availability of HFCS, which is used to sweeten a variety of processed food and drinks, but whose use varies widely between countries. The study, by research teams at the University of Oxford and the University of Southern California, found that countries which produced and sold the most HFCS also had higher levels of diabetes. Diabetes prevalence was 8 per cent in countries with high HCFS availability, compared with 6.7 per cent in countries with lower availability – a difference of around 20 per cent. But it didn’t show that people with diabetes were consuming more HFCS. In the UK, consumption of HFCS is negligible (0.38kg per person per year), whereas in the US it’s 65 times higher (24.78kg per person per year). Despite the alarming headline, the Mail’s report was well balanced, and included a graph that revealed the vast differences in HFCS availability in different countries.

DIABETES UK SAYS This study doesn’t prove that HFCS causes diabetes. For example, it does not show that individuals with diabetes consumed higher levels of HFCS or that this consumption was the key factor leading to their condition. Dr Richard Elliott, Diabetes UK Research Communications Officer, told balance: “While this study is certainly interesting, further research is needed at an individual level to find out if HFCS consumption can cause diabetes. Diabetes UK is currently funding a study to assess the link between fructose and Type 2. Professor Loranne Agius, from the University of Newcastle, plans to identify exactly how fructose triggers the metabolic changes that lead to fat being stored in the liver (or ‘fatty liver disease’), which is a common underlying cause of insulin resistance and Type 2 diabetes.”

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6-15 News AC.indd 13

20/12/2012 16:38

opinion

balance NHS

Hearty meals from Hugh FearnleyWhittingstall

SKY HIGH

Type 1 pilots get ready for take oﬀ

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

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

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

shock Benny talks diabetes and destiny

01 Cover.indd 1

18/10/2012 16:51

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

Plane-sailing?

It’s always exciting to see an article in balance about the artificial pancreas. When I first read about it several years ago, it gave me hope for the future. So it was with great interest that I started reading the article ‘Florence, the machine’ (Research matters, November–December 2012 balance) about the work of Dr Hovorka at Cambridge University; at last, a prototype was ‘undergoing trials’. Not only that, but participants were achieving much better blood glucose control’! How disappointing, though, to read in the following sentence that it could be ‘one or two decades’ until these machines become available. The artificial pancreas will surely have huge health benefits and indeed save many people’s lives, so is there no way we can speed up the process? Could more resources be given to Dr Hovorka? After all, this could be one of the most significant developments in the treatment of diabetes since the discovery of insulin. 20 balance

“My Type 2

“

Professor Boulton presents Professor Frayling with his awards

PLUS

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

GOOD THINGS...

THE GENETICS OF TYPE 2

‘Florence’, the machine

Diabetes UK’s kids’ campaign

What the changes mean

Cutting-edge results reported at conference

Why the delay?

SIGNS & SYMPTOMS

ALL NEW

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

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

PAGE 65

Your diabetes lifestyle magazine • November – December 2012

research matters

STAR LETTER

WIN

A VIRGIN BALLOON FLIGHT

Outcomes:

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

November – December 2012

20-23 Research Matters.indd 20

David Boxell, via email

Editor’s note: The artificial pancreas is very exciting, but the complexity of scientific research means that it can take a long time for significant breakthroughs to be made, and even longer for them to be translated into widespread improvements. We’re keen for this research to move forward, but it needs to be done carefully if it’s to really benefit people with diabetes, so it can’t be rushed. • You can help to move research forward by donating to Diabetes UK: www.diabetes.org.uk/donate.

18/10/2012 13:53

the commercially produced ones because by mid-morning I’m very shaky and on the verge of passing out. I’ve been Type 2 for many years and generally maintain good control through a combination of careful eating, exercise and a minimal dose of medication. I solved the problem of breakfast cereals several years ago by making my own. It’s based on rolled oats (not porridge oats) and a variety of similarly rolled grains and a handful of G Abrahams, via email assorted nuts, seeds and dried fruits. That, soaked in skimmed Editor’s note: Recent changes made by milk and topped with a fresh the Civil Aviation Authority to rules banana, seems to work very for pilots with insulin-treated well for me, whatever the day’s diabetes acknowledge advances in activities might be. the management of Type 1 diabetes. Once made, I store it in an Some press releases have described air-tight container and it lasts the need for pilots to be able to for months. Dr Clive Wheeler, via email demonstrate “good overall control of their condition”. This is misleading; Lidl sells a breakfast cereal called pilots with insulin-treated diabetes will have to demonstrate exceptional Goody, which has ‘no added sugar’. Thank you for such an informative control with rigorous monitoring and interesting magazine. and testing in place. As an airline pilot who was grounded with Type 2 diabetes, I am shocked to hear that pilots may fly with insulin (‘Pilots get all clear for take off’, News, November– December 2012 balance). Type 2 is fine, but not insulin users. Airline pilots are under considerable strain, work long hours at a stretch and often meals are taken at inconvenient times, maybe during the night. In an emergency, blood pressure may reach extreme heights and delays could put insulin out of the pilot’s reach. Not conducive to diabetes care. I hope I never have to fly with an insulin-dependent pilot.

Better breakfasts

I read with great interest and empathy Dr Hallington’s letter regarding the sugar-full breakfast cereals generally available at all supermarkets (‘Breakfast blues’, Letters, November–December 2012 balance). I can’t use any of

opinion

COLUMNIST Andy Kliman

Chatroom

I have scleroderma (a connective tissue disorder) and diabetes, and I’ve recently started on insulin. I’ve had a few problems since and I’m looking for fellow sufferers of both conditions to share tips and advice. I have difficulty writing and would rather keep in touch by phone, so please include your number when replying. Please reply to Mrs O’Loughlin, c/o balance chatroom.

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

was

Tim Edmonds, via email

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

Janet Shepherd, Scarborough

Breakfast blues

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

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

Dr Martin Hadlington, via email

Me & my balance

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

And balance reached new heights Resources when Diabetes UK’s Director of Human the way to Deirdre Saliba (left) took the mag all trek. the top of Kilimanjaro on a fundraising www. You can still support her by visiting virginmoneygiving.com/DeirdreSaliba. address, Keep your photos coming to the usual photo marked ‘Me and my balance’. Every bag. printed wins a Diabetes UK drawstring

The numbers game

So, it turns out it wasn’t threeand-a-half-years of Type 2 diabetes, but instead late onset of Type 1. This has posed a number of challenges, mostly surrounding insulin. There are two things you need to know about insulin: how much to inject and when to inject. And also how sensitive you are to it. Three things, there are three things you need to know about insulin: how much, when and how sensitive you are. And how to carb count so you know how

much to inject. There are four important things you need to know about insulin. Including the fact that there are two different types of insulin, so five things. The five things I have listed above are the key things you need to know about dealing with insulin. And then there are, of course, the effects of exercise, alcohol and what time of day it is as one’s sensitivity to insulin changes. So, in total, eight things. I probably shouldn’t mention the ‘honeymoon period’ when your pancreas splutters out some extra insulin in its death throes. But, despite all these complications, I’m actually doing pretty well. There’s a good support network on Twitter, too.

i After years of treatment for Type 2 diabetes, Andy Kliman has recently been at diagnosed with Type 1. Follow his blog http://t2dkidding.blogspot.com and his Diabetes UK blog at www.diabetes.org. @andykliman uk/bloggers.

19 November – December 2012 balance

18/10/2012 20:21

16-19 Your Views.indd 19

Derek Clements, via email

I would seriously suggest porridge – no sugar needed – with fresh fruit, to taste, cut small and mixed in. I use red top milk with mine. It’s also cheaper than sugary cereals and it’s good for you. Try it! I use one level cup of porridge to two cups milk,

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

14 balance

January – February 2013

14-17 Your Views AC FRIDAY FINAL.indd 14

21/12/2012 09:08

opinion

Blogs, tweets & posts www.facebook.com/diabetesuk twitter.com/diabetesuk “Tomorrow is the big day – I’m off to India to cycle 430km for Diabetes UK! I haven’t added up the grand total but it looks to be in excess of £4,500. I am really pleased and grateful to the amazing people who’ve helped!” Emma Davey-Sinclair, via the Diabetes UK Facebook page. @DiabetesUK I wish the 4Ts had been around when I was diagnosed. Then it wouldn’t have taken so long for a diagnosis. :( Amie Walsh takes to Twitter to support Diabetes UK’s Children and Young Person’s campaign. A low-fat, low-salt, low-sugar, high-fibre diet with plenty of fruit and veg is what most of us should be eating most of the time. I suppose the difference is that the consequences of not eating sensibly are a bit more severe for diabetics. Andy Broomhead discussing lifestyle changes in his blog ‘Diabetes by numbers’.

COLUMNIST Richard Lane OBE

Awe inspiring I continue to be in awe of the extraordinary contributions that have been made by so many people, not just by the Inspire Award winners and nominees, but by the countless volunteers who were unlucky not to have been nominated. All our volunteers are winners! A few weeks ago, I attended the Diabetes UK Scotland Family Weekend in Ayr. The 120 or so people who attended were roughly split equally

and put it in the microwave on ‘high’ for 4 minutes (check halfway through that it hasn’t boiled over). Then take out and stir, add a little more milk if needed, and put back in the microwave for 1 minute. Add more milk, if needed. Eat and enjoy. I buy Sainsbury’s porridge in a polybag – it’s good value.

Ann Eavis, via email

Cereal: 0.3g sugar per 30g portion; Tesco Wheat Biscuits (like Weetabix): 1.7g per two biscuits; Post Grape-Nuts: 3.4g per portion; Weetabix Oatibix Flakes: 4.2g per portion. Enjoy your breakfast, Dr Hadlington.

Rosemary Hamburger, via email

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Even the most innocent-looking cereals, eg corn flakes and the like, still have added sugar. After struggling for years to find a ‘no added sugar’ cereal, that was tasty, I came across puffed wheat. This has no added anything – it’s just wheat and I find it tastier than the shredded variety. If you want, add sweetener to make it taste like Sugar Puffs – children may find this more appealing. The only downside is, in some people, it may make your urine smell of the cereal.

Karen Shuttleworth, via email

I’ve found the following cereals acceptable: Tesco Instant Hot Oat between the children, the parents and carers, and the volunteers and members of staff. The organisation was supported by Head Office but was masterminded by a wonderful team from Scotland lead by a true volunteer, the amazing Bob McQueen, who has been at the helm of this event for more than 35 years! The wide variety of carefully organised activities catered for the different age groups, and for the parents. The support given by the volunteers was crucially important and covered just about every element of care, encouragement,

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New organisations CLINICAL COMMISSIONING GROUPS are made

up of general practices and are responsible for ‘the reasonable health needs’ of people who are in their area. They are responsible for producing the commissioning plan for health services in their area.

All change?

NHS COMMISSIONING

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

The NHS in England is going through one of the biggest reorganisations in its history, which takes eﬀect next April. And, for many, it’s all very confusing. John Fellows, Diabetes UK’s Senior Policy Oﬃcer, tells us what to expect

years. Your feature ‘NHS All Change?’ (November– 0800 197 7981 December 2012 balance) is extremely well written, especially the matter of efficiency savings in the NHS. My diabetes nurse rang me a few weeks ago and, out of the blue, asked me why I use so many test strips. I said that I like to keep an eye on my blood sugars and, because I test three times per day before meals, I have good control. She agreed, but GREAT CHOICE OF SIZES Including 18, 25, 40

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

*On Devon and Grosvenor ranges. Free item must be of the same value or less than your chosen item and December 2012. “Great British Mobility” must be ordered at the same time. is a trading style of The Mobility Rental Offer ends 7th Group Limited, Mobility House, Brinsea Batch, Brinsea, North Somerset BS49 5JP.

There’s been substantial media coverage and reports on the NHS reform, but for many people the changes are still unclear. Why?

One reason is that they’re not primarily about the care that people get from the NHS, the changes are mainly about the organisations that largely work behind the scenes and set the framework for how healthcare is provided. While most people are familiar with their local GP and hospital, people tend to be less interested in the workings of their Primary Care Trust (PCT) or a national organisation such as the National Institute for Health and Clinical Excellence (NICE). That’s not to say people won’t have come into contact with these organisations. For example, if a person has had to go to their PCT to argue for funding of a particular treatment, if they have had to check guidance or guidelines from NICE or if they want to be involved in local healthcare decisions through Local Involvement Networks (LINks). The new reforms are termed ‘marketbased’ because they increase the amount of competition between service providers.

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

Will we see much of a difference?

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

Why is it so controversial?

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

November – December balance 29

28-31 NHS Feat.indd 29

18/10/2012 21:11

fun and commitment that I can think of! The children, of course, enjoyed every second of the weekend, and the only tears that were shed were when they had to go home! The volunteers were to a man and woman, just inspirational, and worked tirelessly as a team, which genuinely ensured the success of the event. I was privileged to have been there with them! i Richard is President of Diabetes UK and has Type 1. • For more on Diabetes UK Care Events, visit www.diabetes.org.uk/care-events.

January – February 2013 balance 15 14-17 Your Views AC final.indd 15

20/12/2012 16:57

opinion

I love my... that I reduce to one test » suggested per day. I’m not happy with this and so I ‘top up’ my blood test strips, which I buy from the pharmacy. What’s going to happen in April 2013 …a restriction on the use of insulin? Maybe… hope not!

I seem to have to permanently wear trousers, so any idea how to cope with my NLD? I’d be pleased to hear from anyone.

Joan Brennan, Leatherhead

French fancy

Stuart Potter, via email During a trip to France, I had two

Editor’s note: See ‘False economy’, This is Diabetes UK, page 4, for what the charity is doing about this issue.

Skin deep

Thank you for your ‘Spotlight on… Necrobiosis’ (NLD) (Life & health, September–October 2012 balance). As last I have a diagnosis of my red patches. I’ve had diabetes for 60 years and, over the past 10 years, I’ve visited A&E and various doctors who were unable to give me a satisfactory answer to my dilemma. I’ve been a golfer for 50-odd years, and this rash appears when I’ve done 18 holes. Medics have happily told me to keep out of the rough, because it’s the long grass that sets it off! This I couldn’t believe. It wears off eventually, over about a week, with me rubbing E45 cream on it, but then my next game comes along and off we go again.

cartridges of short-acting insulin with me, but due to a malfunction either with the cartridges or with the pen (investigation pending), I was left with no usable supply. My friend suggested that it was not necessary to visit a doctor for a prescription, but instead to visit a pharmacy, and voila! Just on production of my pen and the cartridges, he sold me five new cartridges for €37. He didn’t ask for any ID or tag and didn’t want to see my EHIC. Easy and no fuss. For me, this situation has always been a worry, but now I feel much more relaxed about such medical issues arising in France, and for those who need it, English appears to be widely spoken in pharmacies in tourist areas.

Simon Long, via email

Editor’s note: We’re glad you found it was a stress-free experience on your trip away. Not everywhere will be

Columnist Patricia Debney

Never rains but it pours Recent events have made me think more broadly about whether coping with a chronic condition ‘makes you stronger’. Last month I went to the US and decided to move my mother into assisted living. While I was driving to see her there, my husband phoned: our daughter had badly dislocated her knee and was on the way to hospital.

