Balance Magazine March-April 2012 by John Clarkson

balance Your diabetes lifestyle magazine • March – April 2012

Step to it Why diabetes is important to Steps star Lee Latchford Evans

Can you prove that? Lifting the lid on diabetes ‘remedies’

way out west

Family fun in the Rockies

Put your foot down Get the foot care you deserve

Diabetes downsize

Slimmer and healthier after Type 2 diagnosis

Perfect figures?

What to do when you’re off target

plus

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

Lights, camera, action!

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

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Diabetes UK Insurance Services is administered by Heath Lambert Limited which is authorised and regulated by the Financial Services Authority. Registered Office: 9 Alie Street, London E1 8DE. Registered No.: 1199129 England & Wales. www.gallagherheath.com. Gallagher Employee Benefits is a trading name of Heath Lambert Consulting Limited, authorised and regulated by the Financial Services Authority. A member of the Society of Pension Consultants.Registered Office: 9 Alie Street, London E1 8DE. Registered No. 0772217 England and Wales. www.gallagherheath.com SD3339_A/10022012

contents March – April 2012 • no 245

balance

The UK’s leading magazine for people with diabetes. Produced by Diabetes UK, the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. 10 Parkway, London NW1 7AA 020 7424 1000 balance@diabetes.org.uk www.diabetes.org.uk/balance

Editor

Angela Coffey

Deputy Editor

Kate Flagg Designer

John Clarkson Editorial Secretary

Melanie Aldridge COVER IMAGE

Matthew Jones Ad Manager

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

Pindar plc ARTICLES & ADVERTISEMENTS

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

regulars

features

life&health

4 This is Diabetes UK 6 News Diabetes news round-up 14 Columnists 16 Research matters 20 Your views 46 Recipes balance favourites 50 Bite-sized Food news and tips 55 T ravel Family fun in the Rockies 58 Walk Discovering London’s canals in an Olympicsinspired route 60 Fundraising focus Celebrating your achievements and events coming up 64 Fun & games Win: Morphy Richards Intelligrill, Grand Designs Live tickets and a Virgin balloon flight for two! 66 Different types Arthur Smith and Mari Wilson tell it like it is

24 Step to it Steps star Lee Latchford Evans and his partner on diabetes, fitness and the upcoming Steps tour 26 Science or snake oil? Dr Richard Elliott sets us straight on the herbal remedies and nutritional supplements that claim to help treat or cure diabetes 30 Steady as she goes When Carol McCormack was diagnosed with Type 2, she knew she had to gain control – now 5st lighter and medication free, she shares her story 33 Lights, camera, action! Filmmaker Tom Craig takes balance behind the scenes of his latest diabetes horror movie – and explains why he’s doing it 52 Number crunching An insightful look into carb counting for cooks

38 Health notes Time to put your feet first; your guide to a healthy, balanced diet; Timesulin giveaway; how to get free gym vouchers; what are basal & bolus?; and blood glucose targets guide 41 Ask the experts Our bank of diabetes professionals answer your questions. This time: why you should hold on to your glucagon; the contraceptive implant; and diabetic amyotrophy 43 Spotlight on... Arthritis 44 Basic care No such thing as perfect: Sometimes your blood glucose levels may be off target. balance looks at possible causes and what you can do about it

March – April 2012 balance

this is Diabetes UK From the Chief Executive

Join us today

pUTTING FEET FIRST

Supporting Membership keeps you up to date with diabetes developments and connects you with a network of people who understand your condition. And, of course, you receive balance six times a year. To join us now, call 0800 138 5605 or, for details, call our Supporter Services team on 0845 123 2399, Monday to Friday, 9am to 5pm.

hen I talk to people with all types of diabetes about the awful complications that the condition can lead to – like blindness or amputation – I get two main types of reaction, which are pretty much polar opposites. Either: ‘Why are you talking about amputation when we’re just trying to get on with life? With good diabetes control, we can lead a relatively problem-free existence – stop bringing us down!’ Or: ‘You aren’t giving enough clear information about what could happen to me or the person I care about, and it’s your duty to do this.’ Of course, this is a difficult issue to reconcile, and the answer is that we need to give out both kinds of messages. This March we’re launching a campaign to reduce the numbers of amputations suffered by people with diabetes. It’s called ‘Putting Feet First’. Our campaign messages will be conveying the fact that with early diagnosis, good support for self management and proper foot care checks, as part of the 15 healthcare essentials, up to 80 per cent of amputations are potentially preventable. The campaign will also inform people with diabetes about their rights to an annual foot check and how they can reduce their risk of developing foot problems. Readers of balance tend to be well informed, but, unfortunately, we know that one in three people with diabetes say they did not realise that having the condition put them at greater risk of having an amputation. We know that the existence of multidisciplinary foot teams and access to specialist care within 24 hour reduces the risk of amputation dramatically, so we are campaigning for improved, and better co-ordinated, care everywhere across the UK. I’m optimistic that together we can make a difference. I hope we can make good use of the ‘patient power’ you represent. If you would like to support the foot campaign further, do join Diabetes Voices and make your voice count. Baroness Young Chief Executive, Diabetes UK i Turn to ‘News’, page 6, for more on the Putting Feet First campaign,

and page 37 for what to expect from your annual foot check. • Diabetes Voices is Diabetes UK’s network for people who want to influence diabetes care; for more information and to join, visit www.diabetes.org.uk/ diabetesvoices.

balance March – April 2012

Diabetes UK Careline For support and information, call 0845 120 2960 The Careline is open Monday to Friday, 9am to 5pm. TypeTalk calls are accepted and an interpreting service is available. Recorded diabetes information is available 24 hours a day via the 0845 number. Please check the cost of calls to 0845 numbers with your phone provider. You can also write to Diabetes UK Careline, 10 Parkway, London NW1 7AA for a response within 21 days or email careline@diabetes.org.uk for a response within 10 working days. The service is confidential but we are unable to provide individual medical advice.

Tell us what you think Feedback helps us improve If you have any feedback about Diabetes UK services, good or bad, please write to Supporter Services, Diabetes UK, 10 Parkway, London NW1 7AA (marking the envelope ‘Feedback’); call 0845 123 2399, Monday to Friday, 9am to 5pm; or email supporterservices@diabetes.org.uk.

Find your nearest Diabetes UK office Diabetes UK has offices across the UK. Visit www.diabetes.org.uk/contact_us or call 020 7424 1000.

Connect online www.diabetes.org.uk w ww.diabetessupport.co.uk www.facebook.com/diabetesuk http://twitter.com/diabetesuk

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On insulin and regularly making your own insulin dosing decisions? OneTouch® Verio®Pro may be suitable for your needs. To order your FREE meter trial call OneTouch® Customer Care: 0800 279 4142 (UK) quoting code AE167 Or visit www.LifeScan.co.uk/Bal *TERMS AND CONDITIONS Offer open to insulin users aged 16 or over and resident in the UK & Ireland, including users of meters other than OneTouch® meters. Applicants who currently use a OneTouch® meter must have had their meter for 12 months or more and not received a free OneTouch® upgrade during this period. Offer closing date 31st July 2012. Those eligible to participate in the free meter trial will be offered a OneTouch® Verio®Pro Blood Glucose Monitoring System, 25 test strips and a questionnaire about their experience of using the OneTouch®Verio®Pro to complete and return in the reply paid envelope provided. Only one free OneTouch® Verio®Pro Blood Glucose meter trial per person. Meters are subject to availability. This offer is limited to a maximum of 4,000 free OneTouch® Verio®Pro meters. Allow 28 days for delivery.

news

Everyone’s talking about...

Putting feet first Diabetes UK is launching a major foot campaign in March to reduce dramatically the number of amputations suffered by people with diabetes. The first phase of ‘Putting Feet First’ will see the charity provide information materials to healthcare professionals and people with diabetes to support better foot care, help them spot problems early on and help people demand the standard of care that they are entitled to. The campaign will also raise awareness about the seriousness of diabetes and the consequences of poor care. Bridget Turner, Head of Policy at Diabetes UK, told balance: “Everyone with diabetes should have an annual foot check and a healthcare professional should discuss the results and potential risk level. But it’s a sad fact that in 2009–2010, nearly one-third of people with Type 1 diabetes didn’t get a foot check, and less than half of people had their risk clearly explained. Some areas also have far fewer amputations than others – the way foot services for people with diabetes are organised can have a huge impact on reducing amputation.” Diabetes UK will also be calling for key decision-makers to prioritise diabetes services in all areas to ensure that the NHS delivers better-quality foot care. i www.diabetes.org.uk/putting-feet-first

{1/3 6

balance March – April 2012

NICE approves Type 2 weekly treatment

Diabetes UK calls for higher-quality foot care

Information day An information day to improve people’s knowledge and understanding of potential diabetes foot and lower-limb complications will be held in May. At the free event, organised by King’s Health Partners, Guy’s and St Thomas’ NHS Foundation Trust, Diabetes UK and Flexitol, a wide range of healthcare professionals involved in the treatment of lower-limb diabetes complications will be discussing modern, up-to-date treatments. The event will take place on 19 May from 9.45am to 4.30pm at the Weston Education Centre, King’s College Hospital, London SE5 9RJ. Refreshments and lunch are provided free of charge. i To secure your place, email Christian Pankurst at diabeticfootcomplications@yahoo.com or visit www.diabetes.org.uk/In_Your_Area/London to download a booking form.

The amount of people with Type 1 diabetes who didn’t receive a foot check in 2009/10 • See page 37 for more on foot checks

}

The National Institute for Health and Clinical Excellence (NICE) has issued its final guidance on the use of Bydureon (exenatide), recommending it as an option for people with Type 2 diabetes in conjunction with other diabetes medication – metformin and a sulphonylurea, or metformin and a thiazolidinedione. Exenatide is already in use as a twice-daily injection known as Byetta, but Bydureon only needs injecting once a week and works in three ways: it helps the body to produce more insulin when needed; it reduces the amount of glucose being produced by the liver when not needed; and it reduces the rate at which glucose from food is released. Exenatide is recommended for people with Type 2 diabetes whose blood glucose levels are not well controlled and have other risk factors, including a body mass index (BMI) of 35 or above. It can be used in patients with a BMI below 35 if treatment with insulin has presented problems. NICE recommends the treatment should only be continued if tests show it is having a beneficial effect after six months. i For more details, visit www.nice.org.uk. • For more on Type 2 diabetes treatments, visit www.diabetes. org.uk/guide-to-diabetes/ treatments.

balance rounds up all the latest diabetes news

It’s now time to walk the walk, urges Chief Executive

Enjoy precision. Barbara Young (right) on BBC News

The Government’s failure to match its words on diabetes healthcare with action is responsible for the “scandal of early deaths and preventable complications” in people with diabetes, according to Barbara Young, Chief Executive of Diabetes UK. Speaking on BBC News on 21 February, ahead of an edition of Radio 4’s File on 4 on diabetes care, Barbara Young called for the Government to make diabetes a much higher priority: “The Government often says the right things, but the fact is that we are treading water when it comes to delivering quality diabetes healthcare. People are suffering dramatically reduced quality of life as a result of lack of political will. “Perhaps the most frustrating thing is that this is one of the few problems facing the Government that does not require more investment. A colossal amount of money is already being spent on diabetes – about 10 per cent of the NHS budget – but too much of it is being used to treat the complications of diabetes rather than to prevent those complications developing in the first place. “Health professionals are constantly telling us how frustrated they are about the constraints the system places on them, and we want the Government and the NHS to give them the tools they need to provide the excellent care that people with diabetes deserve. It is time to stop just talking the talk on diabetes healthcare and start walking the walk.” i Diabetes UK’s 15 Healthcare Essentials campaign outlines the diabetes checks and services that every person with diabetes should receive or have access to – visit www.diabetes.org.uk/15-essentials.

Driving it to work The Driver and Vehicle Licensing Agency (DVLA) is testing a redrafted form that explains more clearly what people are expected to report when applying (or reapplying) for a driving licence. This follows concerns that drivers with diabetes could unnecessarily lose their licence because of new rules. The redraft – introduced at the second meeting of the working group, which includes Diabetes UK staff and Diabetes Voices campaigners – takes into account comments from Diabetes UK members and will be further tested among people with diabetes. Once the new form is finalised, Diabetes UK will produce guidance for people going through the application process. i For the latest driving news, visit www.diabetes.org.uk/driving.

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they say, we say

Celebs speak out Two familiar faces with diabetes have both spoken out about having the condition. The X-Factor contestant and Diabetes UK supporter Amelia Lily, diagnosed with Type 1 diabetes at the age of 3, helped to raise awareness of 90 years of insulin in an interview with The Sun in January. Amelia said: “I’d be lying if I said it wasn’t hard at times and I think any diabetic would agree with me. But it does get easier and it becomes part of your daily routine. You have to stay on the ball to keep yourself healthy. I believe it [having diabetes] has made me stronger. I think it has helped me to cope with the whole X Factor experience.” Amelia now hopes that her example will show other children and young people with diabetes that you can still get out there and follow your dreams. She will be appearing in the 2012 X-Factor tour, which kicked off on 25 February. Elsewhere, Sky News reporter Stephen Dixon, who was diagnosed with Type 1 diabetes at the age of 17, wrote in the Daily Express about living with the condition. Although he has had his ups and downs,

Jab to do the job?

Stephen also featured in March/April 2010 balance Stephen has mostly enjoyed good health and good diabetes control. He puts this down to “getting to grips with the condition and trying to enjoy being diabetic”. Stephen thinks that it is important to recognise the crucial role played by healthcare professionals – and the responsibilities of people with diabetes: “We always have to remember the care given by diabetes specialist nurses up and down the country, which can be superb. Not everyone is as lucky as I am but there’s an easy way to tell if you’re getting the care you deserve. Your nurse should listen to you as much as advise you, as everyone patient is different. Of course, they can’t do either if you don’t turn up for your annual or biannual checks.” i Check you are getting the care you deserve at www.diabetes.org.uk/15-essentials.

A glow of contentment Congratulations to Martin Pridmore, pictured, for his poem, ‘A Contended Glow’, which won Diabetes UK’s Care Events competition. Children and young people who attended a Family Weekend, Children’s Holiday or Children’s Weekend in 2011 were asked to draw a picture or write about their experience. Martin, 18, received a Kodak Zi8 Pocket Video Camera and £30 of Amazon vouchers for his piece, which brilliantly sums up his time at a Children’s Weekend. i Read Martin’s poem at www.diabetes.org.uk/balance. • To find out more about Diabetes UK’s Care Events for 2012, visit www.diabetes.org.uk/care-events.

balance March – April 2012

Sanofi supply Following a shortage, a new supply of Sanofi’s Apidra SoloStar and Apidra cartridges, for use with the ClikStar pen, became available at the beginning of February. Sanofi has been working closely with the Department of Health and the supply chain to try to ensure that supplies are available to people with diabetes with the minimum of disruption. However, your GP may only supply a prescription for up to three months initially, and it may be that your pharmacist takes up to three days to fulfil. i Sanofi Diabetes Care Line: 0800 035 2525.