16 balance

Only later – after seeing the stricken faces of friends – did I realise how strong indeed we had become. Because it hadn’t occurred to us that I would run home. My husband and Eliot could cope. Our daughter was safe. This isn’t to say I wasn’t torn, or that I didn’t cry and walk into my mother’s room, churning inside. But I do think that when you deal with diabetes in the family, day in and day out, when you deal with the grief and shock of diagnosis at whatever age – you can deal with pretty much anything. You develop resources; you

Email balance @ diabetes.org.uk or post to the usual address (see page 16) marked ‘I love my…’ My father, Roland Leonard Brooker, passed away on 22 October, aged 96. He was born in Sidcup and lived there all his life and married my mother Jean, who died in 1984. At 14, Dad did an apprenticeship with the now British Gas as a gas fitter and worked there until his retirement. For around 20 years he cycled, without gears, carrying a heavy case of tools, attending to business. He’d often ride 30 miles daily. He joked that the exercise was a benefit to his health in later years. He was diagnosed with Type 1 in 1939. He kept to a rigid diet, forsaking many ‘treats’, didn’t smoke but enjoyed the occasional glass of beer or wine. He cycled into his 70s, but following a stroke in 2000, used an exercise bike at home. He was proud to receive his 50, 60 and 70 year medals from Diabetes UK. He received the Macleod at the Diabetic Centre at Queen Mary’s Hospital. Doctors made a point of speaking to him as they’d not met anyone who’d lived with Type 1 for so long. Is there anyone else in the UK who has lived with, or is living with, Type 1 to such an age? David Brooker (via email)

learn to call upon close friends or professionals; you learn how to remain focused and healthy. If you don’t, the truth is that you simply go under. Our daughter is in a full length cast, and will need months of physiotherapy to safeguard the rest of her joints. And my mother is adjusting. I guess I’d choose to have this strength, rather than not. But I’d also choose for it never to be necessary. i Patricia is an author and senior lecturer in Creative Writing at University of Kent. Her son, Eliot, 15, has Type 1. www.wavingdrowning. @PatriciaDebney wordpress.com.

January – February 2013

14-17 Your Views AC final.indd 16

20/12/2012 16:58

opinion

COLUMNIST Andy Kliman as simple, so we do advise people to double check that they have all their kit, as well as spares to avoid any problems while abroad. Visit www.diabetes.org.uk/travel for more tips when going away.

asked to ring Hull for an appointment at the end of October – I did and my next NHS visit will be 7 January 2013 – some 16 weeks – so that’s two private visits between. Brian Hardgrave, East Yorks

Not putting me first

Editor’s note: Diabetes UKs Putting Feet First campaign is working to improve services for people with diabetes in order to reduce the unacceptably high number of amputations – most of which are preventable. You can find out more at www.diabetes.org.uk/ Putting-Feet-First.

I am reminded of Diabetes UK’s campaign, ‘Putting Feet First’. My experience at Bridlington Hospital has certainly been negative as a response by them to the campaign. I was diagnosed Type 1 in November 1990 – with neuropathy in my thighs as a consequence. I have attended the Podiatry Clinic at Bridlington Hospital ever since and had excellent attention by dedicated staff. However, over the last two years, there has been alterations in the timing of my visits – to my detriment. Firstly, six weeks was stretched to eight and eventually to 12 weeks. I was even advised by an NHS employee (on the advice of management) that I should go to a private podiatrist between NHS visits. I had treatment on the 11 September last – and was

Tough Mudder blogging!

I’ve had Type 1 for 31 years, and I recently took part in Tough Mudder North West in Cheshire. I trained for five months, but I found there was very little information out there for what to expect from an event such as this for diabetics. Having successfully completed it I wrote a blog to help others doing the same. It can be found here: http://sarkysharky.blogspot.co.uk. Oliver Chapman, via email

Me & my balance balance made it on a trip to Cambodia and Vietnam, along with Julia Newman and her husband. Julia, who has Type 2 diabetes and is treated with insulin, is seen here outside the entrance to Angkor Wat Temple in Cambodia (below), and getting ready to enjoy an Elephant’s Ear fish in a Vietnamese Village. Julia says: “The trip was wonderful, as was the food, and my diabetes was no problem, despite some high temperatures, thanks to the use of Frio cool bags and the hotel minibar fridges!” Keep your photos coming to the usual address, marked ‘Me and my balance’. Every photo printed wins a Diabetes UK drawstring bag.

The times they are a-changin’ There are three particular things happening to the NHS at the moment, and people with diabetes should be aware of them. The first is that the NHS has to save £20bn over the next four years. The second is that the rise in the number of people with complex illnesses and more than one illness when they are admitted to hospital – so that will be us then – is stretching the NHS. And thirdly, there is a massive re-organisation going on in the NHS. The organisations that buy the services we use, such as diabetic specialist nurses, are changing and you can get involved to help protect these services. Local authorities are setting up ‘Health and Wellbeing Boards’ which will be very influential. Anyone can apply to be on them. You can also ask them about your local Healthwatch and apply to join that board, as well. Healthwatch is the new patients’ watchdog. The Royal College of Nursing says diabetes specialist nurses are being cut as the funding dries up. We need to fight to maintain those services and the best way is to get involved, or we might wake up to find the people we rely on have gone. i Diabetes Voices: www.diabetes.org.uk/ diabetesvoices • Andy Kliman has recently been diagnosed with Type 1. Follow his blog at http://t2dkidding.blogspot.com and his Diabetes UK blog at www.diabetes.org. @andykliman uk/bloggers.

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research matters Patient-friendly stem cells obtained from blood A technique for producing stem cells from a patient’s own blood, which could provide one of the safest and most readily available sources of cells for research and patient treatment has been developed by scientists at the University of Cambridge. Stem cells can transform into every other type of cell in the human body and could potentially be used to repair tissues of the brain and heart, or to regenerate the pancreatic islets that are destroyed in Type 1 diabetes. It is possible to obtain stem cells from embryos, but this is ethically controversial and, like an organ transplant, the cells gathered would be rejected by the immune system if given to a patient. Recent Nobel prize-winning research has shown that skin cells taken from adults can be reprogrammed to become stem cells, which would not be rejected if they were returned to the original donor. However, it can be difficult to obtain the high-quality skin samples needed to produce such cells and a surgical procedure is often required. Dr Amer Rana and his colleagues at the University of Cambridge got around this problem by growing patients’ blood in the lab and isolating repair cells known as ‘late outgrowth endothelial progenitor cells’

Close-up of the ‘patient-friendly’ stem cells (L-EPCs), which they turned into stem cells. Dr Rana, whose research was funded by the British Heart Foundation, Medical Research Council and Wellcome Trust, said: “We are excited to have developed a practical method to create stem cells from a cell type found in blood. Tissue biopsies are undesirable – particularly for children and the elderly – whereas taking blood samples is routine for all patients.”

While there are still many safety hurdles to overcome before cells derived by this kind of technique could be used to treat patients, being able to obtain stem cells from blood will help to move this area of research forward. i This study was published in Stem Cells: Translational Medicine in November: http://dx.doi.org/10.5966/sctm.2012-0093

App Challenge update

‘Take part in research’ right). Diabetes UK’s Head of Research, Dr Matthew Hobbs, said: Back in July (July–August balance) we told struggle to manage their condition, so “We are now at an exciting phase of you about the ‘Diabetes App Challenge’, a using apps to improve their engagement the project, as the newly designed apps competition hosted by researchers at with healthcare appointments could be a will be placed in the hands of potential Peninsula Medical School and the University big help. The first stage of the competition users for the first time. Hopefully they will of Plymouth. The challenge is part of a closed in October and six different apps allow young people with Type 1 diabetes to Diabetes UK research project that has have been submitted for different electronic identify areas where they might need a little encouraged young people with Type 1 platforms (including iPhone, Android and more help or support, and empower them diabetes to design internet and mobile the web). The researchers are now looking to take control of their condition.” phone apps that will help them set the i For details, visit www.diabetesappchallenge.org. for 200 young people with Type 1 diabetes uk and see an interview with the lead researcher at agenda for healthcare appointments. who can help them to test each app and http://youtu.be/L08W-SvRx74. Teenagers and children with Type 1 often determine which is the most effective (see

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TAKE PART IN RESEARCH esearchers funded by Diabetes UK at R Peninsula Medical School and Plymouth University are calling on people with Type 1 diabetes aged 16 to 22 to join a study of internet and mobile phone ‘apps’ that could help young people with diabetes to get more out of their healthcare appointments (see news story, below left). Participants will be asked to try out an app to help them set the agenda for a diabetes clinic appointment and will receive a £20 gift voucher for their time. For more details and to take part, visit www.diabetesappchallenge.org.uk. esearchers funded by Diabetes UK R at King’s College London and Cardiff University are currently recruiting people aged 18-40 who have recently been diagnosed with Type 1 diabetes (within 100 days) to help them evaluate a new vaccine for the condition. The study, which has centres in London, Cardiff, Bristol and Newcastle, will help with the development of a new therapy that ultimately aims to prevent the loss of insulin-producing beta cells and benefit patients with, or at risk of, Type 1. For information, email diabetesresearch@cardiff.ac.uk or call 0781 6240 299. A team at King’s College London, Imperial College London and the University of Oxford would like to recruit people aged over 18 who have diabetes and neuropathy. They are studying the underlying causes of neuropathic pain and hope to uncover why some people with diabetes and neuropathy develop pain when others do not. Findings could help assist the development of new therapeutic approaches in this area. Contact Dr Juan D Ramirez on 07902 114 851 or juan.ramirez@ndcn.ox.ac.uk.

The ‘hidden heroes’ of diabetes research On World Diabetes Day (14 November), the National Institute for Health Research – the medical research arm of the NHS – launched a new website to highlight the groundbreaking work that UK researchers are doing to tackle diabetes. The ‘Focus on Diabetes’ website features interviews with members of the research community who work behind the scenes to link NHS patients with suitable clinical studies – enabling people with diabetes to take part in research and helping doctors to gather the evidence they need to develop better treatments. These ‘hidden heroes’ are hard at work to improve our scientific understanding of diabetes and to explore new ways of improving the prevention, management and treatment of Type 1 and Type 2. The website also provides information for patients on what it is like to take part in a research study, what trials are currently underway, and how they can get involved. Dr Jonathan Sheffield, Chief Executive of the Research Clinical Network, said: “In some ways, the National Institute for Health Research is the best kept secret in the NHS. “Patients benefit from the results of its work, but they don’t always know what goes into creating better treatments. Diabetes is a problem that affects huge numbers of people, so this is a great opportunity to tell patients what researchers are doing to help, and how to get involved.” i Visit the site at www.focusondiabetes.nihr.ac.uk.

Chris Peters (above) was diagnosed with Type 1 diabetes, aged 14, as he was embarking on his GCSEs. He’d been suffering from lack of sleep for about three months: “I was drinking lots, which meant that my sleep was disturbed with trips to the bathroom, and my teachers were concerned about my concentration levels.” On a trip to the doctors, Chris’ blood glucose was found to be extremely high, so he was sent to hospital where he was taught some of the basics about diabetes, such as how to take insulin injections. Chris, now 28, regularly looks into research opportunities to find out the latest diabetes news: “It’s important that clinical research continues in the NHS because it’s an opportunity to help more people with diabetes now and in the future. I think there’s more knowledge about diabetes now, and NHS staff are better trained to advise about diabetes. I think this has stemmed from continued research into diabetes. I’m keen to see more research happening in diabetes especially into looking for a cure for it, as that would be life-changing for millions of people.”

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his study the

an be owing

research matters

Further evidence links Vitamin D and Type 1 A six-year research study in the US has found a strong association between low levels of vitamin D in the blood and the risk of developing Type 1 diabetes. The study, led by researchers at the University of California San Diego, examined blood samples drawn around the same date from 1,000 people who later went on to develop diabetes and 1,000 people who did not. They compared concentrations of the most common circulating form of the vitamin in the blood (vitamin D3) and found that people with levels of 17 nanograms per millilitre (ng/ml) of blood or less were more than three times as likely to develop Type 1 diabetes when compared with those who had readings above 40ng/ml. Accordingly, people with readings between 17 and 23ng/ml were more than twice as likely to develop Type 1. “Previous studies proposed the existence of an association between vitamin D deficiency and risk of Type 1 diabetes, but this is the first time that the theory has been tested in a way that provides the dose-response

relationship,” said Professor Cedric Garland, an author of the study. These findings have enabled Prof Garland to estimate the dosage of vitamin D that might be used to prevent approximately half the cases of Type 1 worldwide. However, the study has some limitations and the results are yet to be confirmed via a randomised controlled trial (the ‘gold standard’ method for evaluating new approaches to healthcare). Moreover, the exact causes of the link between Type 1 and vitamin D remain uncertain and additional factors are likely to be involved. Scientific consensus suggests that there are no known risks associated with adding small doses of vitamin D to the diet, but the researchers recommend that those with Type 1 speak to their healthcare team before changing their vitamin D intake. “This beneficial effect is present at these intakes only for vitamin D3,” cautioned Prof Garland. “Reliance should not be placed on different forms of vitamin D and mega doses should be avoided.”

Making sense of science The sixth annual Networking Day for PhD students funded by Diabetes UK took place in London in November. The day brought together students supported by the charity from across the UK by allowing them to share the latest findings from their research through talks and scientific posters. The focus of the day was ‘communicating research’, and the students were tasked with summarising their work in simple terms for members of the Diabetes UK Grants Advisory Panel (people with diabetes who help to inform the charity’s research funding decisions). Later, the students were given a masterclass on the different avenues of research communication from Dr Natasha Martineau, an experienced science communicator from Imperial College London. They also received tips on engaging the media from the Diabetes UK press office. The most experienced students talked about their work for a video that will appear on Diabetes UK’s website later in the year.

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TAKE PART IN RESEARCH U K researchers in Aintree, Durham, Dundee, Exeter, Glasgow, Hull, London, Manchester, Newcastle, Plymouth and Salford are seeking people with Type 1 diabetes aged 40 or older to participate in a trial of the drug metformin. They aim to find out whether using this drug in combination with insulin for three years will limit the clogging and hardening of the arteries that leads to stroke and heart disease, as well as helping to prevent other complications of diabetes. Contact Tracey Anderson at the REMOVAL Project Management Unit in Glasgow on 0141 232 9543 or researchpmu@ggc.scot.nhs.uk. D iabetes UK-funded researchers at the University of Southampton are asking people with Type 1 diabetes aged between 18–30 to complete an online survey related to alcohol and health. They are studying alcohol consumption, knowledge of the effects of alcohol and strategies for managing diabetes among young people with Type 1. Their work could help to minimise the risks associated with alcohol use and promote improved self-management. To complete the survey, visit www.isurvey. soton.ac.uk/5882 or for more details, contact Dr Barnard at k.barnard@soton.ac.uk. R esearchers at Lancaster University are studying the experience of body image among young women with Type 1. They would like to recruit women from the North West of England aged 16–25 who were diagnosed before December 2011. Participants will be invited to attend a short interview to discuss their views of their body, weight and other aspects of physical appearance, and their ideas about how this relates to their diabetes. The researchers are interested in learning from both positive and negative experiences. For information, contact Nicola Pilkington on 07508 375655 or n.pilkington@lancaster.ac.uk. i For more opportunities to get involved, visit www.diabetes.org.uk/research/ get-involved-in-research.

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“Had I not been diagnosed as having diabetes, I’d probably still be talking, but doing nothing,” says John

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Photos: marathon-photos.com

Triathlon Triathlon Triathlon Triathlon man man man man

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on holidays

Following his Type 2 diabetes diagnosis, John Nicholson, 60, struggled to ﬁnd an inspiring exercise regime. Then, as a spectator at a local triathlon in 2009, John resolved to take part the following year. Since then, he’s represented Team GB at the World Championships and, as he tells Elizabeth Hughes, is now preparing for his next big challenge – alongside Olympic medallist, Jonny Brownlee

Photos: marathon-photos.com

eing told you have Type 2 diabetes can be a shock for anyone, but company director John Nicholson, now 60, has come to view his diagnosis as a cloud with a silver lining. That moment – five years ago – was a wake-up call that not only prompted him to improve his health and fitness, but also led to a world of opportunities and fantastic achievements. Two years after being diagnosed, John felt so inspired after watching a triathlon event in his local village, that he took up the sport himself and his progress since then has been astonishing. “Had I not been diagnosed as having diabetes, I would probably still be talking, but doing nothing, about tackling the village triathlon,” John says. “As it is, I have found a whole new dimension to my life that I would recommend to anyone.” His first competitive event was in May 2010 and by July 2012 he had qualified to represent Great Britain at the Age Group Sprint World Championships in October of the same year. A busy career with engineering consultancy WSP (which provided the structural engineering expertise for The Shard in London) means long hours, frequent travel and overnight

stays in hotels. Before he was diagnosed with Type 2, John did not prioritise exercising or eating regularly and says he “led a fairly sedentary life and drank more alcohol than I should”. Then, in 2007, John noticed he had lost a significant amount of weight over a six-week period and was feeling tired and unusually thirsty.

Tackling treatment

Jonny Brownlee signed John’s Diabetes UK vest and it’ll be auctioned later this year that he immediately start taking insulin worried John, and he sought second and third opinions regarding his treatment. “My reaction was to challenge the insulin prescription and explore what someone like me, who didn’t fit the typical Type 2 risk profile, could do to manage the condition in a range of ways – not just through medication.” John is now very happy with his current GP, with whom he feels he can work in a holistic way.

Despite a family history of Type 2 diabetes (his mother was diagnosed in 1984), he put his symptoms down Making that to stress and overwork. change Like many men, it took a lot of “I currently persuasion by his wife, Jane, to take two 500mg get him to visit the doctor, but metformin eventually he made an appointment. “The first doctor I consulted I’ve found a whole new confirmed my blood dimension to my life that I’d sugars were recommend to anyone abnormally high and diagnosed Type 2 diabetes,” John remembers. It was a real shock. In his mid-50s. John had never suffered from any serious illness, wasn’t overweight and had been eating fairly healthily for years. The GP’s recommendation

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John and wife Jane have travelled to some great places so he can take part in triathlons

tablets twice a day, having tried unsuccessfully to manage my condition by diet and exercise alone. That said, I continue to work with my current doctor and on an overall regime that minimises the need for medication and/or an escalation in clinical treatment.” Immediately after his diagnosis, John made adjustments to his diet and started a limited exercise programme – using the stairs, rather than the lift, getting off the bus a stop early and making short trips on foot. This stabilised his condition, but did little to bring down his blood sugar levels or allow a reduction in medication. John felt that a more challenging

Inspired by John’s story? Sprint distance triathlons involve a 750m swim, 20km bike ride and 5km run. The Olympic Distance event is 1.5km swim, 40km bike ride and 10km run. i To find triathlon clubs and events near you, visit the British Triathlon Federation website www.britishtriathlon.org.

form of exercise was needed, but found gym sessions boring and soul-destroying. It was while pondering what activity would suit him that he went to watch the 2009 annual triathlon in Crondall, Hampshire. “I realised that taking part would provide a focus for the exercise element of my diabetes management regime,” John says. “What’s more, the whole atmosphere around triathlon is extremely supportive, with first-timers encouraged to race alongside experienced competitors. “I resolved there and then to take part the following year. I started training, joined Farnham Triathlon

Club, completed my first triathlon in May 2010 and duly completed Crondall in June that year – beating several people younger than me!” Since then, there’s been no stopping John. He continues setting himself new goals each season, completing his first open water triathlon in Barcelona in October 2011, then representing Great Britain in the World Championships held in

Seeing New Zealand and being part of Team GB has been one of the most amazing experiences of my life

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Auckland, New Zealand, a year later. On that trip, he and his wife stayed in the same hotel as the elite athletes and, despite suffering from a bout of gastroenteritis in the days leading up to his race, John came a very respectable 26th in his age group. John smiles, as he says: “Seeing New Zealand and being part of the same GB Team as elite triathletes Jodie Stimpson and Olympic Bronze Medallist Jonny Brownlee has been one of the most amazing experiences of my life.” It was in New Zealand that Jonny Brownlee won his first World Championship and hours after crossing the line he met with John

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and was kind enough to sign a shirt for Diabetes UK. Now, both Jonny and John have set their sights on the Grand Final of the 2013 Triathlon Championships, which take place in London in September and will use part of the Olympic course where the Brownlee brothers were so successful at London 2012.

Fitter than ever John is keen to raise awareness of diabetes and show people that those with the condition can achieve great things in their personal, professional and sporting lives. He is now healthier and fitter than ever, packing healthy snacks, such as

oatcakes and wholesome salads, when his business schedule leaves little time for proper meals. When travelling, John books into hotels that offer access to exercise facilities or are close to a park or swimming pool, so that he can stick to his training plan. His advice to anyone struggling with their diagnosis is typically positive: “Take it as a challenge that you can deal with and do something about it,” he says. “Diabetes need not be a stigma or something that stops you from doing something. Take it as a wake-up call and build yourself a lifestyle management plan. Stop flogging yourself at work and get some balance in life.”

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research feature

BACK TO

THE

FUTURE

Updates on the latest diabetes research have always been an important feature of balance. Dr Richard Elliott looks back at two of the incredible scientiﬁc milestones that have graced these pages over the years

ublished in January 1935, the first issue of The Diabetic Journal consisted of 48 pages on highquality paper and cost readers a shilling (or twelve old pence). Alongside photographic illustrations and adverts to help it become self-sustaining, it included an article on the discovery of insulin by Dr Charles Best who, along with his co-discoverer Sir Frederick Banting, had recently agreed to become vice-presidents of the Diabetic Association. Although the charity was renamed the British Diabetic Association (BDA) in 1954 and then Diabetes UK in 2000, and The Diabetic Journal later became known as balance, research has featured strongly in its output ever since. The balance archives are a showcase of cutting-edge diabetes research, often presented by eminent researchers who were the recipients of Diabetes UK grants and all of it made possible through the dedicated fundraising efforts of supporters. Below are just a couple of highlights from the last 77 years of scientific progress…

Penject – the first insulin pen As many people with diabetes will know, the number of daily insulin injections recommended by doctors has varied over the years. When first introduced in the 1920s, the only available insulins were short-acting, which meant that three daily injections were needed. The gradual introduction of longer-acting insulins meant that, by the 1960s, most people with Type 1 in Europe and the United States were injecting only once or twice daily. However, by the late-1970s, growing emphasis on glucose control meant that doctors were encouraging more frequent daily injections. In 1979, the Glasgow physician Dr John Ireland began designs for a new device that would simplify the process of drawing up and delivering insulin and help make regular injections as easy and painless as possible. Writing in the April 1983 issue of balance he said: “What we wanted was something that the diabetic patient could pull out of a pocket and use at the touch of a button as easily as the modern ballpoint pen. But the problem was much more difficult than designing a pen – for two special reasons. We had to think of

26 balance

sterility which placed a serious limitation on many of the ideas we had about design. Secondly, instead of just pressing a button as on a ball-tip pen, the diabetic would need a push button which could deliver any dose of insulin accurately and reliably. With support from the company Hypoguard Ltd, Dr Ireland and his colleagues developed a prototype insulin ‘pen’ that converted a disposable syringe into an accurate insulin delivery system. It could administer a precise dose simply by fitting a filled syringe, rotating a dial to the desired number of units and pressing down on the pen head. Dr Ireland was at first uncertain if people with diabetes would take to his new invention and so he applied for a grant from the British Diabetic Association (BDA) to help him test it out. “The BDA generously provided funds to enable an assessment to be made by diabetic patients in several centres in England,“ he said. “By December 1982, 76 diabetics had used the pen (now called Penject).Although the patients found the pen accurate and

reliable, some diabetics found it heavy to handle or had difficulty in setting the dose. As a result of these criticisms the production instrument has been modified to incorporate several improvements.” The finished Penject product was the fruit of a collaboration between the NHS, the BDA and private enterprise and became available in the summer of 1983. Although it was still somewhat awkward to use, it influenced the Novo company’s design of Novopen, a similar device that won design awards after its launch in 1985 and contributed greatly to the uptake of a basal-bolus regimen of multiple daily injections. Modern insulin pens have become a reliable and important tool for people with both Type 1 and Type 2 diabetes and are now in widespread use the world over.

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Beating blindness – from the back of a second-hand ambulance Retinopathy is perhaps one of the most feared complications of diabetes. It involves changes in the tiny blood vessels that nourish the retina at the back of the eye, which, if left untreated, can lead to serious vision problems. Within 20 years of diagnosis, nearly everyone with Type 1 diabetes and almost two-thirds of people with Type 2 diabetes will have some degree of retinopathy. As a result, diabetes is the leading cause of blindness among UK people of working age. Treatments for retinopathy are highly effective if given at an early stage, so it is vital that people with diabetes have regular eye checks to ensure that the early signs of eye damage are spotted quickly. However, until the late-1980s retinal screening could only be carried out by ophthalmologists with specialist equipment, which was expensive and meant that it was almost impossible to screen everyone at risk. To improve the situation, in 1986 the BDA awarded a small grant to Professor Roy Taylor at Newcastle University so that he could test whether a retinal camera could be used to photograph the eyes of people with diabetes. To make screening more accessible to people with diabetes, Prof Taylor’s team set up their

camera in the back of a second-hand ambulance, which visited diabetes clinics in and around Newcastle upon Tyne and could screen up to 48 people a day. Lilian Lovelock, the retinal photographer on Prof Taylor’s team, wrote about her experiences in balance 116 (April–May 1990) and emphasised the unique benefits of the approach: “People are photographed as they arrive at the clinic and are seen by the doctor afterwards. This means that the films are available for the doctor who can, if necessary, discuss any findings with them. The Polaroid retinal photographs have proved invaluable for educating about the progress of diabetic retinopathy. As people are photographed annually and their films are filed chronologically, changes can easily be seen and explained to them. Any treatment required can then be planned with them.” After operating for three years, and travelling more than 9,500 miles around Newcastle, Prof Taylor’s ambulance had demonstrated that mobile photographic screening was cost-effective, practical and more reliable than existing methods. Moreover, a photographic record of

patients’ eyes not only allowed doctors to make decisions with greater confidence, but also revolutionised the teaching of ophthalmoscopy to medical students. With a donation of £150,000 from the Allied Dunbar Foundation and additional support from Diabetes UK Tavistock voluntary group, the BDA awarded Prof Taylor a larger grant that enabled a fleet of mobile screening units to be established across the UK in the late-1980s. The roll-out of a national eye screening programme culminated in 2002 with a revision to the national health guidelines that recommended Prof Taylor’s technique as the most practical method for eye screening. It will take time for the year-on-year benefits of widespread eye screening to be realised, but a follow-up study by Prof Taylor in 2010 has already revealed that, unlike the rest of the UK, retinopathy is no longer the leading cause of blindness among Newcastle’s working age population, thanks to this pioneering experiment.

Looking back, moving forward While it is clear that the areas studied and the techniques used have changed dramatically over the years, the slow and meticulous nature of scientific research remains much the same. Looking ahead, it is important to remember the achievements and the fundraising and hard work it took to get there. James G.L. Jackson, a former Secretary General of the charity, was an advocate of diabetes research and described it adeptly in the pages of balance:

“You may sometimes wonder whether there is any progress at all... but even though they may be imperceptible, there are advances being made; not yet big enough to shout about perhaps, but yet all steps along the road of discovery. Is the winning post yet in sight? Perhaps not yet but it is drawing closer every day – and YOU are helping immeasurably. “Gardeners will recognise the importance of planting seeds, and the need for patience whilst waiting for the

flowers and shrubs to appear. Diabetic research consists, too, of the planting of a number of seeds and waiting patiently for them to come to fruition. Sometimes it is possible to graft two or more seeds together to produce some new plant: so is it possible in research to combine the fruits of separate investigations to make a new discovery.” (balance, March 1962 and September 1966)

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feature

Medals of honour

As charity partner for the Bupa Great Run Series, almost 10,000 runners took part in the events for Diabetes UK in 2012. balance met some of the challengers

homas Wilson and Emma Course both wanted to celebrate Diabetes UK’s role in the Bupa Great Run Series, by taking part in all of the Bupa Great Runs in 2012. After months of training and a vast range of weather conditions, they completed the challenge at the Bupa Great South Run 2012, which took place on 28 October.

Thomas takes up the challenge “I like to set myself a challenge each year to raise money for Diabetes UK,” explained Thomas, 59, from Glasgow, who took part for his 25-year-old son Adam, who was diagnosed with Type 1 when he was 5. “Previously, I’ve cycled from Land’s End to John O’Groats and from Hanoi to Ho Chi Minh City (formerly Saigon) in Vietnam, as well as climbing Everest and Kilimanjaro, but this time I decided to stay a little closer to home. I’ve always enjoyed running, and once I found out that Diabetes UK was chosen by Bupa as the nominated charity for 2012, I knew this was the perfect challenge for me. “My favourite race has to be the Bupa Great North Run, which took place in Newcastle in September, because of the great atmosphere and fantastic

Manchester Run 2012 because the course was fairly flat, which gave me a personal best! My sisters also came along to support me, which was brilliant. The second was the Bupa Great North Run – because it's one long route that doesn’t loop back on itself, each step was one closer to completing it. The course was exciting and there was a fabulous atmosphere the whole way round. The third is the Bupa Great Birmingham Emma runs the course Run 2012, where I ran my fastest half Emma, 25 from Somerset, signed up to run marathon ever. The Bupa Great South Run for Diabetes UK because her sister has the in Portsmouth was my final favourite. Not condition. Emma said: “Sam was diagnosed only was it a flat race, it was also the last with Type 1 when she was 11 and I was 10. race of my challenge, and all my family and We watched the Bupa Great South Run some friends were there to cheer me on, 2011 and I decided to tackle all of the runs making it incredibly special for me.” for Diabetes UK. Mark Fox, Diabetes UK's Events “There were four races that stood out Marketing Manager told balance: “We've seen a fantastic result from the Bupa Great for me: the first was the Bupa Great Run Series. Working together with Bupa, we're hoping to inspire healthier lifestyles and show that anyone can take up running as a past time. I'd like to thank Thomas and Emma for all their determination, hard work and support this year, and congratulate them on raising more than £1,000 each for the charity.” The total distance of all i To sign up for the Bupa Great Run Series 2013, 2012's Bupa Great Runs visit www.diabetes.org.uk/bupa. organisation. The Bupa Great Manchester Run, a 10k event, which took place in May, also had a great atmosphere, so I’m really excited about taking part in that race again this year. Because Diabetes UK will be the nominated charity for the Bupa Great Run Series 2013, too, I’m intending to do all of the races again, but I might have to do something else as well to up the ante!”