The new year kicked off with the Daily Express claiming that a ‘once-a-day fat-busting jab could be the key to battling Britain’s obesity crisis’, and the Daily Mail declaring ‘Gut hormone could cure obesity crisis by suppressing appetite’. Both stories referred to a study, published in the British Medical Journal in January, which analysed the results of 25 trials involving more than 6,000 patients to assess the effect of drugs that activate glucagon-like peptide-1 receptor (GLP-1R). Such drugs are currently used to treat blood pressure in some people with diabetes, but this new study looked at whether the drugs could aid weight loss in people with and without diabetes. The researchers, based at the University of Copenhagen, found that patients given a daily dose for at least 20 weeks achieved weight loss of half a stone. Too good to be true?

DIABETES UK SAYS While both newspapers mentioned that the British Medical Journal advocates further investigation of the risks and benefits of these drugs, claiming that they could ‘cure’ the obesity crisis is jumping the gun. Drugs that activate GLP-1R are currently licensed only for the treatment of people with Type 2 diabetes who are not responding to standard treatment methods. Such drugs are currently not prescribed as weight-loss drugs and have not been medically licensed for this purpose. Further research into the risks and benefits of these drugs is required before they could be considered as potential weight-loss treatments for the majority of people with obesity.

Question Time panel (left–right): Stephen Dorrell, Diabetes UK’s Barbara Young, Viggo Birch, Keith Vaz, Grace Vanterpool, Adrian Sanders and Paul Burstow

Enjoy comfort.

Beyond the Bill A Diabetes Question Time event took place at Westminster Central Hall on 17 January, as part of the series of discussions exploring the issues facing people with diabetes and their carers. Topics addressed included the differences in quality of healthcare for people with diabetes across the UK, and insulin pump access. Audience members also completed

a survey, which suggested that supporting self-management is what people with diabetes think should be the Government’s number one diabetes priority. For those without diabetes, diagnosis and prevention came out on top. i Read Diabetes UK’s tweets from the event at www.diabetes.org.uk/ beyond-the-bill.

The Health and Social Care Bill is back in the House of Lords – and the headlines. The first day of Report Stage in the Lords coincided with The Times quoting an ‘unnamed Downing Street source’ saying that the Secretary of State for Health, Andrew Lansley MP, ‘should be taken out and shot’ for the substance of the Bill and a failure to communicate the reform policies. This quote follows the move to oppose the entire Bill from some of the clinical representative organisations such as the British Medical Association and the Royal College of Nursing. Dropping the Bill is also the position of the Labour Party, and the unnamed source reflects exasperation within the Coalition Government that it is losing political ground on health, one of the two departments (the other is international development) where its programme did not impose a reduction in spending.

At the time of writing, the Health Secretary seems set for a difficult few months, but it remains likely that the Bill will go through and will be made into an Act by May 2012. In the House of Lords, Diabetes UK has been working in alliance with other leading health charities to improve the Bill, for example, tabling amendments on patient and public involvement in service decisions. Meanwhile, Diabetes UK is among more than 40 national health and social care charities – all members of the National Voices coalition – who wrote to The Times to call on the Government to make the Bill work better for patients and service users. The charities say that the Bill is weak on patient involvement in their care and that this can and should be remedied easily through a number of ways. i Visit www.nationalvoices.org.uk/ health-and-social-care-bill-2011-0 to read the letter in full.

ID 20019-UK/V01/2012-02

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news

In brief... Support group success

More than 80 people with experience of Type 1 came together on 21 January at The Hilton Blackpool to learn more about living with diabetes. Volunteer Victoria Elvy told balance: “Attendees networked, looked around pharmaceuticals’ stalls and enjoyed hearing from speakers talking about a range of topics, including growing up with Type 1 diabetes and about reaching personal challenges. “This meeting would not have been possible without the work of the Fylde Coast Children’s Support Group Committee and the support of Diabetes UK North West, plus Diabetes Power, the pharmaceutical representatives and JDRF. Thank you to everyone who attended – we couldn’t have done it without you!”

behind the headlines

NHS Choices has launched a ‘Behind the Headlines’ service, providing an unbiased look at leading health news. Every day the team picks out two stories and draws on the research behind them to explain the issues involved. You can follow this at www.nhs.uk/news. i See ‘They say, we say’, page 8, for balance’s own look behind the headlines.

Be bowel aware

April is bowel cancer awareness month and Bowel Cancer UK is tackling the of issue of low awareness of signs and symptoms of the disease. The charity has developed a range of free materials including booklets, leaflets and posters to help spread the message. i www.bowelcanceruk.org.uk

10 balance

March – April 2012

Product watch Sue Marshall from Desang (www.desang.net) shares her favourite diabetes kit

SimpLance Literally a ‘revolutionary new lancing device’, the SimpLance is flat and circular. It avoids fiddly and sharp lancets with its enclosed disk that stores 20 micro-lancets (that’s 20 tests before you have to reload) for fast and fuss-free testing. Includes adjustable depth setting. Each SimpLance comes with 10 refill cartridges (a total of 200 lancets). It retails at £9 and is also available on prescription.

BD 4mm needles Ask your nurse about these super-short needles. Not just for children, shorter needles mean less pain. They also may well be more effective delivering insulin, making sure you only hit the right layer of skin so that absorption is always the same. In this way, injecting can be ensured not to be a contributor to less-than ideal control. Why wouldn’t you?

Medidos Referring to ‘medical dose’, this neat pill packer (£11.49) has enough chambers for pills to last you through a week, with time-slots to fit around meals and other times of the day. You can fill it up once a week, then not have to worry about which pills to take and when. Great if you are on multiple medications. i www.dudleyhunt.co.uk; 01796 482105.

Analogue insulin Diabetes UK has updated its position statement on the use of analogue insulin. The charity recommends that all insulin analogues should be available to people with diabetes in the same way as human or animal insulin. The decision of which insulin is most appropriate should be made between the person with diabetes and their healthcare team, and should follow NICE guidance that human insulins should, in general, be tried as first-line treatment, with analogues being introduced if optimal control cannot be attained. i Read the statement at www.diabetes.org.uk/analogue-insulin.

Correction

‘Alternative to aspirin’ (Your letters, Jan/Feb 2012 balance), mistakenly implied that omeprazole was an alternative to aspirin. Letter writer John Evans takes aspirin but said that it causes an upset stomach. His GP prescribed omeprazole to help with these symptoms – not as an alternative to aspirin. balance apologises for any confusion.

PIP for pounds Diabetes UK is calling for people with diabetes to sign up to the free PIP Health research panel. Through their surveys, the research company is quickly able to get answers from large numbers of people with diabetes, which inform the design of products and services. PIP Health will donate £1 to Diabetes UK for every person who signs up and fills in the Welcome survey, as well as £1 for every other completed survey. i www.piphealth.com/ DiabetesUK

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news

In brief...

Local links

The Diabetes UK East Berkshire voluntary group has strengthened its links with other local organisations. To mark World Diabetes Day 2011 (14 November), Windsor Farmers’ Market agreed to appoint Diabetes UK as its guest charity for November. The Datchet Border Morris Dancing team (above) also kindly agreed to donate a large proportion of the collections made at its traditional Boxing Day performance to the Group. The two organisations now have an ongoing partnership, starting with a planned joint `fitness and fun’ exercise session. Group Chair Emma Kenny told balance: “Our Group recognises the importance of developing closer links with other local organisations. The key is to find activities that are of mutual benefit. I hope that this will encourage other groups to forge similar links.’’

Plans for a holiday?

Diabetes UK Insurance Services can set your mind at rest that you’re fully covered for some fun in the sun. The company provides comprehensive cover for those living with diabetes, other pre-existing medical conditions and disabilities, and can also quote for friends, family and supporters of Diabetes UK. The charity receives a donation for every policy sold, at no additional cost to the policy holder. i Call 0800 731 7431 to find out more and receive a quote.

Stars offer training tips Daybreak’s Dr Hilary Jones and his partner, celebrity personal trainer Dee Thresher (pictured), joined Diabetes UK in Kent for the filming of the Bupa Great Run training video. The online film aims to help supporters improve fitness and reach their goals. The duo has a strong link to diabetes: Hilary’s son has Type 1 and Dee’s father has Type 2. Both Hilary and Dee are taking part in the Bupa Great South Run in Portsmouth on 28 October. i The video will be available to view at www.diabetes.org. uk/bupa at the beginning of April. • For more training guidance, visit www. bupa.co.uk/running and follow Hilary (@ drhilaryjones) and Dee (@dee_fitness ) on Twitter as they share more training tips.

CHANNEL

SWIM POOL CHALLENGE SWIM

22 MILES BETWEEN 22 APRIL AND 22 JULY Take on the challenge of the channel swim in the convenience of your local swimming pool and help us raise vital funds. Register: www.diabetes.org.uk/swim22 Email: swim22@diabetes.org.uk Tel: 020 7424 1000 Find us on:

#swim22

12 balance

March – April 2012

GET YO

GOGGLES UR ON!

Runs & roadshows As the nominated charity for the Bupa Great Run Series, 10,000 people are expected to sign up for a run in support of Diabetes UK this year. The partnership goes further than the Great Runs too – Diabetes UK and Bupa are working together to inspire healthier lifestyles, and this year hope to raise in excess of £1m to fund a series of healthy lifestyle roadshows across the UK. Some of the main aims will be to improve services for people with diabetes in the UK and make sure the public is aware of the severity of diabetes and the implications it can have, while inspiring the population to make healthy lifestyle changes. i To register to take part in a Bupa Great Run for Diabetes UK, email bupagreatruns@ diabetes.org.uk or choose to run for Bupa’s nominated charity when signing up at www.greatrun.org. • See the insert included with this issue of balance for more on the Bupa Great Runs, including dates.

Chloe said...

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

We listened. Compact, stylish and discreet

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GBIE.BGS.11.12.13

Date of preparation: January 2012

columnists Research works

It’s fine

Richard Lane OBE

Patricia Debney (

Although it is seven years since the completion of my islet cell transplants, I still get a real kick from talking about it, although the emotional effects of this transformation in my life, and in the lives of my family, are still evident. So, when I was asked to write about it in balance, I was delighted to accept, if for no other reason than it was Diabetes UK that funded the project for which I was a ‘guinea pig’. I was diagnosed with Type 1 diabetes in 1976, from which time I was treated firstly with insulin injections and then with a pump. From the beginning I experienced a substantial number of hypoglycaemic reactions (‘hypos’ – low blood glucose), and, critically, over time I lost my warning signs that these were developing and a good number of them developed into full comas. I was experiencing up to

six serious hypos each week, and was suffering from various complications associated with diabetes. However, I had been, and still am, treated at King’s College Hospital, firstly by Professor Watkins and now by Professor Amiel and their staff. Between September 2004 and January 2005, I was given three islet cell transplants at the hospital in the research project, becoming the first person with Type 1 diabetes in the UK to be ‘insulin independent’, although subsequently I have had to return to normal amounts of insulin. However, this is of little consequence, as the primary purpose of the treatment – to reduce the number of severe hypos and to return my hypo awareness – remains intact, for which I and my family are so grateful. i Richard Lane OBE is President of Diabetes UK and has Type 1. Follow his blog for Diabetes UK at www.diabetes.org.uk/bloggers.

@PatriciaDebney)

A year ago, our 11-yearold daughter participated in Phase 1 of D-Gap, a research study investigating genetic markers in siblings of children with Type 1 diabetes. Phase 1 was quite fun – spitting into pots. Phase 2, however, was a blood test. So, in February, we found ourselves at Addenbrookes Hospital, Eliot waiting anxiously as his sister, in another room, faced filling five vials of blood from her admittedly skinny arm. Next to her, I completed the consent form. And had a decision to make: did I want to know if our daughter has a selection of antibodies that will increase her risk of developing Type 1 diabetes? Or not? It shows how far we have come that I signed the ‘yes’ box. Not so long

ago just the thought that she might develop Type 1 diabetes was unbearable. I could not allow myself even to consider the fate of our second child. But reality can be easier than we imagine. With the kind chat of the research phlebotomist and some fancy stickers, nerves are overcome and the job is carefully accomplished. Once she’s standing, I tell our daughter what the results might mean. ‘I don’t mind,’ she says. ‘It won’t change what I do, or who I am. It’s survivable.’ In the waiting room, a relieved Eliot accepts her specially-chosen strawberry-scented sticker and puts it on his jumper. And as we leave the building, I overhear him thank her for going through with it. ‘It’s fine,’ she says, and I believe her. i Patricia is an author and senior lecturer in Creative Writing at the University of Kent. Her son, Eliot, 15, has Type 1. Visit her blog at www.wavingdrowning.wordpress.

test. I did and it was high. This was only the second time I’ve had to face up to the fact that my condition is chronic and progressive, which means it is only going to get worse. The doctor has now given me another tablet to take, sitagliptin, and I seem to be making progress. ‘Progress’ is good but

‘progressive’ is a scary prospect, and one that my partner and me are still coming to terms with. I guess it’s just something we have to live with. i Andy Kliman has had Type 2 since 2009. Follow his blog at http://t2dkidding.blogspot.com. • Turn to page 44 for what you can do if your blood glucose levels aren’t in target range.

Progress not progressive Andy Kliman (

@andykliman)

So it wasn’t my imagination or a random grouping of anomalous high blood sugar readings, in fact, my levels had been getting worse. I wondered if it was something I was doing such as eating badly, drinking alcohol or not doing enough exercise. Or was it just that

14 balance

March – April 2012

my medication wasn’t working as well? The blood sugar readings (8.9, 9.5, 12.3mmol/l) had been getting me down for some time. They felt like a judgement as to how well I was controlling my diabetes. I spoke to a counsellor on the Diabetes UK Careline, who recommended I see my doctor and get an HbA1c

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research matters birth defect risk Research funded by Diabetes UK has shown that pregnant women with diabetes are almost four times more likely to have a baby with a birth defect than women without diabetes. The findings also reveal that the mother’s blood glucose level at the time of conception is the most important factor in predicting the risk of such defects. It is already known that diabetes in pregnancy is associated with a higher risk of various complications, but this project, led by researchers at Newcastle University and the Regional Maternity Survey Office, provides further evidence of this link. The study involved an investigation of the recorded outcomes of 401,149 pregnancies, including 1,677 pregnancies in women with diabetes, between 1996 and 2008 in the north of England. The analysis suggested that around 7 per cent of pregnancies in women with Type 1 or Type 2 diabetes are affected by a birth defect (compared to around 2 per cent in women without diabetes). UK medical guidance already addresses this risk, and the researchers and Diabetes UK emphasise that the vast majority of pregnancies in women with diabetes do not involve a birth defect. Nevertheless, the results are concerning and have prompted Diabetes UK to urge women with diabetes

Women with diabetes can reduce their risk of having a baby with a birth defect by having good blood glucose control before pregnancy who are considering becoming pregnant to make sure they understand the importance of careful planning. Dr Iain Frame, Director of Research for Diabetes UK, said: “This study offers clear evidence that although women with diabetes might still have a higher risk of a birth defect, they can still do something positive to reduce that risk by carefully monitoring their blood glucose level and trying to reduce it if it is high.