70 miles

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“I was lucky to have Father to share my experiences”

Bridget’s father, Jim Nicholls, left her a lasting legacy of how to live with diabetes

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feature

Bridget Wilkins, 69, has had Type 1 diabetes since she was 9. A design and oral historian, she encouraged her 87-yearold father, Jim Nicholls, to record his experiences of living with Type 1 in the 1920s, as well as his care under Dr RD Lawrence. Bridget shares her recollections and explains how her father’s guidance continues to inﬂuence her

ne of my first memories of having diabetes was of my father taking me to the diabetic clinic at Sussex County Hospital in the early 1950s for regular weight checks. It was fairly soon after my diagnosis and I had lost a lot of weight. There was this very sharp sister there, who I used to loath. I was petrified of her! I’d learnt at school that water weighed a lot. Armed with this knowledge, before the appointment I would fill myself up with as much water as I could drink – so that I appeared to weigh more than I actually did – and to avoid being shouted at by this dragon of a sister. I can’t recall the exact chain of events leading up to my diagnosis, but I know that at Christmas time I started to get up in the night to go to the toilet. This got progressively more frequent and I started to lose weight and become regularly thirsty. But it wasn’t until Easter time that I was put on insulin and diagnosed Type 1. Father, who had been Type 1 since his teens, said they didn’t want to jump to conclusions about me being diabetic, which is why it took so long for me to be treated. It was the early 1950s and I was 9. As a young girl, I was lucky to have my dad to share my experiences with. I realise that not everyone is fortunate enough to

Bridget, as a toddler, playing ‘peep-bo’ with Father

30-33 Feat Briodgit AC1.indd 31

have someone at hand to talk about the everyday challenges of living with diabetes. The idea of daily insulin injections didn’t scare me because ever since I could remember, I knew my father injected. And, if my father felt a hypo coming on, he would say he was feeling ‘squiffy’, which meant he needed something to eat – and quick. Growing up in the 1950s and 1960s, you didn’t really talk about emotions like you do today. We talked about the logistics and how to get around a problem, but not about how it actually made you feel. Diabetes was part of our family life and I just ‘got on with it’. On a practical level, my father supported me enormously and invested time in talking me through the practicalities.

With Mum and Dad on the beach

life with diabetes. He did, until he was 90. It is because of his guidance and unyielding support that I’m proving him right. However, the most important thing he gave to me was that I, too, should be my own doctor. In the 1960s and 1970s, I don’t think diabetes management courses existed, so I was lucky that my father – a really good teacher, both by profession and by nature – was at hand to guide me through the complexities of balancing insulin and diet. He taught me well.

You are what you eat

My father was a passionate gardener and I still have his notebooks recording what he planted when, ‘Be your own doctor’ and the time of the year slugs ate My father was very much his own things, for example. At home, we doctor, and he also wanted to tap always cooked food from scratch. into the medical profession and find He grew his own vegetables on a out as much as possible about the small patch to the back of the house condition. This stems from his and on his allotment, and taught me six-week stay in hospital prior about the importance of knowing to being what’s in your treated by food. He hated He was on hand to guide me through the Dr RD ready-made Lawrence. sauces with complexities of balancing insulin and diet My father a vengeance mentioned because he in the diary he kept while in hospital didn’t have a clue what was in them (see box, overleaf) that one of the and how they might affect his blood doctors said to him: ‘You are going to glucose levels. have to be your own doctor,’ and he Today, I have my own allotment, took that to heart and did it. He was grow my own veg and usually cook fascinated by diabetes and was well my own food. Eating my own food read on the subject. means I know what’s going on inside He was also a great believer in my body and how my body will living life to the full – he was react to it. Father would be proud! determined to spread the message Apart from enjoying growing that you can live a long and active and eating my own food, I like the

January – February 2013 balance 31 19/12/2012 10:46

feature of an allotment. We » community can have cups of tea there in the mornings – it’s a wonderful place to enjoy other people’s company. Although healthy food is very important, I also think it’s vital to treat yourself every now and again. Diabetes can be tough and you need something to look forward to. Likewise, it’s important to have people around to support you and appreciate that it’s not always easy. My father taught me how to reduce or increase the amount of carbohydrates I needed for the day, depending on what I was doing, and how my blood glucose levels were behaving. I found this careful balancing between insulin and diet worked well for me. I was able to tell when I was going to go hypo and do something about it before I lost control. The slow-acting insulins also helped with this. Because I’m on only one injection of insulin a day, I’m very meticulous about working out how much insulin I need in order to absorb the amount of carbohydrates I’m eating. It varies from day to day and I’m

Jim’s story

Bridget with Katherine

Motherhood When I became pregnant in 1980, I was meticulous about monitoring my blood glucose levels because it had taken a long time to get pregnant and I was determined to ensure nothing went wrong. It wasn’t easy, although things were made better by the fact that the finger-prick blood sugar monitoring machines had just become available, replacing the test tube urine testing kits which were a nuisance to use. I was admitted into the ‘diabetic maternity ward’ at King’s College Hospital one month before the due date, just to keep an eye on things during the last few weeks of

My father taught me everything I know about diabetes and his legacy lives on pregnancy, which are the most problematic. My daughter, Katherine, came safely into the world in 1980. I’m very proud that she was the first baby born in the diabetic mums ward at King’s who didn’t have to go into intensive care. Now Katherine is 32 and married with two children of her own. Abigail is nearly 3 and James, who was born in February last year, is named after my father, Jim. My father taught me everything I know about diabetes and his legacy lives on. We were particularly close and I think diabetes gave us an extra connection. Coping with Girl Guides i Read more on Bridget and father, Jim, at and diabetes was part of growing up www.diabetes.org.uk/Bridget-JimNicholls

constantly trying to work out a balance. For example, when I travel my blood glucose sometimes goes up and down, or if I’m writing an article and I feel tense, my levels fluctuate.

32 balance

In 1928, only seven years after insulin was discovered, Bridget’s father, Jim Nicholls, was referred by his GP to the Sussex County Hospital in Brighton with suspected Type 1 diabetes. Aged 17, Jim kept a diary of his treatment in hospital, and some 80 years later, at Bridget’s suggestion, he recorded some of his experiences about his treatment under Dr RD Lawrence, an extract of which was featured in balance, July–August 2012. In extracts from his diary, 17-year-old Jim describes treatment on the hospital ward: Brighton Hospital Sunday, 29 April 1928, 11am When Doctor came just this minute he found chart good, and put me forward to No 17 diet… He went on to say I should have to be my ‘own doctor’ when at home, and when lots of sugar, see own doctor, otherwise diet it down. He would give me a list of what I could and could not have… Must use my intelligence and keep my body in good health. Monday, 7 May 1928 At 10.00 got back to bed. Dr Cummings came and had quite a lot to say… he impressed on me that I must take every precaution and be my own doctor, and must not let any sugar appear, or it might be serious, but if I looked after myself there was no need to worry. In one recording, Jim discusses diet: “After six weeks in hospital, I was eventually sent home on a very strict diet, and one day a week was what they called ‘alimentary rest’, which meant I had to exist on something without any food value, but what it really meant was that I just had liquids like Marmite and Oxo, and tea without milk, or coffee without milk, and so it went on, but no insulin prescribed – I don’t think they started using insulin at the hospital then…”

January – February 2013

30-33 Feat Briodgit AC1.indd 32

19/12/2012 10:46

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Carbs & Cals If you want an easy-to-understand visual guide to carbohydrate and calorie counting in diabetes management, then look no further. Carbs & Cals contains more than 1,200 photos of popular food & drink items, with the carbohydrate & calorie values clearly displayed above each photo. Perfect for keeping an eye on the carbohydrate and calories you’re consuming. We’ve got five books to give away.

Prize compet

Beverly Hills New Year Make a fresh start this year with Beverly Hills Formula, which will keep your teeth looking healthy and feeling great! Favoured by the stars, you too can achieve the ‘celebrity smile’! Beverly Hills Formula (www. beverlyhillsformula.com) offers a variety of toothpastes for that Hollywood smile and whitens teeth in just five minutes. They’re now offering one reader the chance to win a year’s supply!

REACH FOR T

This issue’s cover pays homage t topics and people we have featu and we’re no stranger to the od pages in support of Diabetes UK. B faces can you spot on our specia eagle-eyed reader is in with a chan Champagne balloon rides worth £238 Send your answers, along with you balance 250, Diabetes UK, 10 Parkway, must be received by 1 February 2013 be picked at random. Visit www.diabe for the full terms and

Good luck!

Power Packed Yoga Barbara Currie began teaching yoga 30 years ago and has since become the UK’s leading expert in the field. Her new DVD, Power Packed Yoga, is devised to help get you in shape, give you incredible energy, amazing flexibility and allow you to experience yoga’s deep relaxation techniques. We have five DVDs to give away. • Barbara shares her yoga moves on page 48.

How to en

You can enter as many giveawa you have to do is send your nam a sealed-down envelope or po giveaway draw you wish to e bonanza, Diabetes UK, 10 Parkw 7AA. Entries must be receive

2013. Winners will be picked a make sure you enter each d

January – February 2013 34–35 bonanza SRS.indd 34

19/12/2012 10:43

Love your gut! ‘Love Your Gut’ (www.loveyourgut.com) – a campaign by digestive health charities Core and the IBS Network, in association with Yakult, is offering one reader a ‘Love Your Gut’ pack worth £50. It contains: a water bottle, gym bag, sports towel, skipping rope (that counts your jumps and calories burned), baseball cap and a pedometer, along with a range of ‘Love Your Gut’ goodies.

ompetition

FOR THE SKY

s homage to some of the great e have featured over the years, er to the odd celeb gracing our betes UK. But how many famous our special 250th cover? One with a chance of winning a pair of worth £238 with Virgin Balloon Flights. ng with your name and address, to: 0 Parkway, London NW1 7AA. Entries ruary 2013 and the winning entry will www.diabetes.org.uk/balance-balloon terms and conditions.

Stretchworks Stretchworks is an exciting unique approach to exercise for all ages and abilities. It introduces the concept that stretching can be a thorough workout in its own right, enabling you to find your own optimum fitness at your own pace. The DVD is now available to purchase on Amazon £12.99 or direct from www.stretchworks.co.uk but we’ve got six to give away.

Good luck!

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Free & Easy vegan foods help home cooks create delicious, nutritious dishes for all dietary requirements: wheat, gluten and dairy free, artificial additive and preservative free, and low in salt, sugar and fat. Bursting with full-on flavour and priced from £1.11p, they’re available at Sainsbury’s, Ocado and good health retailers (www. healthyfoodbrands.co.uk). We have a hamper worth more than £50 up for grabs.

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250th edition feature

The way we were... A mammoth 250 issues, helping people from all walks of life, young and old, keep up to date on diabetes developments. A place of support, a chance to hear from others, share remarkable stories, as well as years of research progress. We delve into the archives for a look at our unique magazine

1960s Our new title was to help bring to light that ‘balance’ really is the key to managing diabetes, whether controlled by diet alone, diet and tablets or insulin. Editor, Iris Holland Rogers, explained the decison in her Editorial: “The importance of balance in life is everywhere apparent: without it indeed every one of us would topple over just like a young baby taking his very first steps. In diabetics, balance is an obvious keynote in treatment... We have therefore decided to award the important title ‘Balance’ to our Journal as a description and a reminder of our goal.” To emphasise the new name, the covers had a play on balance, with them ‘endeavouring to portray over the years ahead many photographs indicating the many aspects of Balance.’ The first pictured the Leaning Tower of Pisa in all its glory. Readers could send in their cover ideas, with a prize of £1 1s 0d for each one that made it. So many more followed: step forward a baby balancing food on his head (see above), and a whole array of other balancing acts: water-skiers, seals, ballerinas – no stone was left unturned!

When it all began… Born in 1961, balance took the reins from the Diabetic Journal, which had been going since 1935, a year after the creation of the then Diabetic Association, later to become the British Diabetic Association (BDA) and then, as we know it today, Diabetes UK. But whether it’s the original pamphlet-sized journal or the current glossy 64-page magazine, there’s been one particular thing in common: it’s stayed true to keeping you informed about the latest diabetes treatments and chartered the charity’s progress on all the issues that have mattered to you.

140,000

THE NUMBER OF COPIES OF THE MAGAZINE PRINTED EVERY ISSUE

» January – February 2013 balance 37

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02/01/2013 10:12

250th edition feature

1970s

THE ADS WEREN’T ALL ABOUT FOOD: HERE SOMETHING REALLY DOES LOOK LIKE IT’S DISAGREED WITH JIM, STEP FORWARD ANDREWS TO SAVE THE DAY!

Come 1970, the balancing cover images grew to a halt and we changed to a bi-monthly newspaper (and renumbered back to 1). We featured (and still do) a whole variety of ads and, as well as being informative, they help us to be sustainable, funding the printing and mailing costs. But one thing that stood out in the 1970s (and 1960s, too) were the ads for ‘diabetic’ foods – we were awash with them, which did little to dispel the belief that these were necessary for people with diabetes, and you could eat as many as you liked!

LEFT: DIAFRUTES MAY HAVE BEEN DELICIOUS, BUT ‘DIABETIC’ FOODS ARE NOT SOMETHING WE’D RECOMMEND TODAY!

1980s Continuing as a newspaper, here’s our columnist, Mari Wilson (centre), showing her support for changing over to U100 insulin – and showcasing her beehive! It wasn’t until 1985 when we switched back to a magazine format. • See page 66 for Mari’s latest instalment.

100

THE NUMBER OF COUNTRIES BALANCE IS SENT TO, FROM THE HEIGHTS OF NEPAL TO THE LOWLANDS OF THE NETHERLANDS, AS FAR WEST AS PERU AND AS EAST AS THE PHILIPPINES

1990s Anything goes in balance. From rockstars (Bret Michaels from Poison, see above) to politicians, it reflects that diabetes affects people from all walks of life. You name it, we covered it!

2000s We kicked off the new millennium by introducing Diabetes UK (formerly the BDA) to the nation (July–August 2000). And to celebrate, we changed our look – again! It also launched Diabetes UK’s Missing Million campaign during the year’s Diabetes Week, which set out to find those who were unaware that they had Type 2 diabetes by alerting people to common symptoms and risk factors. We broached topics including tackling diabetes in hard-to-reach groups, including the travelling community (see right) and prisoners with the condition – even highlighting the transition for young people changing over to adult diabetes clinics and the problems that can bring (see left).

38 balance

January – February 2013

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02/01/2013 10:12

balance

WIN A VIRGIN

BALLOON FLIGHT PAGE 65

Your diabetes lifestyle magazine • November – December 2012

2010 & beyond

SIGNS & SYMPTOMS

ALL NEW

NHS

Diabetes UK’s kids’ campaign

What the changes mean

PLUS

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

GOOD THINGS...

The first three years of the decade has seen a shift for SKY HIGH “My Type 2 Diabetes UK, and balance has reflected that. 2012 saw the charity emerge with a new brand and, with it, a fresh take on influencing healthcare services. Already we’ve seen Putting Feet First (highlighting that specialist foot care services need to be available to help prevent avoidable amputations), 15 Healthcare Essentials (making sure everyone with diabetes gets the care and services they are entitled to) and, most recently, the 4 Ts, which is helping parents and healthcare professionals understand the early symptoms of Type 1 to get an earlier diagnosis. So, a busy time for Diabetes UK... balance is looking forward to sharing more news, views and research with you in the next 250 issues! Hearty meals from Hugh FearnleyWhittingstall

Type 1 pilots get ready for take oﬀ

shock Benny talks diabetes and destiny

01 Cover.indd 1

18/10/2012 16:51

It’s your magazine!

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Your diabetes lifestyle magazine • January – February 2013

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WE’RE ALWAYS ON THE LOOKOUT FOR NEW IDEAS TO HELP BALANCE REACH ITS NEXT BIG MILESTONE, SO PLEASE SEND IN YOUR THOUGHTS, HOWEVER BIG OR SMALL, TO THE USUAL ADDRESS (PAGE 3) OR EMAIL BALANCE@ DIABETES.ORG.UK. WE LOOK FORWARD TO HEARING FROM YOU!

36-39 Johns (and maybe Angela's last balance feature-1/SRS.indd 39

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012 17:21

life&health Keep it real First things first, don’t be too harsh on yourself and be realistic. Whatever your goals, focus on just one at a time, then you’ll be ready to tackle the next one. Too many things at once is more likely to overwhelm you and cause you to give up on your goals. Talk to your healthcare team about how they can help support you in ringing the changes and reaching your targets. You can even make it part of your care plan (see ‘Spotlight on annual review’, page 47).

Put pen to paper Write down your aims, however big or small. They might include: stopping smoking, eating more fruit and veg, being more active and taking your medication every day. Use our planner, overleaf.

Build in a fail-safe Before you start, ask yourself: Do I need more information? What do I need to do to prepare for day one? Do your homework so that there’s less chance of your plan failing. For example, if you’re aiming to get your five a day, dig out some tasty recipes. Then, make sure that all your ingredients are on the shopping list, make space at home or work for a fruit bowl, and clear part of the fridge for your veg. You can also ask yourself the five ‘W’s: • What sort of problems are you likely to come up against? • When are the problems likely to happen? • Who are they likely to involve? • Where are they likely to occur? • Why are they likely to come up? You can then try and pre-empt the hurdles. For example, if you’re planning to stop smoking and normally have a cigarette at work with a friend at 10am, ask them not to call at your desk on their way. Book a meeting in for this time of day or make a coffee instead.

Make a date Now you have a plan, set yourself a date to start. Choose when you know you’ll be ready to take on the challenge and it’ll be easier to set the wheels in motion. For example, it’s no good starting to cut back on alcohol on the day you’re going to a party.

Say hello to a new you The new year is a chance to think about our goals in a positively and to try to forget about the past. Here are our tips to help you along the way

If at first your don’t succeed… …try, try again. If you feel like it’s all gone wrong just think of it as a minor setback. What happened to stop you succeeding? How can you try to stop this happening again? Learn from the mistake and try again.

January – February 2013 balance 41 40-43 L&H AC1.indd 41

19/12/2012 10:39

life&health

Your 2013 goals My goal is… (be specific)

I will begin to work towards my goal on...

The information I need before I start is...

Are you B12 aware? Our bulging postbag shows that B12 deﬁciency can be a common problem, but why is this?

itamin B12 helps to keep the brain and nervous system functioning healthily. It’s found readily in many sources such as meat (especially liver), fish (especially oily fish), eggs, cheese, yeast extract and fortified breakfast cereals. But dietary deficiency is rare, as it can be stored in your liver.

So what can cause the deficiency? I will get support from...

I will prepare for my goal by...

The challenges to achieving my goal are...

I can overcome these by...

If I achieve my goal I will treat myself by...

42 balance

In the UK, vitamin B12 deficiency commonly develops because of reduced Know the absorption of the vitamin. This can be signs due to a lack of substance produced in Symptoms can include: the stomach called ‘intrinsic factor’, • anaemia which is essential to be able to absorb be stressed • fatigue vitamin B12. A lack of intrinsic factor enough • lack of energy can be due to an autoimmune disease that the benefit • shortness destroying the cells that produce it, of metformin of breath inflammation of the stomach and outweighs the surgical removal of part – or all – increased risk of of the stomach. developing a deficiency Low vitamin B12 levels have been reported in vitamin B12 and its symptoms. in the elderly, but this is usually due to Long-term low vitamin B12 levels can changes in the body’s processes, which lead to neurological damage. Symptoms happen with age, eg a lack of intrinsic factor, can include: which results in reduced absorption of B12. • confusion or change in mental status We also know that people using • depression metformin are at increased risk of developing • loss of balance a deficiency in vitamin B12 because it can • numbness and tingling of hands lead to malabsorption. A recent study has and feet. shown that the decrease in absorption Check it out continues over time until levels were Most GPs will screen you if you have been outside the normal range. on metformin for a long time. They may Don’t be afraid to talk to your doctor arrange for a blood test to check if you are if you have any concerns. However, it is B12 deficient and, if you are, then they’ll important to remember that metformin is decide on the course of treatment. widely used, especially by older people with Depending on the cause, this may include Type 2 diabetes, because of its ability to injections of Vitamin B12 and, in some lower blood glucose levels and improve cases, tablets. management of diabetes. And, it cannot

January – February 2013

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life&health

AFFAIR of the

heart

People with diabetes are at an increased risk of heart disease, but there are many ways to keep your heart in good shape

EAT WELL A healthy diet is most important. You can do this by following a diet rich in fruit and vegetables, but only a little fat, sugar and salt. Have a look at Diabetes UK’s 10 steps to healthy eating (www.diabetes.org.uk/eating-well). WATCH YOUR WEIGHT Being overweight causes raised LDL (bad) cholesterol and triglyceride levels. It lowers HDL (good) cholesterol. Losing even small amounts of weight can be a benefit. Your nurse will weigh and measure you and work out your Body Mass Index, which can indicate if your weight is healthy for your height. A healthy BMI is between 18.5 and 24.9. Keep your tape measure handy and check your waist circumference. (visit www.diabetes.org.uk/overweight-criteria for a guide). If you think that you need to reduce your waist size, ask to be referred to a dietitian. STUB IT OUT It’s not easy to stop smoking, but help and treatment are available free on the NHS. Seek advice on the best way to give up. Smoking has many negative effects on your heart, including reducing the amount of oxygen in your blood, making the heart work harder to supply the body with oxygen. KNOW YOUR NUMBERS Keep track of your blood glucose, blood pressure and blood fats levels: • Blood glucose: Persistently high levels

can damage the walls of the arteries, increasing the risk of heart attack. If you self-monitor, then you should have discussed your target range and agreed them with your healthcare team. Everyone should have a blood test for HbA1c at least once a year, so this is not to be missed. • Blood pressure: High blood pressure also raises your risk of heart disease as it puts a strain on the blood vessels and your heart. Diabetes and high blood pressure together increases the risk even more. Have your blood pressure measured and recorded at least once a year. You may need medication to help to reduce your blood pressure. For best results, be active,

eat a healthy diet and lose excess weight. • Blood fats (lipids): Cholesterol is a fatty substance found in the blood. Too much, especially of the ‘bad’ LDL cholesterol, will increase heart disease risk as fatty deposits will build up and block the blood vessels. Triglycerides are another fat found in the blood. Too much can lead to heart disease. Much of our blood fat is made by our bodies, but eating a low-fat diet can help to regulate levels. You may need medication, such as statins, too. Have your blood lipids measured every year. Like blood glucose levels and blood pressure, you should have your own realistic and achievable target. i See overleaf for a guide to all targets.

GET PHYSICAL

Doing some physical activity that improves muscle strength on at least Aerobic exercise is one of the best types two days of the week is recommended of activity to keep your heart healthy, – as simple as carrying food shopping! eg swimming, group classes or even brisk If you already have coronary heart walking. All types of activity counts, such disease or high blood pressure, talk to as walking, gardening and housework. your diabetes healthcare team before Guidelines recommend adults should increasing your physical activity levels to be active every day and, over a week, it discuss what is safe and right for you. should add up to at least 150 minutes of With any exercise, you should stop if moderate intensity (activity that makes you feel any discomfort, such as pain, you warmer, breath harder and your heart or feel dizzy, sick or unwell, or very tired. to beat faster, but you should still be able i For more on physical activity guidelines for to carry on a conversation). adults, visit http://tinyurl.com/9vjuygr.

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life&health

»»»ON««« »TARGET«

How to... be ID savvy Carrying a medical ID card, necklace or bracelet, which alerts others to your diabetes can save vital minutes if you need emergency treatment. It’s important to carry some form of ID, if: • y our diabetes is treated with insulin or tablets that can cause hypos • y ou have a hypo that you can’t treat yourself (a hypo can sometimes be confused with being drunk) • y ou’re doing any type of physical activity that might cause a hypo, and people you’re with don’t know you have diabetes • y ou are on holiday, or in any situation, where you need to explain about your diabetes. i MedicAlert, 0800 581 420, www.medicalert.org.uk • Universal Medical ID, 0800 055 6504, www.universalmedicalid. com • The ID Band Co, 0845 269 4523, www.theidbandco.com • Medi-Tag, 0121 200 1616, www.medi-tag.co.uk

You and your diabetes healthcare team should agree your ranges. These are to be used as a guide:

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

Lewis Sherwood was diagnosed with Type 1 diabetes when he was 4. Now 8, both Lewis and his family try not to let the condition affect what he does with his friends. For peace of mind, his parents bought him a diabetes ID bracelet to alert others to his condition while he’s out of their care. They chose MedicAlert as the symbol it carries is internationally recognised. “Diabetes is an unseen condition, so unless people already knew about Lewis, they would be oblivious to his needs if he needed help,” explains Zoe. “And, if Lewis is unable to speak clearly, he can point to the symbol.”

What is… neonatal diabetes Diagnosed under the age of six months, neonatal diabetes is a very rare form of the condition. Unlike Type 1, where the body has destroyed its insulin-producing cells, it’s not an autoimmune condition, but is caused by a change in a gene that affects insulin production. About 20 per cent of people with neonatal diabetes also have some developmental delay, eg muscle weakness, learning difficulties and epilepsy. There are two types of neonatal diabetes – transient and permanent. Transient neonatal diabetes tends to resolve before the age of 12 months. But it usually recurs later on in life, generally during the teenage years. It accounts for 50–60 per cent of all cases. Permanent neonatal diabetes accounts for 40–50 per cent of all cases. Most people with neonatal diabetes don’t need insulin and can be treated with a tablet called Glibenclamide, instead. As well as controlling blood glucose levels, Glibenclamide can also improve the symptoms of developmental delay. i Find out about all the various types of diabetes at www.diabetes.org.uk/What_is_diabetes.

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

» H bA1c

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

» B lood pressure 130/80mg hg

» B lood fats (lipids)

• total cholesterol: no higher than 4mmol/l • LDL (‘bad’): no higher than 2mmol/l • HDL (‘good’): above 1mmol/l in men, or 1.2mmol/l in women • triglycerides: 1.7mmol/l or less.

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Health matter on your mind?

Karen Therapist & counsellor

Deepa Dietitian

Cathy Diabetes specialist nurse

Libby Paediatric diabetes specialist nurse

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

HOW LO SHOULD I GO? I have a family history of heart conditions, and so I’ve been using the salt substitute, LoSalt, for a long time as I thought it was a healthier alternative. But I’ve recently been diagnosed with Type 2 diabetes – should I stop using LoSalt and use normal table salt, instead? Colin, Wakefield Deepa says LoSalt is high in potassium, (66.6 per cent potassium chloride) and low in sodium. People often use it to reduce their salt intake and to also reduce high blood pressure. But, salt substitutes aren’t suitable for everyone, including people with kidney problems. As you probably know, having diabetes increases your risk of kidney problems, so it’s important that you attend your annual review to have your kidney function checked. In some cases, it is better to simply use a reduced amount of table salt, rather than LoSalt. Or, you could always try adding herbs and spices to flavour foods, instead. It’s also worth checking with your doctor whether or not LoSalt is suitable for you.

SHARPS PRACTICE I have always used a needle clipper to dispose of my sharps. When this is full I dispose of it in household waste. But my nurse says that I can’t do this anymore, but didn’t explain why. Do you know why this is? Lucy, Exeter Karen says: Your nurse is right; according to current UK regulations, needle clippers are not an alternative solution for sharps disposal, and they must be disposed of

in sharps containers. Needle clippers are fine as a temporary measure for keeping used needles safe, however, once the clipper is full (according to regulations), it should be disposed of in a sharps box and not as part of your household waste. It’s worth talking some more about this with your GP surgery, diabetes clinic or pharmacy, as they may be happy to dispose of full needle clippers in their sharps bins, which may save you the problem of having your sharps bin collected. But this still doesn’t solve the problem of lancet disposal. According to manufacturers, needle clippers aren’t designed for safely clipping lancets or finger-prick devices and so shouldn’t be used for this purpose; again, lancets should be disposed of in a sharps bin. I really do understand how frustrating it is getting the seemingly simple task of sharps collection organised. i You can find more information at www.diabetes.org.uk/sharps-disposal.

TIME FOR A TRANSPLANT? I’ve had Type 1 diabetes for more than 20 years and despite many different approaches and now being on an insulin pump, I can’t get control of my blood glucose levels. They range from very high to very low in short spaces of time – even my nurse doesn’t know what to suggest. I’ve heard that people can have pancreas and cell transplants, and wondered if I can ask for one? Khalid, London Cathy says: Although hugely valuable to people in dire need, transplants are by no means an easy solution or

ask the experts guaranteed success. As with any transplants, organs can be rejected, so anti-rejection drugs need to be taken for life and in many cases the body destroys insulin cells again, returning to a need to again inject insulin. Both islet cell and pancreas transplants can only come from a deceased donor, meaning – like all organ transplants in the UK – operations are quite limited due to the lack of donor organs available. Priority must be given to those most in need. In the case of pancreas transplants, this is quite often performed at the same time as a kidney transplant in those with advanced renal failure, though is also considered for those who experience disabling hypos due to a lack of symptom awareness. Islet cells are again most commonly offered to those with disabling hypoglycaemia, but may be considered in other circumstances. We can’t say whether or not you would be considered for either transplant, but it is certainly worth speaking with your specialist about it in more detail. i For more on pancreas transplants, visit www.nhs.uk/conditions/pancreastransplant. • For the National Institute for Health and Clinical Excellence (NICE) guidance, which gives more information about who may benefit from islet transplant, visit http:// guidance.nice.org.uk/IPG257.

DIABETES UK

CARELINE To speak to a trained counsellor, call 0845 120 2960, Monday to Friday, 9am to 5pm, or email careline@diabetes.org.uk.

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18/12/2012 16:42

Safe: Prevents Finger Prick Accidents Easy: Needle Removal & Storage Proof Of Use Reminder System

Key features of NeedleBay ■ Prevents finger prick accidents ■ Suitable for all types of insulin pen needles ■ Safe sharps containment ■ Visual ‘proof of use’ ■ Case for weekly storage ■ High quality construction ■ Designed for continuous daily use ■ Fully guaranteed

For further information: Visit: www.needlebay.com

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

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

Diabetes Care Technology Ltd Wey Court West, Union Road, Farnham, Surrey GU9 7PT T: 0845 680 7541 | E: info@diabetestech.co.uk

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life&health

Spotlight on...

Your annual review First things first

• make notes • check that you’ve covered all the points in your list.