“If considering becoming pregnant, women should inform their diabetes healthcare team, which will advise on planning and next steps. Blood glucose control continues to be important throughout pregnancy and should be closely monitored to ensure the best result for the baby. “The study also highlights the importance of using contraception if you are a woman with diabetes who is sexually active but not planning to become pregnant. This is because as well as high blood glucose levels increasing the risk of birth defects, some medications taken by people with Type 2 can cause problems in the developing foetus, and higher doses of folic acid are needed for women with diabetes to reduce the risk of complications such as spina bifida.” Dr Ruth Bell, the study’s lead researcher, said: “With expert help before and during pregnancy, most women with diabetes will have a healthy baby. The risk of problems can be reduced by taking extra care to have the best possible glucose control before becoming pregnant.“ The study was published in the journal Diabetologia in February. i For Diabetes UK’s preconception and pregnancy information, visit www.diabetes.org.uk/pregnancy. In this section you can also view the preconception care video, Rebel, Rebel.

New insight into killer T cells

16 balance

March – April 2012

Sewell from Cardiff University and diabetes researchers from King’s College London isolated a T cell from a patient with Type 1 diabetes and studied its interaction with beta cells. “This first sight of how killer T cells make contact with the beta cells increases our understanding of how Type 1 diabetes may arise,” said Professor Mark Peakman of King’s College London, the study’s co-author. “This knowledge will help us predict who might get the condition and also to develop Killer T cells are shown killing beta cells new approaches to prevent it. Our aim is to catch Type 1 early before too many The study was published in the journal insulin-producing cells have been damaged.” Nature Immunology in January.

Photo: Susan Wong and Maja Wallberg

Researchers in Cardiff and London have, for the first time, visualised the mechanism that leads killer T cells (white blood cells of the body’s immune system) to destroy insulin-producing beta cells in the pancreas. It is hoped that this new insight into the autoimmune attack that causes Type 1 diabetes will help scientists to devise new ways of preventing or even halting Type 1. The exact mechanism by which the immune system destroys the body’s capacity to make insulin in people with Type 1 is not fully understood, but increasing evidence points toward rogue killer T cells. Professor Andy

TAKE PART IN RESEARCH

Body clock linked to Type 2

{

of responding to melatonin and led to a much larger six-fold increase in the risk of Type 2 diabetes. The researchers now believe that genetic variations such as these may disrupt the link between the body clock and insulin release, leading to abnormal control of blood glucose and contributing to diabetes. Dr Iain Frame, Diabetes UK’s Director of Research, said: “The more we understand the effect of these genetic differences, the more likely it is that we will be able to design new drugs or apply existing drug treatments for people with Type 2 diabetes, but we are not yet at that stage. “What we can be sure of now is that eating a healthy, balanced diet rich in fruit and vegetables, maintaining a healthy weight and being more physically active can help to reduce the risk of developing Type 2 diabetes, as well as help people with the condition to manage it more effectively and lower the likelihood of developing serious complications.” The study was published in Nature Genetics in January.

£444,051

{

Researchers have found new evidence to suggest that people who carry rare genetic mutations in a receptor for the ‘body clock’ hormone melatonin have a much higher risk of Type 2 diabetes. Melatonin controls the body’s cycle of waking and sleeping and effects body temperature and drowsiness. It is also known to regulate the release of insulin. Previous studies have shown that people who work night shifts have a higher risk of Type 2 diabetes and heart disease, and that volunteers who had their sleep disrupted repeatedly for three days temporarily developed diabetes symptoms. People with common variations in the gene for MT2 (a receptor for melatonin) are also known to have a slightly higher risk of Type 2. The research team, led by Professor Philippe Froguel, examined mutations in the MT2 gene in thousands of individuals and then tested their effect on the MT2 receptor in human cells in the lab. They identified four rare mutations that rendered the receptor completely incapable

The amount Diabetes UK dedicated to five new PhD studentships in January 2012 (turn over for details)

Diabetes UK-funded researchers at King’s College London and Cardiff University are recruiting people aged 18–40 who have been diagnosed with Type 1 diabetes within 100 days to help them evaluate a vaccine for the condition. The study will help with the development of a new therapy that ultimately aims to prevent loss of insulin-producing beta cells and benefit patients with, or at risk of, Type 1. There are study centres in London, Cardiff, Bristol and Newcastle. Contact Rachel Stenson: 0292 074 2193; StensonR@cardiff.ac.uk. Diabetes UK-funded researchers at the University of Dundee are recruiting people with Type 1 diabetes or Maturity Onset Diabetes of the Young (MODY) aged 16 or older who are living in Scotland. The researchers need help to develop a ‘bioresource’ of blood, urine and DNA samples from 10,000 people with Type 1 or MODY that will be used to improve the study of both conditions and could lead to new treatments. Contact Bridget Shepherd: 01382 632353; b.z.shepherd@dundee.ac.uk. Researchers at the Medical Research Council Centre for Human Nutrition Research in Cambridge are looking for non-smoking people with Type 2 diabetes aged 18–50. They are studying and comparing the ways that excess fat from the diet is stored in people with and without diabetes, and hope to contribute knowledge to the future development of treatments or dietary interventions. Contact Michael Osei: 01223 437517; michael.osei@mrc-hnr.cam.ac.uk. Researchers at the University of Oxford are recruiting people with Type 2 diabetes aged 50 or older with a history of heart disease, stroke or poor circulation for an international trial of sitagliptin, a drug that lowers blood glucose. The study, led by Professor Rury Holman, will test whether adding sitagliptin to existing diabetes care can reduce the risk of cardiovascular problems. www.diabetes.org.uk/International-therapy-trial. University of Southampton researchers are looking for people aged over 18 with diabetes and depression to help improve a questionnaire designed to explore how people make sense of and manage both conditions. Visit www.isurvey.soton.ac.uk/2776 to complete the survey. For a hard copy of the survey, contact Jenny McSharry: 023 8024 1047.

March – April 2012 balance 17

research matters

New PhD projects Diabetes UK’s PhD studentship scheme awards grants to experienced researchers to enable them to recruit outstanding science graduates to study for a PhD in a particular aspect of diabetes research. Here are five new projects that the scheme is funding... AMPK, blood vessels and Type 2 Type 2 diabetes is known to trigger changes in the function of cells that line blood vessels, often causing them to narrow. Unchecked, this can lead to complications such as heart disease, stroke and retinopathy (eye damage). This project will investigate the enzyme AMPK that appears to protect blood vessels via a unique signalling pathway. AMPK is already activated by the diabetes drug metformin but now, using human cells grown in the lab, the PhD student will try to clarify the mechanisms by which AMPK has an effect. This will allow the student to evaluate AMPK as a target for new treatments that could limit complications in people with Type 2. i Supervised by Dr Timothy Palmer; University of Glasgow; £86,557

Metformin and diabetes risk The environment children are exposed to during their earliest development can make them more likely to develop Type 2 diabetes during adulthood. For example, mothers who are obese during pregnancy tend to be more resistant to insulin and supply excessive amounts of glucose to their developing foetus. This can impact foetal growth and increase a child’s risk of diabetes in later life. Dr Felino Cagampang studies the mechanisms by which maternal obesity during pregnancy affects the developing foetus and his work focuses on factors that contribute to the ‘metabolic syndrome’ – a combination of medical disorders that increase the risk of heart disease and diabetes. In this project, his student will use experiments in mice to study the effects of the anti-diabetes drug

18 balance

March – April 2012

Diabetes UK PhD student Simona Mazza

metformin on obese pregnant mothers and their children. The research could provide the foundation for a treatment strategy for obese pregnant mothers to improve their health and the future health of their children. i Supervised by Dr Felino Cagampang; University of Southampton; £86,403

Beta cell damage in Type 2 Beta cells in the pancreas produce insulin that regulates blood glucose, but they malfunction or are destroyed in people with Type 2 diabetes. Beta cell damage has been linked to a long-term high-fat diet, but the mechanisms behind this process are not understood. It is possible that by manipulating the signalling pathways that cause damage to beta cells, scientists may be able to preserve or restore their function and help millions of people with diabetes. Using rat islet cells, Dr Mark Turner’s student will identify specific molecules and pathways that trigger beta cell damage or reduce insulin secretion in response to high levels of glucose and fat. The research team hopes to identify molecules that can provide a target for the development of new drugs to help control or prevent diabetes. i Supervised by Dr Mark Turner; Queen Mary, University of London; £92,195

An eye for complications Studies show that using a non-invasive procedure to measure blood vessels in the retina at the back of the eye can help doctors detect the early signs of kidney disease and retinopathy (eye damage) before they develop. So far, most studies have been small and

covered only short periods of time. In this project, a student will confirm these findings by drawing on five years worth of information collected by eye, kidney and diabetes clinics across Northern Ireland. The results could be used to help doctors identify people with diabetes who are at an increased risk of kidney or eye complications and allow the earlier use of treatments to slow or prevent their onset. i Supervised by Professor Peter Maxwell; Queen’s University Belfast; £86,700

Exploring glucagon production Glucagon (a hormone produced in alpha cells of the pancreas) counteracts the effects of insulin (produced in pancreatic beta cells) by raising blood glucose levels. Episodes of low blood glucose (or ‘hypos’) usually result from the inadequate release of glucagon. New approaches to reducing such episodes in people treated with insulin or sulphonylureas are urgently sought by scientists. The zinc transporter protein ZnT8 has been linked to the risk of developing Type 2 diabetes, and Professor Guy Rutter’s team has recently shown that it is present in both the alpha and beta cells and is an important regulator of insulin and glucagon production. Prof Rutter’s student will now use genetic and cellular experiments in mice to explore the exact role of the transporter in glucagon production. Their findings could help develop new therapies for both Type 1 and Type 2 diabetes. i Supervised by Professor Guy Rutter; Imperial College London; £92,196

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your views

balance Your diabetes lifestyle magazine • January – February 2012

HAPPY BIRTHDAY, INSULIN!

CASH-SAVING CUISINE

Delicious dishes for under £2

Celebrating 90 years since its discovery

SWAP SHOP

Simple changes to shed pounds

GOOD MORNING, VIETNAM

PLUS

Type 1 travels on land, at sea & in the air

Diabetic macular oedema; top 2012 go-to destinations; diabulimia; couch to 10k & inspiring art walks

HIV & TYPE 2

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

Star letter

I read the article ‘Diabulimia’ (Life & health, Jan/Feb 2012 balance). I’ve had diabetes for 32 years and have always resented it. I hated the injections and blood tests, so much so that I stopped injecting and lost weight, which gave me the confidence that I was missing. I didn’t realise I was harming myself. I became tired and frequently ill; I was having lots of highs and lows and developed complications including diabetic retinopathy [eye damage] and neuropathy [nerve damage]. I was so unhappy. Then, four years ago, I met my partner, who I love dearly. He started to understand me better than I understood myself and I felt loved – this gave me a reason to fight to become well. I went on the Dose Adjustment For Normal Eating (DAFNE) course, but I still couldn’t get my blood glucose levels down. My HbA1c was always above 97mmol/mol (11 per cent), and every time I had my annual review I felt so depressed – was it too late for me? After discussing my options with my consultant, I went onto an insulin pump last September and it has changed my life. My HbA1c has come down to 56mmol/mol (7.3 per cent), and I have lots more energy and not as many mood swings. I’m getting married this year and wanted to share my experience with those who feel they cannot live with diabetes, and those who have stopped taking their insulin for whatever reason, because there is light at the end of the tunnel. Don’t let your diabetes control your life; there is so much to live for. I found balance, online diabetes forums and having support from friends and family was the key.

Jayne, Chester

I’ve reapplied for my driver’s licence for the third time since being diagnosed with Type 1 diabetes 10 years ago, and I’ve always resented the process. I’ll never forget having my licence revoked after informing the DVLA that I was using insulin, even though I had never been in an accident or been stopped by the police. I dislike how my licence only lasts three years, how it affects my insurance and how the process

20 balance

March – Arpil 2012

“I’m learning as I go” Actress Hannah Waterman on being diagnosed with Type 1 during pregnancy

01 Cover JC.indd 1

09/01/2012 15:26

Diabetes tracked

So much to live for

Driven up the wall

Why are so many people with HIV developing diabetes?

assumes people with Type 1 are constantly collapsing due to low blood glucose. I find the DVLA’s process of assessing whether a person is fit to drive is ill-informed, lazy and unfair. Who with Type 1 diabetes hasn’t experienced an episode of hypoglycaemia? Surely my doctor or diabetes specialist could assess and judge my suitability to drive?

I was diagnosed with Type 1 before Christmas and wondered how I would keep up with testing and recording results while getting my blood glucose levels under control. Diabetes UK’s Diabetes Tracker app was easy to download onto my iPad and provides an easy way of recording data such as blood glucose levels, insulin intake, carbohydrate intake and an indication of how I’m feeling. Even after two months I can look back and see the significant progress I’ve made.

Tegryn Jones, via email

Editor’s note: You can download Diabetes UK’s Tracker app for the iPhone, iPod Touch or iPad for free at the App Store.

Anyone in the same boat?

I’m 77 and have had Type 2 diabetes since 1993. In September I had an ECG after suffering ‘tightness’ in my chest and it was found that I’d had a mild heart attack. I was kept in hospital for further tests and three weeks later had a triple bypass, a valve replacement and a valve repair. A few days later I noticed swellings under the stockings provided to minimise water retention – huge blisters had developed on my feet. No reason has been given for this, other than my diabetes, or a possible unknown allergy for which swabs were taken. Has anyone else had a similar problem with blistering after surgery?

Larry Caley, via email

I can’t eat that!

I have coeliac disease so can’t eat gluten. Eating out can be precarious. Ian Croft, via email I was recently served a Yorkshire Editor’s note: See ‘News’, page 7, pudding at a respected restaurant, for more on diabetes and driving. despite me asking for a gluten-free

your views

THE BIG

QUESTION meal. I complained and it turned out that the gravy contained gluten too – just as well I hadn’t eaten it! Will balance publish any glutenfree recipes in the future?

Ernie, Cambridgeshire

Editor’s note: Yes, we have some tasty gluten-free recipes lined up for May/June 2012 balance. Meanwhile, search for gluten-free recipes at www.diabetes.org.uk/recipes. And see ‘Bite-sized’, page 50, for news on ‘gluten free’ food labelling and new gluten-free foods.

Suitable for all types

I really enjoyed Jan/Feb 2012 balance. My partner has Type 2 and my teenage son has Type 1. I thought that this issue had more references to Type 1, with children and parents also mentioned.

Avril Mills, via email

Treating DMO

I read with interest ‘Diabetic Macular Oedema (DMO)’ (‘Spotlight on...’ Jan/Feb 2012 balance). Although Lucentis is the only licensed medication for the treatment of DMO in the UK, the standard treatment available in the NHS is macular laser therapy.

Oliver Comyn, Clinical Research Fellow, Moorfields Eye Hospital and UCL Institute of Ophthalmology

Editor’s note: Macular oedema is treated routinely in the NHS with laser therapy, and we apologise for omitting this from the article.