All people with diabetes should have a full check-up every year – this is known as an ‘annual review’. It allows your diabetes healthcare team to monitor your condition and check for early signs of complications. You should be invited for your annual review appointments by your diabetes healthcare team. If you don’t receive this – ask for one. You will see different healthcare professionals as part of your review – this is likely to be done over a series of appointments and in different places. Talk with your GP, nurse or consultant who you will see, what their roles and responsibilities are, and what care to expect from them. It’s essential for your wellbeing that you get the right care. There’s a minimum level of healthcare that every person with diabetes deserves and should expect – there are 15 essential checks and services you should receive (see end information for how to get a checklist).

• working together with your healthcare team to set realistic goals and decide how you are going to achieve them in order to maintain your health.

What to expect

Be prepared

The following things are likely to happen at your annual review with your diabetes healthcare team: • blood tests and examinations – the results and what they mean should be discussed during your appointment • a check for signs of the complications of diabetes • an opportunity to discuss your concerns and questions • help for you to access the right services and support • a review of your treatment and medication, and change to them if necessary

Before your appointments: • decide what you need to know – take your 15 healthcare essential checklist with you • write down the points you want to raise • take your blood glucose meter and record with you (if you test) • take your medications with you • take any news stories or research that you have any questions about.

After your appointments: • review what’s been said and agreed • make a note of anything you need to do before your next appointment.

It’s essential for your wellbeing that you get the right care

During your appointments: • ask questions, give feedback and ask for clarification if you’re unsure of anything

To get the best possible care at your appointments, it’s essential for you to work together with your diabetes healthcare team to agree what care and support you need. The goals you agree will form the basis of your care plan (the written summary of what you and the team are going to do to help you to manage your diabetes, day to day). A paper copy of your care plan should be given to you by your diabetes healthcare team. But if not, ask for one. You should have a full review at least once a year and at ongoing intervals as agreed in your care plan.

Problems with your care If you haven’t been invited to annual review appointments or if there are any checks you’re not getting, make sure you ask for them. It may also be that you have been waiting a long time for your diabetes check-up or have been having problems arranging your appointment. You can ask any healthcare professional you see about your diabetes care. i Visit www.diabetes.org.uk/15-essentials to download the 15 healthcare essentials checklist; and ‘Are you really getting your 15?’, which explains each health check, as well as tips for what you can do if there are any that you haven’t had.

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y g r e n E RENEWABLE

Barbara Currie has been teaching yoga for 35 years, appearing regularly on TV and radio to share her enthusiasm. Here, Barbara explains the benefits of this ancient exercise system for mind and body, including some of the yoga movements she teaches in her classes

t’s estimated that a million people in the UK practise yoga, which comprises slow, deep breathing together with specific physical poses. There are said to be many health benefits: increased flexibility and strength, as well as improved muscle tone and posture. And, because the exercises are combined with slow, deep breathing, yoga can help you to relax and reduce stress. A former nurse and, subsequently, an air hostess, Barbara Currie has been teaching Hatha yoga for 35 years and is one of the UK’s leading experts in the field. Hatha yoga places an emphasis on slow, deep breathing, while practising specific exercises designed to maintain physical and mental health, as well as to induce relaxation. Now teaching more than 500 devotees, Barbara considers Hatha yoga to be a complete exercise system – encouraging people to adopt a healthier diet, too: “Yoga stimulates blood flow and is good for the circulation – and, as people are taking care of their body through getting the yoga movements right, they concentrate on health more, and tend to move towards a healthier diet. It works on all levels, so every part of the body is worked, and helping to get the body into perfect balance – both inside and outside.” Barbara believes that anyone can benefit. “Yoga involves stretching, breathing and flexibility, Barbara explains. “It’s therapeutic – toning and firming, and you finish with deep relaxation. You work at your own level; everyone has aches, pains and health problems to consider, and yoga focuses on getting into position without strain.”

SI MPLE T W IS T This movement ensures flexibility of the spine and is excellent for slimming the midriff and waistline. This incredible movement releases tension from the spine and tones the spinal nerves. It’s an excellent massage for the abdominal organs and stimulates circulation to the liver, spleen and kidneys. It is a powerful toner for the midriff and waistline, hips and buttocks. Also a great help when parking your car!

1 2 3 4

Sit straight with both legs straight out in front of you.

Inhale deeply and lift your right foot over your left leg and place it on the floor on the outside of the left thigh as you exhale. Place the right hand on the floor behind you.

Now take your left arm and place it on the outside of the right knee and place your left hand on your left knee. (If you can’t quite reach don’t worry, just let the hand rest where it is comfortable). Now take a deep breath in and, as you exhale, carefully twist the body to the right. Hold this position, breathing normally, for a count of five increasing to 10 as it becomes easier. Slowly return to the front. Repeat to the left and then repeat the entire movement once.

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Basic care special

BACK S T RE TCH

All movements should be performed slowly, carefully and without strain

Barbara’s Tips GETTING STARTED • Don’t be afraid to just try it out – just one lesson will be enough for you to judge whether it’s right for you. • Teachers put a bit of themselves into it, so if you don’t get on with the class after the first one, try a different one. • Yoga classes are all different, so find a class you feel comfortable with – keep looking until you find what suits you. • Most people do one class per week. BETWEEN CLASSES • We’re programmed to stretch as a reflex. Start with a simple stretch. Do this by stretching forwards, backwards and one side to the other. Warm your body up and then you’re ready to go. • There are movements you can do in class and then you can keep your flexibility from one class to another by doing breathing and stretches in the morning, and a few relaxing stretches at night (as it’s more about relaxation at this time of day). Your yoga teacher can advise you on which to practise between classes.

This is a yoga essential. It’s perfect for stretching and realigning the spine, for toning the back and the thighs. The backstretch releases tension in the lower back, stretches the hamstrings and tones the back of the thighs. It also tones the abdominal area and rejuvenates the entire spine, massages the heart and is very relaxing

1 2

Sit very straight with both legs straight out in front of you. Take a deep breath in and lift both your arms straight up in the air. Exhale as you gradually bend forwards with your head up and back flat, eventually aiming your chin to your knees. (When you first start this movement, your chin and knees may be a long way apart. Don’t be discouraged, keep practising and you’ll be amazed at how quickly you progress in the movement). Stay in your maximum position, breathing normally for a count of five.

3 4

Inhale and slowly lift your head and arms and return to an upright position exhale and relax and repeat twice.

BO DY RO L L This simple tension releasing movement does wonders for your waistline while relieving lower back tension.

1 2 3 4

Stand straight with your feet facing forwards and about 12in apart. Place your hands at your waistline with your thumbs in front and fingers behind.

Inhale deeply and, as you exhale, move slowly forwards keeping your head up.

Breathing normally, slowly and carefully in continuous motion roll your body to the right, then carefully backwards, then to the left and slowly forwards. Do two circles to the right followed by two circles to the left.

After completing the body roll, inhale deeply. Stand straight and stretch your arms straight up above your head. Place your hands together and straighten your spine. Hold the stretch for a count of five then exhale and slowly lower your arms and relax.

Turn to p34 for a chance to win a copy of Barbara’s latest DVD, Power Packed Yoga

CLINICAL ADVISOR CATHY SAYS: Always check with your healthcare team before starting any new exercise

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recipes

ÂŁ2.75 per serving

Comfort zone Kick off the new year as you mean to go on with these guilt-free yet super tasty comfort foods from Healthy Food Guide magazine

50 balance

January â&#x20AC;&#x201C; February 2013

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Lamb, date & sweet potato tagine Serves 4 • dairy free • 4 portions of fruit & veg per serving

• • • • • • • • • • • • • • • • •

cooking oil spray 500g lean lamb, diced 2 medium red onions, cut into thin wedges 2 garlic cloves, crushed 30g fresh ginger, finely grated 2 tsp sweet paprika 1 tsp ground turmeric 1 tsp ground cumin 10cm cinnamon stick 400g can chopped tomatoes 400g sweet potato, peeled and coarsely chopped 80g dates, stoned and halved freshly ground black pepper small bunch fresh coriander, chopped 175g couscous 1 tsp reduced-salt vegetable stock powder 1 large courgette, grated

Spray a large saucepan with oil over a medium-high heat. Cook the lamb, stirring, for 7–8 minutes or until browned. Add the onions, garlic and ginger and cook, stirring, for 5 minutes, or until softened. Add the paprika, turmeric, cumin and cinnamon stick. Cook, stirring for 1 minute, or until fragrant. Add the tomatoes and 250ml cold water. Bring to the boil, cover and simmer over a low heat for 1 hour. Add the sweet potato and dates. Cook, uncovered, for 20–25 minutes or until the lamb is tender and the sauce has thickened slightly. Season well with black pepper and stir in half the coriander. Meanwhile, put the couscous, stock powder and courgette into a heatproof bowl. Add 300ml boiling water. Cover and stand for 5 minutes. Use a fork to separate the couscous, then season with pepper. Serve the tagine with the couscous, topped with the remaining coriander.

2 3

Per serving (675g) 557Kcal – 36.7g protein

• •

– 79.2g carbs ( 27.3g sugars) – 0.8g salt ( 4.7g saturates) –

•

11.9g fat

£3.93 per serving

Minute steaks with red onion compote Serves 4 • dairy free • gluten free • 2 portions of fruit & veg per serving

• • • • • • • • • • • •

400g small potatoes, quartered 200g mini peppers, halved cooking oil spray freshly ground black pepper 200g mixed cherry tomatoes 2 medium red onions, thinly sliced 2 tbsp runny honey 4 tbsp red wine vinegar 2 tbsp sultanas 2 tbsp chopped walnuts 8 x 75g minute or thin frying steaks fresh thyme leaves, to garnish

Preheat the oven to 190°C/fan 170°C/gas 5. Put the potatoes and peppers in a large baking dish and spray lightly with oil. Season with black pepper and toss to coat. Roast for 30 minutes or until golden and cooked through, adding the tomatoes for the last 10 minutes of cooking.

Meanwhile, make the red onion compote: spray a large frying pan with oil over a mediumhigh heat. Cook the onions, stirring occasionally, for 15 minutes or until soft and golden. Add the honey, vinegar, sultanas and walnuts. Cook, stirring, for 5 minutes or until the liquid has evaporated and the onions are caramelised. Remove from the pan. Heat the same pan over a medium-high heat. Cook the steaks for 1 minute on each side, or until cooked to your liking. Serve with the compote and vegetables, garnished with the thyme leaves.

Per serving (470g) 443Kcal – 38.9g 28.4g protein – 45.1g carbs ( 12.7g fat ( 3.3g sugars) – 0.3g salt saturates) –

••

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Baby pumpkins with quinoa stuffing Serves 4 • vegetarian • gluten free • 4 portions of fruit & veg per serving

£2.16 per serving

Pan-fried chicken with bubble & squeak

• 4 x 450g baby pumpkins (or small butternut squash) • cooking oil spray • freshly ground black pepper • 100g quinoa • 1½ tbsp pine nuts • 1 medium carrot, peeled and grated • 1 celery stalk, trimmed and finely chopped • 1 medium red pepper, finely chopped • 2 tbsp currants • 2 tbsp lemon juice • 125g reduced-fat feta, crumbled • 2 tbsp fresh chives, finely chopped

Serves 4 • 2 portions of fruit & veg per serving

• 2 rashers rindless smoked bacon, finely chopped • 250g parsnips, peeled and grated • 150g savoy cabbage, shredded • 400g boiled potato, mashed • 2 tsp mild curry powder • 50g fresh wholegrain breadcrumbs • 1 egg white, lightly beaten • cooking oil spray • 400g skinless chicken breast fillets, halved horizontally • 150g fat-free Greek-style yogurt • 1 tbsp creamed horseradish • 2 tbsp finely chopped fresh mint, plus extra to garnish • mixed salad, to serve

Put a large non-stick frying pan over a medium-high heat. Cook the bacon, parsnip and cabbage, stirring, for 5–7 minutes, or until the vegetables are tender. Add the potato and curry powder. Mash together

52 balance

with a fork, then set aside to cool. Stir in the breadcrumbs and egg white and shape into 12 patties. Spray a frying pan with oil over a medium-high heat. Cook the patties, in batches, for 3 minutes on each side, or until golden and heated through. Remove from the pan and cover to keep warm. Spray the pan with a little more oil and cook the chicken for 8–10 minutes, turning occasionally, until browned and cooked through. Combine the yogurt, horseradish and mint. Serve the chicken with the yogurt, patties and salad, garnished with the remaining mint.

• radicchio leaves, to serve • balsamic vinegar, to drizzle

Preheat the oven to 190°C/fan 170°C/gas 5. Slice off pumpkin tops and set aside. Remove the seeds and a little of the flesh from each pumpkin. Spray the insides with oil and season with black pepper. Put on a paper-lined baking tray with the lids and roast for 30 minutes. Remove lids and set aside. Turn over and roast for 30 minutes more. Simmer the quinoa in 300ml boiling water,

£2.77 per serving

Per serving (470g) 337Kcal – 36.5g protein – 37.2g 10.2g sugars) carbs ( 5.7g fat ( 1.5g – 1g salt saturates) –

• • ••

January – February 2013

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recipes HALF-PRICE SUBSCRIPTION OFFER

covered, for about 20 minutes until tender and opaque. Drain and set aside. Spray a large frying pan with oil and put over a medium heat. Cook the pine nuts, carrot, celery, pepper and currants, stirring for 10 minutes, or until the vegetables are just tender. Stir in the quinoa and lemon juice and set aside to cool. Add the feta and chives to the quinoa. Spoon into pumpkin shells and top with the lids. Bake for 15 minutes, or until heated through. Serve with the radicchio and a light drizzle of balsamic.

5 issues of Healthy Food Guide for just £7.35

Per serving (440g) 277Kcal – 12.3g protein – 36.6g carbs 22.5g sugars) – 9.9g ( fat ( 3.9g saturates) 1.5g salt –

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£1.53 per serving

•

Beef pot pies with celeriac mash Serves 4 • 4 portions of fruit & veg per serving

• cooking oil spray • 500g lean braising steak, cut into 3cm pieces • 6 shallots, peeled and halved • 2 garlic cloves, crushed • 2 tbsp plain flour • 1 large red pepper, chopped • 2 tbsp tomato purée • 250ml reduced-salt beef stock • 300g butternut squash, peeled and chopped • 1 medium celeriac, trimmed, peeled and chopped • 1 large baking potato, chopped • 6 tbsp skimmed milk • freshly ground black pepper • 30g reduced-fat mature cheddar, grated • 320g steamed green vegetables, to serve

Spray a large saucepan with oil and put over a

medium-high heat. Cook the beef in batches until browned all over, then transfer to a bowl. Reheat the same pan over a medium-high heat. Add the shallots and garlic and cook, stirring, for 5 minutes or until golden. Return the beef and juices to the pan and add the flour. Cook, stirring, for 1 minute. Add the red pepper, tomato purée, stock and 200ml water. Bring to the boil, reduce the heat to low and simmer, covered, for 1 hour. Then add the squash and simmer, uncovered, for 20–30 minutes, or until the beef is tender and the sauce has thickened. Meanwhile, put the celeriac and potato into

a large saucepan. Cover with cold water and bring to the boil. Reduce the heat to medium-high and boil, uncovered, for 20 minutes or until tender. Drain and mash with the milk and season with black pepper. Preheat the oven to 190°C/fan 170°C/gas 5. Spoon the beef mixture into 4 x 300ml ovenproof bowls, spoon over the celeriac topping and sprinkle with the cheese. Bake for 15–20 minutes, or until the cheese is golden brown. Stand for 5 minutes, then serve with the green veg.

Per serving (680g) 386Kcal – 37.9g protein – 37.6g carbs 13.3g sugars) – ( 10.3g fat ( 4.1g 1.1g salt saturates) –

••

Healthy Food Guide is the magazine for people who want to be healthy and still enjoy great food. Inside every issue you’ll find • more than 40 good-foryou recipes • nutritionally balanced meal ideas • comfort food makeovers • brilliant nutrition and health tips • expert advice on how to transform your health, and much more…

SUBSCRIBE TODAY HEALTHYFOOD.CO.UK/ SUBSCRIBE and quote HFDUK12 0844 245 6914 and quote HFDUK12 Valid until 28 February 2013. Available on UK subscriptions only.

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January – February 2013 balance 53 50-53 Recipes AC/SRS.indd 53

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bite-sized

In season

Count your blessings As Jack Frost continues to bite, nature’s very own, vitamin-rich store cupboard should help to keep you fighting fit and full of energy during the winter chill. Celeriac, pumpkin, broccoli and sweet potatoes feature on the recipes pages this month, and are the perfect healthy comfort food ingredients. Fruit yogurt (125g) (136Kcal, 3.8g fat)

has a softer flavour than its cousin, celery, but twice the amount of fibre, and is a good source of potassium and B vitamin folate. Compared with the humble spud, which weighs in at around 75 calories per 100g, cooked celeriac notches up just 15, so makes for a lighter comfort food when mashed along with potato. despite its sweet taste, is Pumpkin good for the waistline, with an 80g portion containing only about 10 calories – if you skimp on the fat during cooking. Being bright in colour, it’s also high in beta-carotene, the plant form of vitamin A. a member of the brassica family, like its cousin, Broccoli the cabbage, provides vitamin C and plenty of folate. Containing glucosinolates, broccoli has been dubbed a superfood because, although not scientifically proven, these natural compounds may have anti-cancer properties. provide potassium and Sweet potatoes vitamin C, are low GI and, like pumpkin, are rich in beta-carotene because of their orange flesh. This plant form of Vitamin A can help keep the skin, eyes and immune system healthy. i Turn to page 50 for some delicious and healthy recipes, using these vegetables, from Healthy Food Guide.

Celeriac

SWAP ’N’ SAVE 46Kcal & 2.3g fat

Plain low-fat yogurt (125g) + mixed berries (80g) (90Kcal, 1.5g fat)

Gourmet on the go

February Make the most of apples and pears as they come to the end of their season. Meanwhile, rhubarb crops start appearing, so treat yourself to a homemade crumble. The humble swede may not be the prettiest veg, but this ugly duckling is extremely versatile. Combine it with root vegetables for a sweet and nutty tasting mash.

Broccoli with chestnuts & lardons

Recipe kindly provided by www.tenderstem.co.uk and adapted by Diabetes UK

January Take the chill out the air by including wonderful iron-rich kale, chunky carrots and crunchy celery in warming stews and soups. Four heaped tablespoons of kale count as one of your five a day. And why not add a carrot or two to your smoothie for some much-needed vitamin A?

Serves 4 • Dairy free

£1.61p per serving

Bring a pan of salted water to the boil. Add 400g of Tenderstem broccoli, cut into strips. Cook for 30 seconds. Drain, cool under cold running water and set aside. Heat a frying pan, add 20g monounsaturated margarine and 75g back bacon lardons. Cook until the lardons start to release some fat and turn golden brown, about 5 minutes. Add 200g of roughly chopped, cooked chestnuts and the broccoli. Cook for a further 2 minutes, season to taste and serve. Per serving (174g) 190Kcal / 5.5g protein / 18.7g carbs ( 4.8g sugars) / 8.8g fat ( 1.6g sats) / 0.8g salt

•

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January – February 2013

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WHAT YOU NEED TO KNOW TYPE 1 DIABETES

TYPE 2 DIABETES

TREATMENT

T1_Part1_Dcare.indd 1

GROwinG UP

WHAT YOU NEED TO KNOW

28/11/2012 12:31

T2_Part1_Dcare.indd 1

tReatMent

FOOd

LIFESTYLE

WHAT YOU NEED TO KNOW

28/11/2012 12:36

what YOU need tO KnOw

Parents guide Part1 DCareAC.indd 1

29/11/2012 10:48

Whether you’re new to diabetes or in need a of a refresher, these free guides are a great source of information. Treatments, the care to expect, healthy eating, physical activity and much more are covered, helping you live your life to the full.

Ready, steady, grow

Type 1 diabetes – What You Need to Know (code 6954)

A new year brings new garden projects for our columnist Stephen Rayner January brings a buzz of excitement to every gardener, as we look forward to the coming growing season. But this year, I’m getting an extra buzz from a brand new garden. We’ve moved from deepest Dorset to the lovely market town of Hungerford in Berkshire. Our new garden consisted almost entirely of lawn, so I got busy digging a strip to plant rhubarb, gooseberries and blackcurrants. With those planted, I’m now turning my mind to the coming season and that is – of course – what you should all be doing! First, buy your seed potatoes and onion and shallot sets as soon as they’re available. Start chitting your potatoes at once in a cool light place, and plant your onion and shallot sets outside at the end of February or the beginning of March. January is a good time to clean the glass of your greenhouse, especially on the inside. Fix a layer of bubble wrap on the inside, too, for extra frost protection when you start sowing seeds. Speaking of which, February is the ideal time to sow broad beans in pots under glass – ready to harden off and plant out at the end of March. Finally, if you’re in a fairly mild area and winter wasn’t too unkind, sow early varieties of peas in February – under those cloches you put in position before Christmas to warm up the soil. Happy gardening.

Type 2 diabetes – What You Need to Know (code 6955)

Your child and diabetes – What You Need to Know (code 6956)

Order your free (+£1.50p&p) copy by calling Diabetes UK on 0800 585 088 or visit shop.diabetes.org.uk

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54-55 bite sized AC-SRS.indd 55

19/12/2012 10:33

walk

Wild at

heart

Leave the city behind you and head into the wilds of one of Britain’s National Nature Reserves. With more than 350 to choose from, here are some of the best walks on offer

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MOOR HOUSE HABITAT Wild, open moorland, weird rock, juniper woods and awesome waterfalls – a mighty Pennine landscape with a complex ecology in the Upper Teesdale. ANIMAL ATTRACTIONS Spring brings lapwing, curlew and oystercatchers nesting in the high pastures. Get up early to see the rare black grouse dancing. Traditional farming makes colourful hay meadows of globeflower, orchids and yellow rattle and, in August, the heather blooms and golden plovers make their strange, sad cries. In winter, only the Swaledale sheep stir. WILDEST WALK One of the best walks starts and ends at Bowlees and follows the Pennine Way for 12½km/5½ miles along the river, through an ancient juniper wood to High Force and Cauldron Snout waterfalls. WARDEN’S TIP “Come in spring, when the birds display, and walk to Green Trod for the best view.” Heather McCarty. i 0300 060 6000; www.naturalengland.org.uk/nnr

January – February 2013

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Turn to page 64 for your chance to win a wildlife walk book

LOCH LEVEN HABITAT A vast freshwater loch in Perth and Kinross in the Central Lowlands. ANIMAL ATTRACTIONS Loch Leven is one of the most important stops on the planet for migrating birds. Pink-footed geese come from Iceland to winter here before heading south, and tufted ducks and gadwalls breed in spring. From late March to August is the best time to see the spectacular plunge of an osprey in pursuit of fish. The eight-foot wingspan of our greatest bird of prey, a white-tailed sea eagle (pictured), has also been seen here in recent years. WILDEST WALK The Land Reform (Scotland) Act 2003 opened up the reserve to public access and a trail runs round two-thirds of the loch, from Kinross Pier to RSPB Vane Farm – 13.5km/8.5 miles one way. WARDEN’S TIP “Summer is a great time for duck broods. But there’s nothing to compare with an autumn dawn, when 20,000 geese fly as one to feed on nearby fields.” Craig Nisbet. i 01577 864439; www.nnr-scotland.org.uk

LIZARD HABITAT The flat-topped heath of Cornwall’s Lizard peninsula is Britain’s southernmost point and – as its madly coloured beach pebbles attest – it’s a geological hotchpotch. ANIMAL ATTRACTIONS Look out for ravens and peregrines. And, between Kynance Cove and Lizard Point, listen for the high-pitched ‘chi-ow’ of the Cornish chough – they returned here in 2001. Each spring, the coastal grassland is rich in plants uniquely adapted to the Lizard’s mild climate, geology and salty air, such as green-winged orchid, wild chives and fringed rupturewort. Squill, vetches, trefoils, thrift and ox-eye daisies abound. WILDEST WALK With some ups and downs, the 13-km/8-mile romp along the South West Coast Path from Mullion Cove to Lizard Point is an unbeatable slice of the precious Lizard landscape, passing through the lovely Kynance Cove. WARDEN’S TIP “You’ll hear the choughs before you see them. Look out for their tumbling, acrobatic flight and a flash of red beak.” Duncan Lyne. i 01326 240808; www.naturalengland.org.uk/nnr

ASTON ROWANT

A version of this article first appeared in Walk, the Ramblers magazine.

HABITAT A Chiltern landscape of chalk grassland, juniper and beech woods in Oxfordshire, with endless views over the vale of Oxford. ANIMAL ATTRACTIONS The flowers are spectacular: the frog orchid and bee orchid, the rare clustered bellflower and, in August and September, the Chiltern gentian. In the beech woods, chiffchaffs and bluebells abound. The flowers attract butterflies: the silver-spotted skipper, the chalkhill blue and the marbled white. Look out for anthills made by yellow meadow ants. Autumn fungi include King Alfred’s cakes, evil-smelling stinkhorn and the shiny white cap of porcelain fungus. Red kites fly close overhead. WILDEST WALK Beacon Hill is the highlight, but you could extend your walk along the Ridgeway National Trail, which passes right through it. WARDEN’S TIP “Take a short, sharp hike to Beacon Hill for amazing views.” Jenny Crook. i 01844 351833; www.naturalengland.org.uk/nnr

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19/12/2012 10:29

Paradise found Travel writer, Judy Darley goes on an adventure on the tropical island of Borneo

Clockwise from top: Judy and Mount Kinabalu; Kinabatangan River; Judy’s guide, Manuel, on the Poring Hot Springs Canopy Walk; silver leaf monkey at Labuk Bay; and Manukan Island

ravelling with Type 1 diabetes can be a challenge, especially when going to such far-flung and exotic destinations as Borneo. But as a travel writer with an appetite for new experiences, I was determined to see this spectacular island and its wildlife for myself. One of the world’s biggest islands, Borneo is divided between Indonesia, Brunei and Malaysia. The tour I opted for takes in Sabah, in the Malaysia part of the isle. My first stop before leaving for my trip was my local GP surgery, where, as well as having inoculations and being prescribed malaria medication, the nurse advised me on how to manage my insulin. Whenever I travel, I always carry at least a week’s more insulin than I expect to use, in case of flight delays or cancellations. Borneo is eight hours ahead of Britain, which made things relatively simple. I take long-acting Lantus insulin in

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the morning and evening, so just needed to keep the two doses far enough apart and take my quickacting Humalog insulin whenever I wanted to eat. I also packed a large amount of Fruit Pastilles – my hypo remedy of choice – and carried muesli bars with me most of the time, as a longer-acting way of topping up my glucose levels. After around 14 or so hours of flights, I finally reached Kota Kinabalu and slept till morning. I had a whole day before my tour group meeting, so after a breakfast of fruit, noodles and chicken porridge, I set out to find Jesselton harbour and catch a ferry to Manukan, one of five islands that make up Tunku Abdul Rahman National Marine park. What better way to get through jet lag than on paradise island? The ferries were tiny white and blue speedboats that bounced across the waves with a ferocity that made the proffered life jackets seem more

than a formality. Nearing the jetty, I noticed hordes of zebra-striped fish around the boat. The water here is clear and shallow, so even the snorkelers wade, rather than swim, here, shrieking with delight as shoals of fish swarm around them. On the shore, red ants ran amid tiny white crabs that raced along the sand like scraps of paper caught by the breeze.

Tip of Borneo Then it was time to meet my guide Manuel and fellow tour members. A drive along pot-holed roads lined by stray dogs, occasional monitor lizards

January – February 2013

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travel feature the heat definitely played a role. So when I woke up in the darkness to the sound of insects cricking and geckos yipping, I knew I was hypo. Climbing out of the mosquito net that swathed my bed felt akin to swimming upstream through a tangle of algae, but I made it out, retrieved the Fruit Pastilles that I’d left on the other side of the room, and ignored the sign asking guests not to eat in their rooms. Dawn came, light streaming through the slatted walls of my hut and we were visiting the animal sanctuaries. For most people the Sepilok orangutans are a key reason for visiting Sabah, but I found myself

and stalls selling tropical fruits, took harmful than not doing so! us to Tanjung Simpang Mengayau, The primates come and go at these the northernmost point of Borneo, sanctuaries, with eco-tourism just before dusk. Like all the shores I ensuring at least a couple of patches encountered here, the water was of rainforest are protected from the shallow and warm, if choppier than encroaching palm oil plantations. most, due to the meeting of the South But I was still keen to see the wildlife China and Sulu seas. roaming free. I got The sun set as we my wish at our next When I woke up to the sound of insects cricking swam, drenching us accommodation, – and the waves – in Myne Resort, which and geckos yipping, I knew I was hypo saffron and rose. sits on the bank of The following day, the Kinabatangan we travelled to Poring Hot Springs, River. A twilit boat tour offered up more enamoured with the proboscis pausing en-route to take photos of sightings of crocodiles, wild boar and monkeys at Labuk Bay Proboscis Mount Kinabalu. Hiking the trails to Monkey Sanctuary. Known locally as long-tailed macaques. Majestic the 41-metre-high canopy walk we white egrets rose in formation, and a Dutchman monkeys, they are like no passed a spectacularly vast cobweb. I other primates, with immense noses flock of rhinoceros hornbills hopped couldn’t decide what would be more marking out the males’ status in the from tree to tree. High in the scary – one huge spider or countless spindliest branches, a group of group, and domed bellies. The smaller ones spinning as a team! proboscis monkeys played. The sanctuary also attracts the pretty, if Once up in the canopy, the world pygmy elephants opted not to put in cataract-afflicted, silver leaf monkeys. quietened. I opted to go first, and an appearance, but that was forgiven the foliage was so dense I had no real Riverside sightings as forked lightning began to dance The orangutans were charming, sense of how high we were until the over the clouds. Our little boat too, with two adolescents performing trees suddenly thinned out, and made it back to the resort just as the forest floor admitted to being far, acrobatics while a female cradled her the rainstorm began, and we all baby. Food and water aren’t allowed far below. We all made it across, scattered for shelter. Laughing at the in the sanctuary, but it’s a long, red-faced from the humidity, but, fury of the night, we knew the true hot walk to the viewing platform, nonetheless, smiling. wildness of Borneo was just out and smuggling in some Fruit of sight, in the darkness beyond the Wildlife & mosquito nets Pastilles seemed less potentially hotel lights. Our accommodation that night i www.intrepidtravel.com was my favourite of the trip – Editor’s note: There is no evidence that wooden cabins right on the Misai Kucing tea brings down glucose levels. jungle-edge at Paganakan Dii, complete with narrow balconies from which to watch exotic squirrel species dart about. Have you travelled anywhere The day before I’d drunk a tea interesting or in a weird and made from Misai Kucing, a plant wonderful way? Email us at recommended as being good for balance@diabetes.org.uk or write people with diabetes. Since then I’d to the usual address (see p14). been running consistently low, and

TELL US!

although I can’t say it was the tea, The cars reach their destination

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January – February 2013 balance 59 19/12/2012 10:28

fundraising focus Zealous zombie zumbathon A massive thank you to everyone who participated in the hugely successful zombie zumbathon in Keighley, with special thanks to Vicky Lakin for organising the event. Vicky said, “When we told our clients about the event, we found many of them had members of their family who had diabetes, from dads to sons to sisters. Hence our huge support at the event.” Together, they raised a superb £1,605! If you like the idea of hosting a zumbathon, check out www.diabetes.org.uk for more details on how to organise one. Left: zumbathon fundraisers sporting fantastic zombie outfits

BUPA GREAT SOUTH RUN The Diabetes UK team (of more than 1,300 people) took to the streets of Portsmouth for the BUPA Great South Run this October in a bid to raise over £100,000 to fund a series of Healthy Lifestyle Roadshows. Among the runners was Jess Goodman from Bedford, along with her parents Jenny and Trevor. Between them they raised over £1,000 for Diabetes UK. Jess was diagnosed with pancreatitis at 14, which means that she has to take Creon with every meal. She has been warned that her condition may develop into Type 1 diabetes. Jenny said: “Jess has had to make some lifestyle changes over the last few years, but she has dealt with everything marvellously and is an inspiration to us all.” Steve and Leanne Jones from Southmoor, Berkshire, also took part, raising £415. They were running for their 9-year-old god-daughter Sophie, who has Type 1 diabetes. They said: “Sophie controls her diabetes by injecting insulin four times a day, but she manages brilliantly. The money we’ve raised will go towards support and information on diabetes, which will ultimately help Sophie to manage her condition as she gets older.”