90 years on

‘The discovery that changed our world’ (Jan/Feb 2012 balance), reminded me of a visit to an uncle in the 1950s, when I was about 17. He had Type 1 diabetes and told me about Banting and Best and the birth of insulin treatment. He showed me his mentholated spirit lamp, used to sterilise his needles, and the emery board to keep the needle points sharp. My uncle lived to 88, remarkable as one of the early users of insulin. I was diagnosed with Type 1 at 26 and went straight to the library to read up on Banting and Best. Now I am in my 50th year on insulin. I will join Arthur Smith and Mari Wilson in raising my mug of tea.

Peter J Lennon, via email When I was diagnosed with Type 1 diabetes I was told that my insulin injections wouldn’t leave much scarring, but my confidence was knocked because as the years went by, the scars and bruises seemed to become worse. I’m about to go onto an insulin pump and I cannot wait, but injections have kept me going for four years and, despite the scarring, I love insulin! Without it I wouldn’t be here. Thank you very much, Dr Frederick Banting!

Hannah Jarrett, 14, via email

What do you wish everyone knew about diabetes?

That it’s not as simple as just having a few injections a day. I have to count all the carbs in my food, plan exercise, have four finger-prick tests a day, consider where I’m injecting, make sure I get my prescription in good time – and still my blood sugars aren’t perfect! I wish people would understand that I talk about diabetes all the time because it’s on my mind all the time – it has to be taken care of 24/7!

Laura May Perrins, via email As a healthcare professional I believe that everyone should know the facts about diabetes as it affects so many people in one way or another. Patient education is the key to people with diabetes living healthier lives.

Usman Mir, via the balance Facebook group That everyone knew how important managing their diabetes is. Despite all the warnings from my husband’s diabetes healthcare team, it wasn’t until his high blood glucose stopped him from scuba diving that he became motivated to do something about it. Without outward symptoms, it is difficult to accept that damage is taking place where it can’t be seen.

Anonymous, via email

I love my...

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

I love my son, Danny, and I couldn’t do without him. I’ve had Type 1 for 50 years and Danny has grown up with this. He can sometimes sense when I’m having a hypo before even I do! He never panics and knows exactly what to do in an emergency, and there have been a few of them – he’s saved my life a few times. Thank you, Danny. You’re a wonderful son. Marina Lightbown

NEXT BIG

QUESTION What’s the best diabetes-related advice you’ve received?’ Email balance@diabetes.org.uk or post on the balance Facebook group wall. A selection of answers will be printed next time.

March – April 2012 balance 21

your views

Blogs, tweets & posts The bright side of life

My son, Harry, was diagnosed with Type 1 diabetes in 2010, aged 2, and was hospitalised with diabetic ketoacidosis. I felt so sad and grieved for the life that I had dreamed of for him. Just over one year on, the daily worries are still there but we have come a long way thanks to my amazing son. Despite Harry sometimes having really difficult times, when he says he never wants injections again, he always manages to bounce back. He’s such a happy child and he gives me so much strength. My husband and I make sure that diabetes doesn’t get in the way of Harry doing what he wants to do, and we channel any negativity into doing good. We sponsor a little girl with diabetes in India so she can receive her insulin and medical checks. We do this through the charity Dream Trust (www.dreamtrust.org). It costs £19 a month to give a child insulin in India, which is more than many families over there can afford. We have so much to be thankful for. I want to thank Harry for being the best son in the world and show people that you can have a great life with diabetes.

Jenny Potter, via email I am very fortunate, since I’ve had Type 1 diabetes for only 14 years and have had more than 48 years free of the condition. I have to thank my wife, family and friends who have given me so much support. I have a meter that gives me an almost instantaneous blood sugar reading, and my pen delivers an accurate dose of vital insulin using a disposable needle safely. These, along with lancets and test strips, are dispensed freely from my GP surgery, which is only a five-minute walk away. I have seen the same doctor and diabetes healthcare team for the last 10 years. At my hospital, a 10-minute walk away, I have an annual retinal scan. My chiropodist, who has given my feet excellent care for many years, is a five-minute walk away. Yes, I am a truly fortunate man.

Colin Levesley, Rotherham

Chatroom Hi, I’m 23 and have had Type 1 diabetes since I was 11. I would like to hear from other people with Type 1. In my spare time I like to sew, knit, make cards and go to the gym. I also love travelling! Please reply to Lindsay Wilson, c/o balance chatroom Send your reply or your own advert to: balance chatroom, 10 Parkway, London NW1 7AA. After balance has forwarded on replies, correspondence is made directly between individuals. i You can also connect with others online – see page 4 for details.

22 balance

March – April 2012

www.facebook.com/diabetesuk http://twitter.com/diabetesuk “The look on someone’s face when you randomly blurt out happily that you were ‘5.2 this morning’ and they have no idea what you’re on about. Or when you do a secret sugar test in your handbag and end up with a huge grin on your face after a good score.”

Charlotte Bostock, via the Diabetes UK Facebook page “@DiabetesUK, thanks to you I never take anything for granted and the support is always amazing.”

Lizzie Cullen, via Twitter “I hope by taking part in this scheme I am able to help other diabetics succeed in successful control, even if it is a brief conversation over the phone or by email.”

Vanessa Haydock writes about joining Diabetes UK’s new Peer Support scheme in her latest blog post ‘Looking forward’: http://blogs.diabetes.org.uk.

Me & my balance Here’s Ian Sloan ending his winter break on a high note by catching up with balance in Arrecife Airport, Lanzarote. Ian, 65, was diagnosed with Type 2 in 2007; he quickly became involved with Diabetes UK and is now Chair of the East Fife voluntary group. He told balance: “Getting away recharged my batteries before the excellent Diabetes UK Volunteering Conference in Inverness.” Keep your photos coming to the usual address (see page 3), marked ‘Me and my balance’. Every photo printed wins a Diabetes UK scraggy bear.

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March â&#x20AC;&#x201C; April 2012 balance 23

feature

Step to it Health and fitness have always been important to Steps Star Lee Latchford Evans and his partner, Kerry-Lucy Taylor, who are taking part in the Bupa Great Birmingham Run for Diabetes UK in October. Elizabeth Hughes finds out more...

fter five successful years and 14 top-five hits, Steps – one of the best-selling British pop acts of all time – split up. It was 2001 and, as members of the group went off to do their own thing, Lee Latchford Evans, 37, went into acting, appearing in movies and on stage. His real interest, however, was fitness, and a few years later he became a qualified personal trainer. This led him, more recently, to set up his own health and fitness website, FamouslyFit.com. But now Steps is preparing for a comeback tour in April. So it’s back to the world of show business for Lee, but he won’t be hanging up his sports kit just yet, as he and his partner, singer-songwriter Kerry-Lucy, are running the Bupa Great Birmingham Run for Diabetes UK on 21 October.

Why are you running for Diabetes UK? Lee: We both have parents with diabetes, so we want to promote the great work

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of the charity. We also want to highlight the importance of fitness –so it’s an ideal opportunity!

Have you always enjoyed exercise? Lee: Yes, I took up martial arts and football when I was 8. For me, fitness and performance are two sides of the same coin – I love to be part of a team or in the show.

eating more seriously to keep off the ‘love handles’ and stay healthy. My dad has Type 2 diabetes and I realise the importance of sticking to a healthy lifestyle to reduce my risk of developing it too. I’m also more careful about how I exercise – I always protect my back, as it can take longer to recover from injury as you get older.

Life seemed to slow down and then suddenly Steps reunites – my life has been thrown upside down again Kerry-Lucy: I took ballet lessons when I was very young but I hated them because I was a bit of a tomboy. So I moved onto street dance and jazz, then gymnastics and later cheerleading for Watford Football Club, which was a lot of fun. I’m also a black belt in kick-boxing.

Lee, how has being in your 30s affected you? Like anyone, I had to start taking exercise and healthy

When was your dad diagnosed with diabetes? Seven years ago. He had a stroke and while being treated for that the doctors diagnosed him with Type 2.

What was the impact on your dad and the rest of your family? The first thing he did was empty the fridge and learn more about the foods he should be eating. It’s a shame that it often takes something drastic to happen to make

you buck up your ideas – it’s been an eye-opener and a major learning curve for everyone in the family.

What would your advice be to someone diagnosed with Type 2 diabetes? I recommend the ‘everything in moderation’ approach. You can have the odd pizza, glass of wine or other treat, but you just have to make sensible decisions about what toppings you put on the pizza and how often you choose to eat it.

Do you cook? Yes, I’m no Jamie Oliver but I can throw a few things together, such as a salmon dish or spaghetti bolognese.

Kerry-Lucy, how has diabetes affected your family? My grandad had Type 2. He was very lucky, though – he managed his condition with diet and exercise and was very fit, it never really affected him. But my mum, she’s the opposite, she’s had diabetes

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Reunited... (From left) Faye, Lee, Lisa, H and Claire are preparing for the Steps tour, which kicks off in April since I was about 8 and has been on both metformin and insulin. Her health can be up and down, and it can be very scary. There have been times when she’s had a hypo [hypoglycaemia – low blood glucose] and I’ve had to rub honey into her gums to bring her round. There may also be days when my mum is unwell but has to eat regularly to manage her diabetes, even when she has no appetite. It’s worrying to see her with no energy so I’ll check her sugar levels to make sure she is OK. Likewise, my mum is constantly checking mine and my little brother’s blood sugar levels – so far, we’ve been OK.

Lee, how did you come to set up FamouslyFit? After qualifying as a personal trainer I wanted to share my knowledge, so I decided to set up FamouslyFit in affiliation with OK! magazine. All of our writers and contributors are famous or experts in their fields – athletes like Sally Gunnell, stars of Gladiators and Harley Street doctors. These are people who really know what works. The website covers health, fitness, nutrition, fashion, beauty, and news about celebs and their marathon plans or other challenges, etc.

as diabetes and how the right food and exercise can help.

How do you feel about Steps reuniting and the tour in April? Lee: It’s a little bit crazy. Being in Steps was like living inside a bubble – when it ended I wondered ‘what can I do?’ and life seemed to slow down a little bit. The world moved on and then suddenly Steps reunites and my life has been thrown upside down again. Kerry-Lucy: I will miss Lee, obviously, but he loves performing and he’s a bit of a show-off, so it’s a great thing for him. I’m in a new girlband called Concrete Rose and completing our first album is on the agenda for April, so I’ve got that to keep me occupied.

Lee, once the Steps tour is over, what’s next? FamouslyFit will always be there and I’d like to expand it into TV. As for Steps, we don’t know ourselves yet. I would like to see the band carry on for a few more years. The most important thing is that we are all happy and enjoying being back together, so as long as that’s the case, why not? i www.famouslyfit.com • To run with Lee and Kerry-Lucy in Birmingham, sign up now at www.diabetes.org.uk/bupa. @llatchfordevans; @kerrylucytaylor

And do you raise awareness of diabetes through FamouslyFit? Kerry and I both think it’s very important, so when the website relaunches this summer, it will include a section on health conditions such

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Warners Remedy images: Warner’s Safe Cure blog

Science or snake oil? As the number of people with diabetes continues to grow, so too does the number of herbal remedies and nutritional supplements that are promoted as potential treatments. But is the use of these products supported by the findings of medical research? Dr Richard Elliott sets the record straight and supports a new campaign that encourages consumers to ask for evidence

very month, dozens of media reports and advice columns bombard us with stories about the latest ‘wonder drug’ or ‘miracle cure’ for long-term health conditions such as diabetes. The situation can be even more confusing online, with adverts and socialmedia posts testifying to the extraordinary benefits of a wide range of herbal, mineral and nutritional remedies. Such products offer people with diabetes and other health conditions the hope of an improved quality of life or even a cure, and some may find this comforting. Others, however, are understandably concerned that this is a false hope, based on flimsy ‘pseudoscience’, which is exploited for profit. Herbal and nutritional remedies have been promoted since the 19th century as a route to improved health and wellbeing – either as an alternative or complement to mainstream medical care. A few, such as aspirin and milk of magnesia, were clinically proven and are still available in pharmacies today. Others, such as CocaCola and tonic water, ditched their health-restoring claims (it was believed that carbonated water was good for health and could cure many diseases) and are now marketed simply as foodstuffs. The most dubious products were exposed as ineffectual or even harmful

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and have come to be known as ‘snake oil’ remedies, because many listed this mysterious substance as an ingredient in order to impress potential customers. Although the sale of fraudulent medicines has been curbed by regulation that enforces standards of safety and quality, and limits the medical claims that manufacturers can make, herbal concoctions and nutritional supplements are still promoted as treatments for particular ailments. Sometimes their benefits are supported by data from clinical trials, but often the methods used by such trials are of poor quality and their findings are exaggerated or misinterpreted to make them seem more impressive. Accordingly, advertisements for such products are usually careful not to make explicit medical claims and often carry disclaimers, which reveal that they are not tested in the same way as mainstream drugs and are not proven to be an effective treatment for specific illnesses. Diabetes UK receives frequent requests for information about herbal remedies and nutritional supplements. Here are a few of the most popular, along with the latest scientific evidence on their use as treatments for diabetes...

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L-arginine and nitric oxide

L-arginine is one of the most common amino acids (the building blocks of all proteins). It is obtained naturally in the diet – in dairy products, meat, poultry, fish and nuts. It is also sold in supplement form and is marketed for a wide range of health conditions under different brand names. L-arginine is important for the body’s production of nitric oxide, which triggers the relaxation of blood vessels to increase blood flow. People with Type 2 diabetes have a reduced ability to make nitric oxide from L-arginine, and this is thought to contribute to poor blood circulation, which can lead to a variety of problems, including difficulties with exercising and neuropathy (nerve damage). The evidence Although small studies have shown that adding L-arginine and nitric oxide (also sold as a supplement) to the diet can help to improve blood vessel function, others have reported mixed results or even adverse effects (such as a greater risk of heart problems in those who had already suffered heart attacks) as an outcome. Larger studies are necessary to determine the long-term impact of L-arginine on Type 2 diabetes and its complications. Diabetes UK is currently funding a study at the University of Exeter that hopes to determine whether increasing nitric oxide levels by consuming more nitrates (in the form of beetroot juice) can enhance blood supply to the muscles, making it easier for people with Type 2 to exercise. The bottom line Diabetes UK does not recommend L-arginine or nitric oxide supplements, as there is still a lack of clinical evidence about their safety and effectiveness for people with diabetes.

Karela Karela (also known as bitter melon, bitter gourd or balsam pear) is a member of the cucumber family; its fruit, seeds and leaves are used in traditional Asian food and in capsules for the treatment of Type 2. The evidence Although small studies suggest that karela might help to improve control of blood glucose levels and help lower them in the short term, there is a lack of evidence from well-designed clinical trials to support this. Moreover, some people report gastrointestinal problems after using karela and it may interact with other diabetes medications, increasing the risk of hypoglycaemia (low blood glucose). The majority of studies using karela have been on animals, so further human trials are necessary. The bottom line Karela is not currently recommended for the management of diabetes as there is insufficient research data to prove that it is safe and effective. Those planning to use karela should discuss it first with their healthcare team.