Steve and Leanne Jones with goddaughter Sophie

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TREK ACROSS THE SEVERN Bryan Swallow, his wife, Ellie Townsend Jones, and Ellie’s son, Robin Jones, were just a few of the fundraisers who enjoyed splendid views of England and Wales while they walked across a landmark bridge for Diabetes UK in November. The event took place in sparkling sunshine on the Severn Bridge, which crosses the wide estuary near Bristol. More than 50 fundraisers made the 4-mile trek and have so far raised a fantastic £1,710 – with donations still rolling in.

A TALE OF TWO FOOTBALL CLUBS A young football fan from Diss, Norfolk, cycled between two local clubs to raise an amazing £523 for Diabetes UK. Nathan Steggles, 19, organised the 30-mile challenge in memory of his grandmother. He said: “I was very close to my nan and I always remember her being so brave, positive and selfless throughout all her diabetes-related problems. Doing the bike ride was my way of remembering both her and my other grandmother, who was a keen cyclist.”

January – February 2013 20/12/2012 17:09

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.

LONDON BRIDGES WALK

OFF TO A FLYING START The weather held up, the runners turned out and passers-by cheered as Newport Marathon, now being managed by Diabetes UK Cymru, hit the trail back in October. At least 40 runners lined up for the full and half-marathon events, whose backdrop included some of Newport’s most famous landmarks – Newport Castle, the Fourteen Locks canal system, the Transporter Bridge, the new University, the Riverfront Theatre and Arts Centre, and the River Usk. Honours for the fastest time went to Hywel Davies (pictured) of Rugby at 2 hours 55 minutes and 24 seconds for the full marathon. i To take part in the 2013 Newport Marathon, contact wales@diabetes.org.uk.

On Sunday, 18 November, the River Thames was lined with splashes of blue, as hundreds of people with diabetes, along with their friends and family, took on the London Bridges Challenge to raise vital funds for Diabetes UK. The route took the fundraisers across London’s iconic bridges and showed them the wonderful city sites, including the Houses of Parliament and Big Ben, the London Eye, St Paul’s Cathedral, the ‘Gherkin’, the MI6 building and Battersea Power Station. More than 600 people registered to take on the 8-mile walk and they are set to raise an amazing £45,000, which is £15,000 more than last year!

CHANNEL CROSSING Six teams set off from Dover last August to take part in the Diabetes UK Channel Swim Relay. Negotiating the English Channel, one of the world’s busiest shipping lanes, is not for the faint-hearted and the intrepid swimmers’ incredible efforts have raised more than £50,000 for the charity.

DIARY ONGOING Step It Up Make a positive start to your new year by taking the ‘Step It Up’ challenge. As an added incentive, why not get your family, friends and colleagues to sponsor you? Then you can get fit and healthy while raising vital funds? It’s a win-win situation! i 01922 614500 • midlands@diabetes.org.uk 16 FEBRUARY Winter Ball Diabetes UK Cymru has come up with the perfect Christmas gift to beat the winter blues and bring romance back into any relationship – tickets to its much-anticipated Winter Ball. To be held in Prestatyn, North Wales. i 01745 508 506 • wales@diabetes.org.uk 17 MARCH Reading Half-marathon Dust off your running shoes and sign up for this year’s Reading Half-marathon. Enjoy a course that takes in all the highlights of the city centre and offers huge crowd support. i fundraising.southeast@diabetes.org.uk • www.readinghalfmarathon.com 6 MAY Northumberland Coastal Challenge Do you want to do something a little different or push yourself a little further? This 26-mile walk covers the stunning Northumberland coastline from Bamburgh to Alnmouth. i 01325 488606 • northyorks@diabetes.org.uk 4 AUGUST Ride London 100 Lead out the greats when you take on a cycling challenge like no other. Just hours before the world’s top cyclists race the RideLondon Classic, 20,000 cyclists will have the chance to experience a modified version of the Olympic Road Race. i 020 7424 1000 • www.diabetes.org.uk/ridelondon100

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

READY STEADY Timesulin cap A replacement cap for your insulin pen that shows how long since your last insulin injection. Never miss an injection or accidentally double dose again. £29.99, free p&p, Lilly Kwikpen (6031), Novo Nordisk Flex Pen (6031a), Sanofi Solostar (6031b)

SHOP!

DIABETES ADVERT

Diabetes UK pen Great value for money, this white pen bears the Diabetes UK logo. Black ink. £1.25+p&p (code 4200a)

Carbs & Cals A visual guide to carbohydrate and calorie counting for people with diabetes. £12.99+p&p (code 4352)

Just a few of the items available at our online shop Desang Roll Up kitbag (Microfibre) Great for people who use a lot of kit, or have several types of insulin to use. Also excellent for pump users to carry their supplies. Good for longer trips for those who use insulin pens or bottles and syringes. £22.99+p&p (code 4262)

Order these and other Diabetes UK items at https://shop.diabetes.org.uk or freephone 0800 585 088, Monday to Friday, 8am to 6pm. Please quote B159 when placing your order. (Postage is charged on some items.)

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fun&games

WIN!

£100

John Lewis Vouchers

PRIZE CROSSWORD

To enter: Cut out the grid and send to the usual balance address (see below) marked ‘Crossword’. The first correct entry drawn after 1 February 2013 will win £100 worth of John Lewis vouchers. Congratulations to last issue’s winner, Mrs A Skelt from Tarporley. 1

ACROSS 1 Division of poem (5) 6 Some only cope near red carotenoid pigment in tomatoes? (8) 7 Roman poet (4) 9 Twosome (3) 10 Turnip (Scots) (4) 12 Marine mammal (6) 13 Task (6) 15 Italian Adriatic resort (6) 17 Persecute (6) 18 Eyelid inflammation (4) 20 Wildebeest (3) 21 Fruit with Conference variety (4) 22 Adventurer (8) 23 Stranger (5)

DOWN 1 Complicated matter (3,2,5) 2 Amphibian (4) 3 German philosopher, Arthur ___ (12) 4 Top-order batsman (6) 5 Leg joint (4) 6 Okra (5,7) 8 Muslim religion (5) 11 Uninspired (10) 14 Succulent plant (5) 16 Lover of Tristram in Arthurian legend (6) 19 Printed words (4) 21 Apostle (4)

Name Address Postcode

SOLUTION to November/December 2012 ACROSS 1 Remedy, 4 Scree, 9 Sternum, 10 Piton, 11 Manhattan, 12 Toil, 13 Cairn, 16 Iris, 19 Guerrilla, 21 Radii, 22 Diamond, 23 Crock, 24 Celery DOWN 1 Russet, 2 Muesli, 3 Denim, 5 Captain, 6 Estate, 7 Amontillado, 8 Inane, 13 Cardiac, 14 Agora, 15 Leader, 17 Remote, 18 Sundry, 20 Agate

WALK ON THE WILD SIDE

LINKLETTER

Wildlife Walks: Great Days Out at Over 500 of the UK’s Top Nature Reserves is a guide to a great day out. Illustrated with colour photographs and maps, there’s details on facilities, how to get there, and attractions. We have three of these books to give away. Send your name and address on a sealed-down envelope or postcard to: ‘balance walk giveaway’, Diabetes UK, 10 Parkway, London NW1 7AA by 1 February 2013.

Find the missing letters that link each two pairs of words, as per the example. When completed correctly, the inserted letters read in order will spell out a 10-letter word. Example:

64 balance

TE LI

ER EN

DE BO

TE RO

LA MO

SH ES

DE NO

IN RY

PA EN

NA TY

IR CL

Last issue’s solution: ELECTORATE

Puzzles set by Neil Locker

January – February 2013

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fun&games

S U D O K U

Wordworkout

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

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

2 Fill the grid so that every column, row and 3x3 box contains the digits 1 to 9. Rating Intermediate Last issue’s solution

Berry

6 2 5 3 1 9 4 8 7

4 7 1 2 8 6 5 3 9

3 8 9 5 7 4 2 1 6

9 4 6 8 3 2 7 5 1

7 3 8 6 5 1 9 2 4

5 1 2 4 9 7 8 6 3

2 9 3 1 4 5 6 7 8

1 5 4 7 6 8 3 9 2

8 6 7 9 2 3 1 4 5

How many words can you make from these letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word. Names and plurals are not allowed. There is one nine-letter word in the grid. Clue: BOXER. 15 = Average; 20 = Good; 25+ = Excellent. Last issue’s nine-letter word: TRUNCHEON

E G L Y H I F W T

tasty

A BALANCED LIFE John Byrne

The same fast acting GlucoGel, now in a fruity flavour Now available in triple pack (3 x 25g tubes) Fast acting 40% glucose gel Raises sugar levels fast

Last issue’s solution: ELECTORATE

For people who require glucose, or are in need of an energy boost Easy to carry, easy to use, easy to swallow

For more information visit www.glucogel.co.uk or call BBI Healthcare on 01656 868930

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NOWK5

different types

ARTHUR SMITH

MARI WILSON

Many happy returns

woman in America has been awarded a medal for managing 50 years on insulin and maintaining good health, all things considered. Hurrah for her, I say, and let her be an inspiration to all of us. I read this news just as World Diabetes Day was approaching. For us, that’s always the case – diabetes month, week, day, hour, minute, tick-tock… People are often surprised when I tell them my daily routines and rituals – for my diabetes, that is, as I think everyone knows what I’m like when it comes to hair, shoes, handbags… But really, what we do every day is quite complicated and we never get a day off. Also, it’s invisible. So, to the outside world, we look fine – most of the time. I’m not forgetting those who live with us, of course, who know almost as much as we do. My lifestyle is such that every day is very different. One day a rehearsal, another a concert, then recording in the studio, or working at home writing, etc. So, I have to be very in charge and knowledgeable about what I’m doing because, although my working life and hours are all over the place, my control has to remain the same. I’ve known my best friend since we were 11 and she was fantastic when I was diagnosed with Type 1, 34 years ago. She helped me get through injections, urine tests and hypos. But the other day she said that she still doesn’t really know what I do to keep things under control. I remember travelling on a train with a fellow musician – she’s seen me injecting and blood-testing in dressing rooms many times (oh, I’m such a rock chick), and, of course, I’ve explained all about it. So, we were discussing work. At the end of the conversation she said, ‘Oh well, at least you’ve got your health... Well, apart from that…’ I love that I don’t look ill and wouldn’t recommend having a tattoo on my forehead saying: ‘Type 1 Diabetic’, as it wouldn’t suit my hairstyle for a start, but wouldn’t it be a good idea if everyone was just a little more up on it? I’m often banging on about having health education as part of the National Curriculum; we could have a kind of health and safety course for all students, so that they’d know what to do for an epileptic fit, a hypo, the Heimlich manoeuvre, etc. Then, we would have chefs who would come and teach about good nutrition. Afterwards, our children can cook the dinner! See, there’s a method to my madness! I can dream, can’t I? Right I’m off to check my blood sugar and see if I can get a medal in 16 years, when I reach my 50th year on insulin. i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 and coeliac disease. Her latest album, Cover Stories, is out now; www.mariwilson.co.uk.

Photos: Mari: Claire Lawrie; Arthur: Steve Ullathorne

his is the 250th issue and congratulations are in order. But it’s worth remembering that the ideal balance front cover would be the one announcing that diabetes has been cured and the magazine is closing, as no one reads it any more. This day will arrive eventually, no doubt, and I hope they have a great endof-the-road party. In the meantime, we diabetics can still leaf through this noble organ, gape at some of the physical prowess exhibited, and we can still celebrate how far treatment has come in the last century. (Shut up at the back – 100 years is nothing in the scale of human history.) There is much to be done – too many remain undiagnosed, not enough receive a proper annual review, etc. And, my own bugbear, why do all the ads for meters still put blood sugar readings as 5.6 or 5.8? Please can’t we get an ad showing 11.7 or a 3.9? I digress… Consider 14-year-old Leonard Thompson, lying silently in a corner of a ward in Toronto General Hospital, January 1922. He is weak, listless, emaciated and the doctors give him no chance of survival because he has what we now call Type 1 diabetes and there is nothing they can do. Into the ward one morning walks a young doctor who, along with his research team, has developed an experimental new treatment… Well, it worked on the diabetic dogs… The doctor is 30-year-old Frederick Banting, and Leonard is about to become the first diabetic ever to receive insulin. (Fred, marvellous chap, has injected himself to check it isn’t dangerous.) After one false start, the liquid begins to do the trick. Len gains strength and is eventually discharged into the bright Canadian spring. Three years later, an intern recalled seeing Leonard and described ‘a sturdy young man who showed little resemblance to the dying boy he had been’. The ideal end would be Leonard living to old age, tap dancing into the second millennium. Alas, life, as ever, resists the Hollywood narrative. He died of pneumonia, aged 27. Let’s hope Leonard had a great extra 13 years. People with diabetes can now lead long lives, as Bob Krause will testify. On his 90th birthday CBS News asked whether he was the world’s oldest diabetic. Well done, Bob, you are close – but no cigar. The world’s oldest Type 1 diabetic, I found with a cursory Google, may well be the ‘fit and fierce’ 92-year-old Irene Seymour of Dargaville. I can’t wait to hear about the first diabetic centurion. Perhaps it will be me? Perhaps I’ll pen my last column for the last copy of balance on my 103rd birthday. Wow! Look up there at all those pigs whizzing by… Happy 250th, balance. i Arthur Smith is a comedian, writer and broadcaster with Type 2.

Random routines

66 balance January – February 2013 66-68 A n M AC/SRS.indd 66

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Photos: Mari: Claire Lawrie; Arthur: Steve Ullathorne

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