Vitamin D Vitamin D allows the body to process calcium, which is essential for healthy bones and teeth. It has also been suggested that vitamin D may protect against cardiovascular disease (heart attack and stroke), diabetic retinopathy (eye damage), diabetic neuropathy (nerve damage), prostate and colon cancer, and may help to reduce blood pressure. Day-to-day exposure to ultraviolet (UV) sunlight skin produces more than 90 per cent of the body’s required vitamin D, and the rest can be obtained through a healthy, balanced diet. The evidence There is some evidence to suggest that the risk of Type 1 diabetes is greater at higher latitudes, where there is less sunlight and therefore a higher chance of vitamin D deficiency. Deficiency in vitamin D may also be associated with Type 2 diabetes, since levels of it in the blood decline with age, obesity and in Black and South Asian populations, while the risk of Type 2 increases in these groups. With funding from Diabetes UK, Professor Naveed Sattar of the University of Glasgow is conducting a two-year study of samples and information from more than 9,500 people from three existing studies spanning 12–15 years to establish who, if anyone, might benefit from vitamin D supplements. The bottom line Although vitamin D is widely available as a health supplement, as yet there is no conclusive evidence to suggest that adding it to your diet can reduce the risk of diabetes. Further clinical trials are necessary to determine whether it can prevent or slow the progression of Type 1 and Type 2 diabetes, and what dosages might be beneficial.

Although vitamin D is widely available as a health supplement, further clinical trials are necessary to determine whether it can prevent or slow the progression of diabetes

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Cinnamon

Vitamin B1

Cinnamon, which has been used for medicinal purposes since ancient times, contains the active ingredient hydroxychalcone, a substance that is thought to enhance insulin action. The evidence Some small studies have indicated that cinnamon capsules might help to lower blood glucose as well as cholesterol and blood fat levels in people with Type 2 diabetes. However, other investigations have shown conflicting results. There are few adverse effects from taking cinnamon but as it may contribute to lower blood glucose levels, those taking insulin should avoid taking it in large doses since it could contribute to the risk of hypoglycaemia (low blood glucose). The bottom line Diabetes UK is interested in seeing more research into the effects of cinnamon but does not recommend that people with diabetes take large doses of the spice, as suggested by some American doctors.

Vitamin B1 (thiamine) cannot be produced by the body and therefore needs to be obtained from dietary sources such as pork, vegetables, eggs and fortified breakfast cereals. A vitamin B1-based molecule is key to the function of enzymes involved in the metabolism of glucose, one of which also helps to provide resistance against kidney, nerve and retinal (eye) damage caused by high blood glucose levels. The evidence In 2007, Diabetes UK-funded researchers at the University of Warwick, led by Professor Paul Thornalley, were the first to show that people with Type 1 and Type 2 diabetes have 75 per cent less vitamin B1 than those without diabetes. A student in Professor Thornalleyâ&#x20AC;&#x2122;s lab is now investigating the mechanisms by which this occurs and the expectation is that Vitamin B1 supplements might benefit people with both forms of diabetes. The bottom line Despite promising initial findings, larger and longer trials of vitamin B1 supplements are needed before we know whether they can help prevent the progression of diabetesrelated complications.

Fenugreek Most herbal and nutritional remedies cannot be recommended for routine use by people with diabetes until more clinical trials have been completed

Fenugreek is a plant native to India and North Africa; its seeds are commonly used in Chinese medicine for a variety of ailments, including digestive problems and menopausal symptoms, but it is also available in capsule form and as a tea. The evidence Recently, fenugreek has become a popular remedy for Type 2 diabetes after several small studies suggested that the plants and products based on it may help to lower blood glucose, possibly by stimulating the release of insulin. Like cinnamon, fenugreek products may enhance the effects of insulin and, therefore, contribute to hypoglycaemia (low blood glucose levels). Consuming fenugreek in large doses may also lead to gastrointestinal problems (such as bloating and diarrhoea). The bottom line Further study of fenugreek and diabetes is warranted, but until there is more evidence as to its safety and effectiveness, it is not recommended for people with Type 2 diabetes.

A role for supplements? There continues to be much research into nutritional and herbal supplements and their effects on diabetes. Until clinical trials have been completed to narrow down which supplements are effective and in what doses they can be taken safely, most herbal and nutritional remedies cannot be recommended for routine use by people with

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diabetes. It is far more important for people with diabetes, and those at risk of the condition, to eat a healthy, balanced diet, to stick to prescribed medications and to take regular physical activity. Anyone considering a herbal or nutritional remedy should first consult their healthcare team. i www.diabetes.org.uk/complementary_therapies

Asking for evidence To help combat the misinformation and public confusion that often surrounds nutritional products, the charity Sense About Science has launched a new campaign encouraging consumers and patients to demand that organisations provide scientific evidence for the claims they make about goods and services. “Organisations that seek to persuade people about products or policies should expect questions about their evidence,” says Tracey Brown, Director of Sense About Science. “We’ve been working with scientists and the public for some years to challenge misinformation, whether about the age of the earth,

the causes of cancer or wifi radiation. It’s often very effective but no sooner is attention turned elsewhere than misleading claims creep back up again. To make a permanent difference, we need the public to be evidence hunters.” You don’t need to be a scientist to ask for evidence, insists Sense About Science: anyone can pick up the phone or send an email asking what kind of tests have been done, what mechanisms are involved and whether findings have been reviewed, replicated and published. To help everyone get started, the charity’s database, of more than 5,000 scientists and hundreds of organisations, is on hand to provide information, advice and case studies on the best ways to go about asking for evidence, whether your question relates to an advert, an article in the media or the campaign statements of an MP. The hope is that if more people start asking for evidence, ADVERTISEMENT

more organisations will anticipate this and start to think more deeply about the claims they make and the evidence they present. “Diabetes UK fully endorses Sense About Science’s campaign,” says Dr Iain Frame, Director of Research. “We seem to see another miracle treatment or cure for diabetes discussed in the national press every week and often hear from people who are confused or misled by sensationalist claims. While news stories and adverts may be based on good science, they often leap to misleading or flawed conclusions. We would always encourage people with diabetes to ask for evidence about health products and services that seem too good to be true.” i For more details, see www. senseaboutscience.org/a4e.

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Carol at her heaviest (far left) and today, 5st lighter

Steady as she goes

wasn’t surprised when I diagnosed with Type 2 diabetes in September 2009 – the condition runs in my family – but I was still devastated when the nurse broke the news. My husband has Type 2, so I was familiar with the symptoms, but I didn’t have any that I was aware of. My diabetes was only discovered when I went to see the nurse about a recurring abscess; she suspected diabetes could be the cause and my first blood test proved her right. I was immediately put on two 500mg metformin tablets a day. I wasn’t happy about this but knew it was necessary to lower my blood glucose.

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Since being diagnosed with Type 2 in 2009, Carol McCormack, 41, has lost more than 5st to get her weight, and her diabetes, under control. She tells balance how she did it – and how her weight-loss journey’s not over yet

I was already a member of WeightWatchers at this point. I’d joined in May 2009 when I weighed just over 20st (127kg) – I was having difficulty walking and knew I needed to lose weight. By September I’d lost 1st (6.3kg), and being diagnosed with diabetes gave me the motivation to keep losing weight and start exercising – I was determined to gain control of the condition.

Lifestyle overhaul I stuck with WeightWatchers and lost weight steadily by monitoring my calorie intake and getting more exercise. I don’t think of myself as being on a temporary diet, more a

realistic healthy lifestyle programme that I’ll need to stick to for the rest of my life. My primary care trust doesn’t supply test strips to people with Type 2 diabetes who aren’t on insulin or certain glucose-lowering drugs, so I have to buy my own. I’m frustrated at this not only from a financial point of view, but because testing my blood glucose helps me to self-manage my diabetes. Soon after diagnosis, I tested my blood glucose before and after eating different foods to find out how they affect my levels. I was surprised that out of five cereals, the one I thought of as healthy (Special K) was the one that raised my blood

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glucose levels the most. Porridge had the least impact. Bread sends my levels high, so I limit myself to two slices per day, but most foods are fine. I haven’t banned any food but have cut down on ‘naughty’ ones. The hardest food to moderate has been crisps – I used to eat up to eight packets a day, now it’s one or two. I always eat breakfast now, as it helps me avoid snacking on junk food at elevenses. And when I have a craving for something ‘naughty’, I take my mind off it by either going for a quick walk, doing some housework or catching up on paperwork. I keep a photo of myself at my heaviest on my fridge, so I can look at it and remember how far I’ve come. When I was bigger, the most exercise I got was walking from my house to my car. So I started exercising gently by doing aquaaerobics three times a week. I now just get one bus on my way to and from university (I’m studying biomedical science) and walk the rest of the way (10 minutes each way). Previously, I’d get the bus to the terminal, then get another bus for four stops. I wear a pedometer and average 8,000 steps a day.

Hard work pays off By August 2010, I’d lost 4st 10lb (30kg). Losing weight reduced my HbA1c to within target range, so I decided to ask my nurse if I could stop taking metformin and, to my delight, she agreed. I’ve been off all medication since and manage to control my diabetes by exercise and diet alone, which has given me a great sense of achievement. My last HbA1c was 34mmol/mol (5.3 per cent). My nurse is extremely pleased with my progress and explained that she thinks my diabetes is caused by insulin resistance and not by my insulin-producing beta cells failing (as evidenced by my weight loss reducing my HbA1c).

But as Type 2 diabetes is progressive, she said that my beta cells may eventually start failing and/or my insulin resistance will reappear, and I’ll then need to go back on medication. I’m fine with that.

The future looks bright In total I’ve lost more than 5st (31.7kg), which is great, but I still have to lose around 7st (44.5kg) to get to my ideal body mass index. Other, non-diabetes-related, health issues put my weight loss on hold for a while, but I maintained my weight and now those issues are under control, I’m back to losing the pounds.

Diabetes will always be with me, but now I’m in control I’m now fit enough to do three Zumba classes per week and have so much more energy. Last year I completed a 5k Race for Life, raising more than £300 for Cancer Research. I finished in 57 minutes, which I’m really proud of considering I never used to exercise! Although I still have a long way to go, I feel much healthier, both physically and mentally. I can now go for a 30-minute walk and not be out of breath, I’ve dropped five dress sizes and can now buy clothes from ‘normal’ shops. I can also turn my car steering wheel without it rubbing against my stomach! Being diagnosed with diabetes gave me a scare and the impetus to do something about my health. Diabetes will always be with me, but now I’m in control. • As told to Kate Flagg • Maintaining a weight that is healthy for your height will help you to control your diabetes and reduce your risk of complications. While some people with Type 2 diabetes can reduce/come off their diabetes medication after losing weight, this is not the case for everyone because Type 2 is a progressive condition.

Carol’s tips for success

If you’re looking to lose weight, join a slimming club such as WeightWatchers. The meetings are really informative and you’ll get a lot of support from others in the same boat.

Stop eating when you feel full; many of us are brought up to finish all of the food on our plates out of politeness, but you don’t have to! Learn to tune into your body and let it tell you when you are full.

Don’t feel you have to jump in at the deep end with exercise – even if it’s just a daily 20-minute walk, every minute helps! My husband now walks to work and back five days a week (35 minutes each way), and within six months his HbA1c came down a whole percentage point.

Ask for support as you make changes to your lifestyle – my family and friends have been great. My husband eats the same healthy food as me, just more of it, and we enjoy going for walks together.

Join the Diabetes Support Forum (see below) – I did immediately after diagnosis and have found it invaluable. It’s a great place to exchange thoughts, and I’ve made many friends there.

i Connect with others online at the Diabetes Support Forum (www.diabetessupport.co.uk) and the Diabetes UK Facebook page (www.facebook.com/diabetesuk). • For information on Diabetes UK’s new Peer Support scheme, which connects you to others with diabetes, go to www.diabetes.org.uk/peer-support.

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Lights, camera, action! In 2009, filmmaker Tom Craig, who has Type 1, told balance about the first film in his trilogy exploring the psychological aspects of diabetes through horror fiction. Now he’s back with his second feature, and the personal and professional have once again collided…

Photos: Matthew Jones

’ve had Type 1 diabetes since I was 4 years old and I learnt all about the possible complications growing up, but being diagnosed with diabetic retinopathy [eye damage, see box overleaf] nine years ago was hard to accept. While my retinopathy is currently stable, following several years of laser treatment, it is never far from my mind, so it was perhaps inevitable that it would play a part in my Bitter Sweet Trilogy. For those of you who didn’t read about it in balance (‘Rewriting the script’, Sept/Oct 2009 balance) or

elsewhere, some time ago I hit on the idea of combining mine and my family’s personal experiences of diabetes (both my partner, Sarah, and 6-year-old son, William, also have Type 1) with my day job as a film lecturer at the University of Derby, and my particular interest in the genre of horror. This became the Bitter Sweet Trilogy, a series of three films aiming to raise awareness of diabetes and explore the psychological aspects of living with the condition through the medium of horror fiction.

A considered choice Is the genre bad taste? A serious medical condition turned into Hammer House of Horror-type fodder? I’ve certainly heard that criticism before and I reject it. I feel that, having lived with diabetes for a long time myself, I am well qualified to discuss the fears and pitfalls that those with the condition often struggle to open up about, even within their own community. Secondly, I have worked closely with trainee doctors and nurses, helping them to better understand the viewpoint of someone with

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feature them engaged and thinking, and that’s just what’s needed for people managing a life-long condition.

Popular viewing The first film in the Bitter Sweet Trilogy dealt with hypoglycaemia [low blood glucose]. Entitled Sugar Drop, it was filmed largely with one actor in a small lift. Over 20 minutes we see the character with diabetes, Ben, descend into panic, sweats and hallucinations after being trapped in the lift without access to food or medicine. What is left open at the end is whether the diabetes, and with newly diagnosed presence he senses in the lift with young adults. As dedicated as him is real or imagined. The film’s the medical professionals were, my budget wasn’t so much ‘shoestring’ talks with them left me feeling that as ‘no strings’. The University kindly they saw addressing the patient’s shut-off a lift in a tower on its main psychological acceptance of diabetes site for the day’s filming; and my as very much secondary to the unpaid production crew, make-up management of physical symptoms. girl and actor were all students, At the same time, the newly diagnosed graduates or academic colleagues. young adults I spoke to weren’t going Everyone did a terrific job and to be engaged in taking responsibility I thought it might raise ‘some’ for managing their condition if the interest. How wrong I was. only medical information at hand As well as mentions in UK was delivered in a ‘dry’ literary or mainstream press, I received calls video format. But broaching the from NHS professionals and leading subject in popular formats that pharmaceutical companies wanting people were familiar with – the to screen the film at seminars and horror or thriller genres – could get conferences to give a unique insight into life with diabetes. To date, the film has been selected for industry competitions as far afield as Toronto and Bangalore.

Building on success I originally envisaged the Bitter Sweet Trilogy as three short films of around 20 minutes each, but the success of Sugar Drop gave me and my band of volunteers confidence to go one better. We’re now shooting the second film in the trilogy, Argon Green (named after the laser used to treat retinopathy), which has been expanded into a 90-minute feature. The film has personal resonance for me, as it deals with the reactions of an artist (Daniel Corrigan) to his gradual loss of sight through diabetic retinopathy. The intention is that the film will both introduce the condition

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to a largely ignorant public, as well as encourage those with diabetes to look after themselves more effectively in order to decrease the number of people being diagnosed with retinopathy. While this is done against a haunted-house backdrop, in the spirit of The Innocents and The Woman in Black, the film has some very positive things to say about human resilience and the ability to find happiness. Argon Green has been written and produced by myself, directed by University of Derby graduates Sean

The film has some very positive things to say about human resilience and the ability to find happiness Ford and Daniel Romero, and the Director of Photography is my colleague Stephen Watson, who worked on British director Shane Meadows’ 2004 hit Dead Man’s Shoes. We’ve been enormously lucky in attracting a cast that includes award-winning French actress Stefana Brancastle (previously seen in Tim Burton’s Sweeney Todd and zombie horror 28 Weeks Later), and theatre actor Chris Attle. The film also features Hannah Murphy, in her debut film role, as Daniel’s 9-year-old daughter, Holly Corrigan.

High-spec, low cost Our main location couldn’t have been more fitting. We are the only feature-film crew to have ever

been given permission to film at the National Trust’s Calke Abbey in Derbyshire. Once the Trust heard why we were doing the film, it reduced its usual fee to a fraction. The film will look wonderful. It has been shot on the University’s state-of-the-art Red Epic camera, the same equipment used on Hollywood blockbusters including the upcoming The Amazing Spider Man and The Hobbit. While we can’t match such films’ colossal budgets – and indeed would still welcome financial backers – interest around Sugar Drop has enabled us to attract more help this time around. The University of Derby has kindly invested and Cooke Optics of Leicester, manufacturer of film industry high-specification camera lenses, lent the project £30,000 worth of Prime Lenses, which will enhance the picture quality further. A ballet sequence in the film was created with the help of the renowned Gielgud Academy of Performing Arts in West Sussex and Piers Gielgud, who previously worked with director Oliver Stone on historical epic Alexander. I’m delighted that my script received the approval of Robin Hardy, director of cult British horror film The Wicker Man, who said it struck a ‘clever balance between what is cinematically horrific, and what is recognisably human and believable’.

Just as important has been the clinical review our script received from Dr Tasso Gazis, Physician in Diabetes and Endocrinology at Nottingham University Hospital’s Queen’s Medical Centre campus, and the access granted to shoot portions of the film at the site.

A warning to all We’ve now shot two-thirds of Argon Green, which should be ready for distribution in late autumn (2012), when we hope to top Sugar Drop’s excellent reputation and move on to even greater things for the Bitter Sweet Trilogy’s final third. We plan to give a percentage of any net producer’s profit from the film to Diabetes UK. Above and beyond commercial success, I want this film to raise awareness of a serious and frightening condition and encourage discussion among those at risk. As with many complications of diabetes, the price of freedom is eternal vigilance. People with diabetes must get their eyes checked regularly for tell-tale signs of retinopathy, so they can be treated early on and avoid ending up with damaged or even lost vision. If to some a ‘spooky film’ seems a sensationalist way of grabbing people’s attention, I make no apologies. If Argon Green and the rest of the Bitter Sweet Trilogy can both entertain and alert young people (including my own son, one day) to the psychological aspects of living with diabetes, and the possible consequences of not looking after their condition, I will be delighted. i www.argongreen.co.uk.

Photos, clockwise from top left: Tom and Sarah with their children Charlotte, 9, and William, 6; Left–right: Steve Watson, Daniel Romero and Sean Ford call the shots; The renowned Gielgud Academy of Performing Arts; Tom (fifth from left) with cast and crew; Behind the scenes with Steve Watson, Daniel Romero, Paul Tilbrook (lighting) and Sean Ford; Chris Attle and Hannah Murphy as father and daughter, Daniel and Holly

Retinopathy Diabetic retinopathy is damage to the retina (the ‘seeing’ part at the back of the eye) caused by persistently high blood glucose levels. If left untreated, it can lead to sight loss. You can reduce your risk of developing retinopathy by keeping your blood glucose, blood pressure and blood fats within a target range, which should be agreed by you and your diabetes healthcare team. Smoking also plays a major part in eye damage so, if you do smoke, stopping will be extremely helpful. However, the best protection is making sure you have your eyes screened with a digital camera when you are first diagnosed and every year after that. If retinopathy has been diagnosed, and provided it hasn’t reached an advanced stage, good control of blood glucose will prevent it from developing further. Laser eye surgery is also available as a treatment to slow its progress. i For information and support about any aspect of living with diabetes, you can call the Diabetes UK Careline on 0845 120 2960, Monday to Friday, 9am to 5pm. • For more on retinopathy, visit www.diabetes.org.uk/retinopathy.

March – April 2012 balance 35

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life&health

Put your feet first As Diabetes UK launches its ‘Putting Feet First’ campaign, balance looks at what to expect from your annual foot check

Pulses The blood supply to your feet will be checked by feeling the pulses on the top of your foot and at the back of your heel.

Changes in shape The examiner will look for changes in the shape of your foot, such as claw toes or bunions, as these can cause increased pressure and lead to ulceration.

Pain Soreness can indicate neuropathy (nerve damage) or problems with your blood supply.

Sensation The bottom of your foot will be tested for feeling, by gentle pressure with a finger while your eyes are closed or using a tuning fork or a tube called a monofilament.

hink about it: our feet take a real bashing every day. They bear our weight, get us from A to B and keep us upright. And when you have diabetes, you need to make doubly sure that your feet are in tip-top health, which is why it’s vital to attend an annual foot check.

What your check involves Everyone over the age of 12 should have their feet and legs checked at least once a year – see above for what this should involve. If more than a year passes since your last foot check, don’t wait to be invited. Ring your clinic and ask when they plan to see you. At the end of your check, the examiner should tell you your risk of developing foot problems: Low risk This means there are no problems with your nerves and the blood supply to your legs and feet. You will be given general advice and your feet will be reviewed in another 12 months. Increased risk This means your foot does not have full sensation or pulses, or there is deformity or infection. You will be referred to a specialist foot team for treatment and then it’s likely that you will need to have your feet checked every 3–6 months. High risk This means you have had an ulcer or amputation in the past and any of the above problems apply. You will be urgently referred to the foot protection team and will be reviewed every 1–3 months. If you have an ulcer, you should be referred to this team within 24 hours. Once the problem has been addressed, you need to focus on preventing future foot problems. This is likely to include regular foot inspections, maintaining good diabetes control and making healthy lifestyle changes.

Infection Redness, hot skin, swelling of your legs or feet or signs of pus will show that an area is infected.

Footwear Your shoes will be checked for damage and areas that may be rubbing your feet.

Why the fuss? Prolonged high blood glucose levels can lead to neuropathy (nerve damage). This can lead to loss of sensation, so you might not realise if you hurt your legs or feet, which could lead to ulceration. An estimated 59,000 people with diabetes in England and more than 10,000 in Scotland have foot ulcers at any given time. If left untreated, they can become infected, leading, in extreme cases, to gangrene and amputation. Neuropathy can also weaken muscles, leading to fracturing and severe deformity, which is known as Charcot’s joint (or Charcot’s foot).

March – April 2012 balance 37

life&health you can do » What The best way to avoid foot problems is to maintain good blood glucose levels, but there are also other practical ways you can keep on top of foot health: • Check your feet every day, looking for changes in shape and colour, and any cuts or scratches. Don’t ignore problems – seek advice from your podiatrist or nurse. • Be aware of any loss of sensation in your feet – don’t go barefoot and avoid extremes of temperature if you think you have lost any feeling. • Avoid using corn-removing plasters or blades of any kind as these can damage your skin. • Wash your feet daily and use an emollient (softening) cream – but not between your toes as this will make the area too moist. • Make sure you wear shoes that fit properly. i For more on the campaign, see ‘News’, page 6, and visit www.diabetes.org.uk/ putting-feet-first.

Foot facts •A human foot and ankle contain 26 bones, 33 joints, and more than 100 muscles, tendons and ligaments. • T he 52 bones in your feet make up one quarter of all the bones in your body. • T here are approximately 250,000 sweat glands in a pair of feet, and they excrete as much as half a pint of moisture each day. • T he soles of your feet contain more sweat glands and sensory nerve endings per sq cm than any other part of the body.

Why good foot care counts Diabetes Voice Sheila Burston is campaigning for improved standards of foot care... As I fit into the high-risk category for podiatry, I’ve received regular foot checks and a degree of neuropathy was noted. However, it all went wrong when I had sharp pain in one foot. Eventually, I was diagnosed with a stress fracture, but at no time did anyone connect the stress fracture with the fact that I have diabetes or a possible Charcot condition. I was given crutches and told to get on with it! A few months later, after a fall that damaged my foot, ankle and shin, my GP and local urgent care centre failed to deal with the injuries. It wasn’t until treatment from a specialist hospital foot-care team that another stress fracture was found and Charcot’s foot was diagnosed. I wore a foot cast for seven months. The shin injury resulted in a haematoma (blood clot), which became an infected ulcer. Treatment at the local urgent care centre aggravated the ulcer, and a severe bacteria infection developed that put my leg in danger of amputation. I was on antibiotics and had daily wound packing and dressings by district nurses for several months – I narrowly avoided a skin graft. After seven long months and excellent hospital care, I eventually got back on my feet. As a member of the Diabetes UK Bexley voluntary group, we have campaigned for many years to get podiatry re-instated as an important area of diabetes care, with more training for practice nurses to ensure that patients’ feet are examined efficiently and patients are referred to the foot protection team when necessary. Following my complaint to the urgent care centre, I was assured that staff would receive more training on diabetic foot conditions. i To join Diabetes Voices, visit www.diabetes.org.uk/diabetesvoices.

38 balance March – April 2012

Getting

e know we’re meant to eat a healthy, balanced diet, whether we have diabetes or not, but what does it even mean? Well, you need to make sure you get enough fruit and vegetables, milk and dairy, carbohydrate and protein per day. No food is off limits – it’s fine to have a treat every now and again, just don’t overindulge! Food can be divided into five main food groups:

Starchy foods Bread, rice, potatoes and pasta contain the all-important nutrient carbohydrate, which is broken down into glucose and used by the body’s cells as fuel. Try to choose those that are more slowly absorbed (have a lower glycaemic index), as these won’t affect your blood glucose levels as much. Starchy foods are naturally low in fat, and the high-fibre varieties are good for keeping your bowels regular and preventing digestive disorders. How much per day? 7–14 portions. One-third of your diet should be made up of these foods, so you should include them in all meals. What’s a portion? One portion is equal to: 2–4 tbsp cereal; 1 slice of bread; 2–3 tbsp rice, pasta, cous-cous, noodles or mashed potato; 2 new potatoes or half a baked potato.

SEASONING Eating too much salt (6g/0.2oz) or more per day) can raise your blood pressure, which can lead to stroke and heart disease, so limit the amount of processed foods you eat and try flavouring foods with herbs and spices instead.

life&health

the balance right Fruit and vegetables All of these foods are low in fat and calories, and packed with vitamins, minerals and fibre, which are vital for good health. How much per day? Aim for at least five portions. Fresh, frozen, dried and tinned fruit and veg all count. What’s a portion? Roughly what you can fit into the palm of your hand. It’s best to mix and match fruit and veg to get as wide a range of vitamins and minerals as possible.

Meat, fish, eggs and pulses These foods are high in protein, which is needed for building and replacing muscle cells in the body. They also contain minerals, such as iron, which are needed for producing red blood cells. Omega 3 fish oils, found in oily fish such as mackerel, salmon and sardines, can help to protect the heart. Good sources of protein for vegetarians are beans, pulses, lentils, soya and tofu. How much per day? Aim to have 2–3 portions. What’s a portion? One portion is equal to: 60–85g (2–3oz) meat, poultry or vegetarian alternative; 120–140g (4–5oz) fish; 2 eggs; 2 tbsp nuts; 3 tbsp beans, lentils or dahl.

Foods high in fat and sugar Technically, your body doesn’t need any foods in this group, but eating them in moderation will still mean you are following a healthy, balanced diet. Sugary foods will raise your blood glucose, as will sugary drinks, so bear this in mind and choose diet or low-calorie soft drinks instead. It’s also worth remembering that fat contains a lot of calories, so try to reduce the amount of oil you use in your cooking and choose lower-fat alternatives where possible. How much per day? 0–4 portions (the fewer the better!). What’s a portion? One portion is equal to: 2 tsp spread, butter, oil, salad dressing, sugar, jam or honey; 1 mini chocolate bar; 1 scoop ice cream or 1 tbsp cream.

dairy products Milk, cheese, yogurt and butter, etc contain calcium, which helps to keep your bones and teeth strong. They are also a good source of protein, but some can be high in fat so choose lower-fat alternatives where you can. How much per day? Aim for 3 portions. What’s a portion? 1/3 pint of milk; a small pot of yogurt; 2 tbsp cottage cheese; or a matchbox-size portion of cheese (40–45g/1½oz).

i For more information on healthy eating, download Eating Well With Diabetes (Type 1 or Type 2) for free at www.diabetes.org.uk/shop. • For more on the glycaemic index, visit www.diabetes.org.uk/gi.

March – April 2012 balance 39

life&health

Many people with diabetes (especially Type 1) take multiple daily injections of insulin, also known as basal bolus therapy. Basal insulin is the background insulin that stops the production of glucose in the liver Bolus insulin is the short-/rapid-acting insulin that is taken before a meal. The amount taken depends on the size of the meal.

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383,548 {

{

What are… basal & bolus?

smokers kicked their nicotine habit in 2010–2011. Smoking increases your risk of developing the complications of diabetes.

Source: Statistics on NHS Stop Smoking Services: England, April 2010 – March 2011 No Smoking Day: 14 March; www.nosmokingday.org.uk

How to… ...go to the gym for free If you’re thinking about becoming more active, it’s worth talking to your diabetes healthcare team about exercise referral schemes in your area. These schemes are often led by exercise specialists who will be able to advise, assess and tailor a physical activity programme for you, as well as monitor your progress. They are usually held in leisure centres or gyms, and quite often you can get a reduced membership fee or free passes as part of the programme.

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

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

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

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

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

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

»»» «««

40 balance

March – April 2012

Do you have a health matter on your mind?

Karen Therapist & counsellor

Deepa Dietitian

Cathy Diabetes specialist nurse

Libby Paediatric diabetes specialist

Write to ‘Ask the experts’, balance, Diabetes UK, 10 Parkway, London NW1 7AA

Glucagon need gone? When my son was diagnosed with Type 1 four years ago, aged 6, we were given an emergency glucagon kit and shown how to use it, but now the only thing I can remember is the needle being huge! We’ve never needed it, so is it necessary to keep one on prescription? Leah, Cardiff Libby says… Glucagon is a hormone produced in the pancreas that causes the liver to release glucose into the bloodstream when blood glucose levels are too low. In people with Type 1 diabetes, the pancreas loses its ability to secrete insulin (which lowers blood glucose) and sometimes it stops producing glucagon, too. Fortunately, an emergency glucagon injection kit is available on prescription to anyone with Type 1. It is for use by a family member or friend, should the situation arise when the person with diabetes experiences severe hypoglycaemia (low blood glucose) and is unable to treat it by mouth, due to loss of consciousness or confusion. The glucagon is injected into the person’s muscle, usually the thigh, and blood glucose levels usually return to normal within 5–10 minutes. The syringe has quite a big needle because it is for use in both adults and children, and it must be strong and long enough to inject into muscle. It’s great that you’ve never needed to use the glucagon, but it’s best to keep it with you, just in case the need arises. There are instructions inside the kit, and your son’s diabetes nurse can remind you how to use it. It is also important that the nurse advises you of the correct dose, as this is different for adults and children. And don’t forget to check the expiry date. After being injected with glucagon, people do complain of headaches

and feeling sick, and blood glucose levels may be higher than usual, but these side effects should soon pass.

ask the experts Not just old age

I’m 72 and have Type 2 diabetes. I had put my slowing mobility down to my age, but now my doctor has told me Contraception confusion I have diabetic amyotrophy. I’ve never I wanted to get a contraceptive implant heard of this and I’m waiting to see a fitted but my practice nurse told me I specialist who can explain it further. couldn’t have it because I have Type 1 Malcom, London diabetes. She said the insertion wound Cathy says… could get infected and the hormones Diabetic amyotrophy (or ‘proximal would make my now stable blood motor neuropathy’) is a form of glucose levels unmanageable. Is this true? neuropathy (nerve damage) that Lucy, Wigan affects the motor nerves (those Cathy says... that trigger muscles to contract). Firstly, you shouldn’t have been It usually affects the nerves denied the contraceptive implant. supplying the thigh muscles of Lots of women with Type 1 diabetes one leg, but can affect both legs. have it fitted without any problem. The neuropathy, which is a The contraceptive implant is a complication of diabetes, makes small, flexible tube that is inserted control and movement of the affected under the skin of your upper arm. It limbs difficult. The muscles waste releases the hormone progestogen quickly, worsening any problems of to prevent pregnancy. As the implant reduced mobility. The pain associated is tiny, so is the insertion wound with amyotrophy can be severe and and so it doesn’t need stitches. As difficult to control. Some people also long as your blood glucose is well have numbness in the affected area. controlled and you keep the area People can greatly improve or clean, it shouldn’t become infected. recover from amyotrophy, but it may It is true that the hormones take time. Intensive physiotherapy released by the implant could affect and occupational therapy are vital your blood glucose, but the same and should start as soon as a diagnosis could happen with the contraceptive has been made. Good control of pill or even during your period. diabetes is very important, as is pain During the first few weeks of having control. A number of medications the implant, your insulin may need can be tried, which can have a adjusting slightly, and you should calming effect on the nerves, and keep a closer eye on your blood your specialist will be able to advise glucose levels, but the impact of you further about these. hormones on your diabetes should i www.diabetes.org.uk/neuropathy. be manageable. If not, the implant can be removed at any time. You can pass this information to 0845 120 2960 your practice nurse or, if you’d prefer, Monday to Friday, 9am to 5pm you can speak to your GP or local careline@diabetes.org.uk family planning clinic to arrange Careline accepts TypeTalk calls and to have the implant fitted. has an interpreting service i For details of your nearest family planning clinic, visit www.fpa.org.uk.

CARELINE

March – April 2012 balance 41

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life&health

Spotlight on...

Arthritis What is it?

modifying anti-rheumatic drugs, NSAIDs, biologics and steroids.

Arthritis is inflammation (swelling) of the joints and bones, which can cause extreme pain, stiffness and restricted movement. It is a common condition, affecting 10 million people in the UK. There are many different types, but the two most common are osteoarthritis and rheumatoid arthritis.

What else can be done to manage the symptoms?

»»

Osteoarthritis Osteoarthritis is the most common form of arthritis in the UK, affecting around 8.5 million people. It occurs when the cartilage (connective tissue) between bones gradually wastes away, leading to painful rubbing of bone on bone in the joints. It develops over time, affecting several joints, and is most frequently seen in the hands, knees, hips, feet and spine. There is no known cause, but osteoarthritis is more common in women and usually develops over the age of 50. However, it can occur at any age due to injury or another joint-related condition.

Rheumatoid arthritis Rheumatoid arthritis is more severe but less common. It affects around 400,000 people in the UK and usually develops in people aged 40–50. It occurs when the body’s immune system attacks and destroys the affected joints, causing pain and swelling. This can lead to a reduction in movement and the breakdown of bone and cartilage. There are more than 200 different types of rheumatic diseases.

Is there a diabetes link? There is some research to suggest that there could be a link between rheumatoid arthritis and Type 1 diabetes, but there isn’t enough evidence to support this claim. The pain of arthritis can lead people with the condition to lead a sedentary lifestyle and, therefore, become overweight,

There are steps you can take to help ease the symptoms of arthritis: Follow a healthy, balanced diet – this will make sure that your body gets all the nutrients it needs (see ‘Getting the balance right’, page 38). Aim to have at least two portions of oily fish a week – there is growing evidence to suggest that Omega 3 oils (a type of polyunsaturated fat found in oily fish) can help with inflammatory arthritis, and also help to protect against heart disease. Manage your weight – it can be difficult to lose weight with limited mobility and pain. But being overweight can increase pressure on the weight-bearing joints, so losing even a few pounds can have a beneficial effect on your joints – as well as your blood glucose control. Try to be as physically active as you can – this will help to increase your range of movement, joint mobility and muscle strength. Try exercising when in least pain, eg after a bath. You may find low-impact exercises, such as swimming, easier and, remember, all activity counts, whether it’s washing the dishes, or vacuuming. If you find that a particular joint is more painful, try doing an activity that uses other parts of your body or even armchair exercises. Your doctor or physiotherapist can advise on an activity that suits you. Whatever type of arthritis you have, a lack of physical activity can make your blood glucose levels rise, so you may need to change your medication and/or your diet. Speak to your diabetes healthcare team about how you can manage your diabetes. i Arthritis Care: www.arthritiscare.org.uk.

»»

There is growing evidence to suggest that Omega 3 oils can help with inflammatory arthritis which increases their risk of developing Type 2 diabetes. Steroids that may be used to treat arthritis can lead to steroid-induced diabetes, which usually goes away after the steroids are stopped (they are generally only used for a short time). If you have diabetes and your arthritis is treated with high doses of steroids, you may find that your blood glucose levels rise – ask your doctor about how you can effectively manage your diabetes while taking the steroids.

Can it be treated with meds? While many types of arthritis are long-term conditions and cannot be cured, there are treatments that can help manage symptoms and flare-ups. Medication for osteoarthritis includes painkillers, non-steroidal antiinflammatory drugs (NSAIDs) and steroids, which can either be taken in tablet form or can be injected into the joint. Treatments for rheumatoid arthritis include disease-

»»

March – April 2012 balance 43

basic care

No such thing as

perfect

f you’re finding it hard to keep your blood glucose levels within your target range, don’t blame yourself. There are lots of things that can affect diabetes control, so check the following:

What are you eating? Changes to your diet are likely to upset your diabetes control. Maybe you’re eating more than usual or perhaps you’re a bit off your food? Even eating different foods than usual – like when you’re on holiday, for instance – can make a difference. If you take insulin (especially if you have Type 1 diabetes), you may have been taught how to carb count, which involves adjusting your dose in response to the amount of carbohydrate in the food you’re eating. If so, are your ratios right? Insulin-to-carbohydrate ratios can change for many reasons, eg as you grow older or if your lifestyle changes – they can even change at different meal times. If you think that this might be the problem, talk it over with your diabetes healthcare team. If you’ve not been taught how to carb count, talk to your team about whether it would help you to manage your diabetes.

44 balance

March – April 2012

Nobody with diabetes has perfect blood glucose control all the time, and many people go through periods when, despite their best efforts, their diabetes just seems to do its own thing. balance looks at what can cause unpredictable control, and what you can do about it

If you take any other type of diabetes medication, it’s not so easy to adjust your dose. Ask to speak to a dietitian, who can help you get the balance right between food and medication.

More or less active? Being active can play an important part in managing diabetes, but it can upset your blood glucose levels. Physical activity tends to make your blood glucose levels drop, so if you’re more active than usual, your blood glucose levels are likely to be lower. Similarly, if you’re less active than usual, you may find your levels creeping up. If you take insulin, you may be able to adjust your dose to compensate for the increase/ decrease in activity levels. Talk to your diabetes healthcare team if you are unsure about this. If you take tablets, it’s more difficult to make

adjustments in response to short-term changes in activity levels. But if your activity levels change for a significant period of time, your healthcare team may recommend increasing or reducing your dose. The amount of carbohydrate you take before being active can also upset your levels – ask a registered dietitian to help you work out what you need.

Under the weather? Infections, especially if you are running a fever, tend to make blood glucose levels rise, as the body releases glucose-raising hormones. But things like nausea, vomiting or diarrhoea can actually make them fall, as your body isn’t able to absorb glucose from food as normal. This can also make a difference to how tablets are absorbed. If you take insulin, your diabetes healthcare team will probably have talked to you about how to alter your dose and what to do if you don’t feel like eating. But if you’ve got any concerns at all, get in touch with them. Whatever type of medication you take, don’t stop taking it when you’re sick, and contact your healthcare team for advice.

basic care

{ 37% of people with diabetes have an HbA1c above 58mmol/mol (7.5 per cent)

{

Source: National Diabetes Audit Executive Summary 2009–10

Step onto the scales Significant changes to your weight can also upset your diabetes management. If you gain weight, you will probably need your medication increasing. If you lose weight, you’re likely to need a decrease in your dose. Again, if you take insulin, you may well feel confident in altering your dose. But if you don’t, or if you take other medications, you’ll need some advice from your healthcare team.

Check your meds If you have Type 2 diabetes, it’s likely that your treatment will change as time goes on. You could experience unpredictable diabetes control while you get used to your new treatment. Check your blood glucose levels carefully and keep in touch with your healthcare team. Medication that you may be taking for other health conditions can also upset your diabetes, eg steroids tend to make blood glucose levels rise. Depending on how long you’re taking the other medication for, you might need your diabetes

treatment altering to keep your blood glucose levels under control. If you’re prescribed any other medication, ask your healthcare team if it’s likely to affect your diabetes, and whether you need to make any changes to your diabetes medication dose.

Feeling stressed? In stressful situations your body releases adrenaline (the ‘fight or flight’ hormone), which makes blood glucose levels rise. Also, when you’re stressed you may not always have the time or motivation to look after your diabetes properly. If you’re struggling to cope on your own, ask your diabetes healthcare team for a referral to a psychologist or counsellor.

Lumps and bumps? If you inject insulin, make sure you are rotating your injection sites. If you inject too many times in the same place, you can get hard lumps forming under the skin (called lipohypertrophy). This can mean that your insulin isn’t absorbed into your bloodstream properly, so your blood glucose levels can go up and down. Check your injection sites for lumps (or ask your nurse to take a look) – if you find any, avoid injecting into that place until they have gone. Make sure that you’re using the right size needle, as ones that are too long can upset how your insulin is absorbed.

Speak up Your healthcare team can help you find out what’s causing your unpredictable blood glucose levels, so book an appointment. It may also be helpful to attend an education course, so ask your team what’s available in your area. You can call the Diabetes UK Careline for support and information, and join Diabetes UK’s new Peer Support scheme, which will connect you with people who know first-hand that managing diabetes can be tough. You’ll also find support from others going through the same thing in Diabetes UK’s online forums (see below). i Call Careline on 0845 120 2960, Mon–Fri, 9am–5pm. • For details of the Peer Support scheme, visit www.diabetes.org.uk/peer-support. • Online forums: www.diabetessupport.co.uk; www.facebook.com/diabetesuk.

March – April 2012 balance 45

recipes Fave fish

of the

best

46 balance

March â&#x20AC;&#x201C; April 2012

Fish, veggie, meat, treats... balance has had it covered over the years. Hereâ&#x20AC;&#x2122;s a selection of our favorite dishes

Asian salmon with noodle broth This tasty broth is packed full of nutrients and is a great accompaniment to salmon Serves 2 • 2 portions fruit & veg per serving • dairy free • £5.12 per serving

• 2 pieces boneless, skinless salmon fillet each weighing about 150g (5½oz) • 2 tsp reduced-salt soy sauce • grated rind and juice 1 lime • 1 tbsp maple syrup • 2cm piece fresh ginger, finely chopped • 1 clove garlic, crushed For the noodle broth:

• 500ml low-salt vegetable stock (1 cube) • 1 clove garlic, thinly sliced • small piece ginger cut into fine matchsticks • 1 red chilli, finely sliced • 300g (10oz) ready-cooked noodles • 2 pak choi, quartered • 100g (3½oz) shiitake mushrooms • handful fresh coriander, chopped

Place the salmon in a non-metallic bowl. Mix together the soy sauce, lime rind and juice, maple syrup, ginger and garlic. Pour over the salmon and marinate for at least 30 minutes. Heat a non-stick frying pan, add the salmon and fry for 3–4 minutes on each side until just cooked, then flake into large chunks. Meanwhile, bring the stock to the boil with the sliced garlic, ginger and chilli. Simmer for 5 minutes. Add the noodles, pak choi and mushrooms, and continue to simmer for 3 minutes. Ladle the broth into 2 deep bowls and serve topped with the flaked salmon and the coriander.

2 3

4 5

Per serving (794g) 466Kcal / 38.4g protein / 37.5g carbs 18.9g fat ( 9.8g sugars) / 1.7g salt ( 3.2g saturates) /

••

Super soup

Red lentil soup Serves 2 • 1.5 portions of fruit & veg per serving • vegetarian • can be frozen • 34p per serving

• 100g (3½oz) red lentils • 1 small onion, chopped • 1 carrot, chopped • 1 clove garlic, crushed • 600ml (1pt) good vegetable stock • 2 tbsp light crème fraîche • 1 tbsp fresh parsley, chopped • freshly ground black pepper

Place the lentils, onion, carrot, garlic and stock into a pan, bring

to the boil and simmer for 20–25 minutes until the lentils are tender. Transfer to a blender with the crème fraîche and parsley and blend to desired texture. Season and serve with a chunk of bread.

Per serving (158g) 256Kcal / 14.2g protein / 35.3g carbs 7.5g fat ( 6.3g sugars) / 1.6g salt ( 4.2g saturates) /

••

March – April 2012 balance 47

recipes

Marvellous meat

Pork chops with roasted pear, apple & new potatoes Tender pork chops are fantastic roasted with fruit. If you’re feeling adventurous, try plums or apricots for a great alternative Serves 2 • 2 portions of fruit & veg per serving • £1.96 per serving

• 1 tsp olive oil • 2 lean pork chops, each weighing approx 125g (4½oz) • freshly ground black pepper • 2 eating apples, quartered and cored • 1 large pear, quartered and cored • 200g (7oz) new potatoes • 1 small onion, cut into wedges • grated rind and juice 1 orange • 1 tsp fresh thyme • 1 tbsp wholegrain mustard • 2 tsp runny honey • 2 tbsp light crème fraîche

1 2

Preheat the oven to 1800C/ 3500F/gas mark 4. Heat the oil in a frying pan, season the pork chops and add them to the pan – fry for 1–2 minutes on each side until golden. Place the pork in an ovenproof dish and add the apple, pear, potatoes and onion. Mix together the orange rind and juice, thyme, mustard and honey and pour into the dish. Cover the dish with foil and bake for 40 minutes, removing the foil halfway through the cooking time. Stir through the crème fraîche and serve with vegetables such as green beans and sautéed spinach.

3 4 5 6

Per serving (545g) 496Kcal / 43.7g protein / 52.4g carbs ( 36.1g sugars – mainly 13.8g fat from fruit) / 0.6g salt ( 5.1g saturates) /

• •

48 balance

March – April 2012

• •

recipes

Watercress, butterbean & feta frittata Serves 2 • 1.5 portions of fruit & veg per serving • gluten free • vegetarian • £1.15 per serving

• 1 tsp olive oil • 2 spring onions, sliced • 85g bag watercress • ½ 400g tin butterbeans, drained and rinsed • 4 small eggs, beaten • 30g (1¾oz) feta, crumbled • freshly ground black pepper

1 2 Tasty veggie

Heat the oil in a medium non-stick frying pan, add the spring onions and fry for 1 minute. Scatter the watercress and the beans over the onion. Stir together the eggs and feta, and season well with the pepper. Pour into the pan and cook for 4 minutes until almost set, then place under a grill until beginning to turn golden. Serve with a rocket and tomato salad, and a slice of wholegrain bread.

Per serving (301g) 301Kcal / 24.6g protein / 16.9g fat 13.4g carbs ( 1.1g sugars) / 1.7g salt ( 5.7g saturates) /

•

Citrus panna cotta with mixed berry compote Serves 6 • 0.5 portions of fruit & veg per serving • gluten free • 48p per serving

• •

•

Top treat

• sachet lemon and lime sugar-free jelly • 650g (1lb 7oz) 8%-fat fromage frais • 2 tbsp icing sugar or intense sweetener to taste • 250g (8oz) frozen summer berries

Dissolve the jelly in 150ml (¼ pt) boiling water. Once this has cooled, stir in the fromage frais and half the icing sugar. Pour into 6 dariole moulds or ramekins (very lightly greased with a flavourless oil) and place in the fridge for about 4 hours until set. Place the berries and the remaining icing sugar in a small pan, heat through for about 2 minutes until the berries are oozing juice. Cool. Tip the panna cotta onto serving dishes and serve with the berries.

2 3

Per serving (183g) 84Kcal / 9.2g protein / 12.1g carbs

•

(

11.4g sugars) /

•

0.2g fat (

•

0.1g saturates) /

0.1g salt

March – April 2012 balance 49

bite-sized

In season

Gluten free? If you have coeliac disease it can be so frustrating checking labels to make sure foods really are gluten free. Thankfully, a new law, introduced in January, clarifies how food can be labelled with claims about gluten. And this should make managing a gluten-free diet safer and easier, hopes The Food Standards Agency (FSA). The phrase ‘suitable for coeliacs’ can no longer be used on its own and must appear alongside either ‘gluten free’ or ‘very low gluten’, which are now legally defined as: Gluten free These foods are suitable for people with coeliac disease (they can contain no more than 20 parts of gluten per million). Very low gluten Small amounts of these foods can be eaten

by most people with coeliac disease, but they should get advice from a dietitian or healthcare professional about how often they can eat them. These foods must contain no more than 100 parts of gluten per million. The phrase ‘no gluten-containing ingredients’ may be used on food where gluten has not been intentionally added, but a small amount may be present from contact with other food. This phrase is not controlled by the law, and it can’t be guaranteed that this food has less than 20 parts of gluten per million so people on a strict gluten-free diet should be cautious. i Download the information sheet ‘Coeliac disease and diabetes’, produced in association with Coeliac UK, at www.diabetes.org.uk/coeliac. • Coeliac UK: www.coeliac.org.uk • FSA: www.food.gov.uk

Easy peasy What’s new on the shelves? Free & Easy has launched a range of soups, sauces, ready meals, curry pastes, gravies and soft drinks that blends wholesome ingredients, spices and seasoning for easy, nourishing and healthy meals. What’s more, they are free from wheat, gluten and dairy, but bursting with full-on flavour. balance loves the Organic Leek & Potato Soup and the Free & Easy Organic Chickpea & Bean Tagine. Organic Leek & Potato soup (£1.35) is available at Sainsbury’s. Organic Chickpea & Bean Tagine (£1.69 ) is available at Tesco.

Gourmet on the go

March Add grated beetroot and carrot, radishes or spring onions to your salads for some seasonal flavour and crunch. It’s also the time of year for artichoke, cabbage, chicory, parsnip, sorrel and the first spring greens. And you can bake your first rhubarb crumble of the year. Yum! April With spring come new potatoes, which are delicious cooked in their skins. Serve them with a knob of lowfat spread and some chopped fresh mint or chives. Also in abundance are morel mushrooms, spinach and rocket, which are great additions to pasta dishes.

Spaghetti with crab & radish shavings

Recipe kindly provided by loveradish.co.uk

Serves 4 • Preparation time: 5 mins • Cooking time: 15 mins

Cook 500g spaghetti in a pan of boiling, salted water. Fry 4 sliced garlic cloves in 5 tbsp olive oil and 1 tsp fennel seeds. When the garlic turns golden brown, remove from the heat and add 1 large red chilli (deseeded and finely chopped), 150g white crabmeat, 50g brown crabmeat, the zest and juice of 2 lemons, and 1 large bunch of shredded parsley. Add the pasta to the crab sauce and season with sea salt and black pepper. Divide between 4 warm bowls, sprinkle with 50g thinly sliced French breakfast radishes and serve. Per serving (211g) 598Kcal / 87.5g carbs ( 4.4g sugars) / 16.5g fat ( 2.3g saturates) / 0.7g salt

•

50 balance

March – April 2012

•

Grow your own Vegetables can be grown anywhere – even in the smallest of urban gardens. David Lewis, Head Gardener at The Roof Gardens in Kensington, shares his tips Many plants can be grown in a small urban garden and yield quick results for the table. Salad leaves are quick and easy. You don’t need much space and now the weather is warmer you could get away with sowing them outside without any protection. The trick is to use every space. Planters on the terrace are best when they are as large as possible. This type of gardening is very intensive so keep the compost fertile and fed regularly, with a combination of compost from kitchen waste and seaweed liquid feed applied regularly in the growing season. Plants that are great to grow in this kind of space are: • Peas: choose your favourite types and perhaps a trailing form to grow on a pergola. • Broccoli: there are many forms but take note that it takes a full year to come to flower. • Broad beans, runner or green beans: these are great in a small space. I grow them at The Roof Gardens and they do very well. The runner beans can also be used on a pergola – and you can also eat the flowers!

Inspiration Seeds of Italy (www.seedsofitaly.co.uk) is great for unusual varieties of easy-to-grow vegetables. Seed Pantry (www.seedpantry.co.uk) has some great seasonal starter packs – the Window Salads Starter Pack (£34.99) is a great place to start! i www.roofgardens.virgin.com

Lindt Gold Bunny (100g) = 525Kcal

1hr 54 mins’ vigorous spring cleaning (eg window cleaning)

Swap ‘n’ save Walkers Max Cheese & Onion crisps (50g) 264Kcal

Save 80 calories

Walkers Cheese & Onion crisps (34.5g) 184Kcal

feature Drawing: Emma Kelly

Number crunching Many people with Type 1 diabetes extol the virtues of a carbohydrate-counting regime, so what’s it like for their partners, especially if they do most of the cooking? Autumn Barlow spills the beans

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March – April 2012

’d heard of diabetes. Everyone has, haven’t they? I was even aware of the different types. So when my new man told me about his Type 1, I thought I understood. What I didn’t expect was to find myself in a restaurant, watching him count the potatoes on his plate, muttering under his breath and doing mental arithmetic. He’s done the Dose Adjustment For Normal Eating (DAFNE) course. He can eat whatever he likes – in theory – but he adjusts the amount of insulin he’s going to take according to how much

carbohydrate (carb) he’s going to eat. And the carb-to-insulin ratio varies according to the time of day. We’re married now, and I’m the chief cook. There’s always a stack of paper in the kitchen so I can scribble down the carb amounts he needs to know.

The joys of normality The key is in the name – ‘Dose Adjustment for Normal Eating’. Because that’s what everyone wants: normality. To be able to join your workmates when

feature they spontaneously decide to have a sized potatoes early on, but there were long pub lunch. To be able to have times when I overlooked the dash of flour a pudding even though you’ve had I’d thrown into the stew to thicken it. heaps of potatoes. It makes socialising All recipes in magazines seem to list a far more relaxed experience. the fat and sugar contents – but only a It also makes cooking with the handful, such as Prima and, of course, family more enjoyable. He can bake balance, give the carb values per portion. a heap of cakes with his son and enjoy Though most pre-prepared foods do the outcome without worrying about list carb content, there are times when a strict diet. It’s a simple thing that it’s given as ‘per 100g’. If it’s a 35g packet many people take for granted. It does of stir-in sauce, it can be a fiddly job to mean I get to eat fewer cakes, though sit and work out the exact amount per – they scoff most of them! portion. Given that a large All this talk of pub lunches, proportion of the population potatoes and cakes does hated numbers at school, it can Telling my seem daunting. It’s easier to fall sound like it’s a caloriefrenzy. But it’s not. In fact, it husband that back on the same old packaged makes weight management goods because you know exactly the cheese sauce what’s in them. far easier. The discipline my husband has learned over Then there are the contains ‘some’ the years in counting his idiosyncrasies of the human flour and that carbs becomes a more natural body. My husband works outside, he’ll only be awareness of healthy eating often in the cold, in a physically patterns. Sitting around eating half of demanding job. So he eats and eating lard and crisps is injects insulin accordingly. that – well, never a good thing, whether Occasionally he finds himself it’s no good you’ve got diabetes or not. unexpectedly confined to the And just because you can, office when he’s all primed for doesn’t mean you will! a day of activity, and this can send his blood sugar level crazy.

A methodical approach

Carb counting was easier for my husband when he was a bachelor. Most prepared foods are well labelled, so pizzas and cakes were no problem. However, I’m a keen cook and we soon ran into problems. Over time, I’ve collected piles of recipes. They’re dog-eared and sticky with the residue of cooking experiments, and I’ve developed a slap-dash confidence when it comes to cooking. I make a basic roux sauce with ‘some’ flour, ‘some’ butter and ‘quite a bit’ of milk. But telling my husband that the cheese sauce contains ‘some’ flour and that he’ll only be eating half of that – well, it’s no good. How many carbs in ‘half of some’? I’ve had to be much more methodical in my cooking. He has a booklet with the carb content of most major foods. But when you cook meals from scratch, as I do, it still means I need to scribble out the relevant foods and add up the total – and then divide by the number of servings. I’ve made many mistakes too. I grasped the concept of hen’s-egg-

Top tips We’ve found it useful to keep a small, hardback (wipe-clean!) A–Z notebook in the kitchen. When I try a new recipe, we note down what the carb content is, as far as I can work out. We keep an eye on his blood sugar for the rest of the day and adjust my calculations for next time, if necessary. Overall, my husband is much happier on the DAFNE regime. But he does warn that not everyone has heard of it – even healthcare professionals – which can cause confusion if you’re suddenly admitted to hospital, for example. The maths involved isn’t as scary as you might think. All you need is a pencil, paper and a bit of patience to reap the rewards. Or you could do what my husband did – marry an ex-maths teacher! i How do you find carb counting? Share your tips on the wall of the balance Facebook group (search for ‘balance magazine’) or email us at balance@diabetes.org.uk.

How to become an expert Diabetes UK advocates that all people with diabetes, whether recently diagnosed or with pre-existing diabetes, should receive the education they need to self-manage their diabetes. There are lots of different education courses available. Some of the nationally developed courses are: DAFNE – Dose Adjustment for Normal Eating. This course provides people with Type 1 diabetes with the skills to estimate the carbohydrate content of meals and inject the right dose of insulin accordingly. • www.dafne.uk.com DESMOND – Diabetes Education and SelfManagement for Ongoing and Newly Diagnosed. This course supports people with Type 2 diabetes to understand and take control of their condition. • www.desmond-project. org.uk X-PERT – this programme supports people with Type 2 diabetes to develop the knowledge, skills and confidence to make informed decisions regarding lifestyle and self-management. • www.xpert-diabetes.org.uk i Find out more about education courses, including upcoming dates, at www. diabetes.org.uk/structured.

March – April 2012 balance 53

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

Mar ellous!

Hermesetas SteviaSweet – with the calorie free sweetener from the Stevia plant. Natural sweetness without calories is no longer a dream because Hermesetas SteviaSweet has arrived, containing the extract of Stevia leaves. For hundreds of years, the wild plant Stevia has been known as “honey leaf” to the original inhabitants of South America and used to sweeten foods and drinks. And now you can enjoy Stevia in Europe with Hermesetas SteviaSweet. Available in tablet, granulated or liquid, you can use it to sweeten tea or coffee, sprinkle on fruits and desserts, or cook and bake delicious low calorie recipes. Enjoy the pure sweetness of Stevia. For more information on SteviaSweet go to: www.hermesetas.com/steviasweet 54 balance March – April 2012

River deep,

mountain

high

A holiday of a lifetime in the Rocky Mountains provided a few diabetes challenges for Tim Gillett and his family – but he says it’s the perfect destination for an adventurous trip

rizzly bears, snow-capped mountains and areas of vast wilderness were on the agenda as my wife, Rebecca, and I planned our family’s month-long road trip in the USA last year. But before considering any of that we needed to think about all things diabetes. Two of our three sons – Louis, 12, and Victor, 10 – were diagnosed with Type 1 at 4 years old. Since then, our holiday choices hadn’t really been affected by diabetes, but this trip would be different – long flights, a month living in a motorhome (known as a recreational vehicle – RV – in the States), long periods at high altitude, and, of course, those fabled, vast American food portions. While we were confident that we’d manage, there’s always a concern when you are so far away from home. The boys, of course, had no such worries – they were just looking forward

to sampling the local cuisine and searching for Yogi Bear!

The adventure begins Aside from being long and boring, the flights, totalling about 18 hours including a stopover, didn’t present much of a problem. We increased the background basal rates on the boys’ Medtronic insulin pumps and checked them regularly throughout the journey, being sure to adjust the clocks to reflect the eight-hour time difference on our arrival in Denver. We were later told that the effects of take-off and landing can sometimes cause the pumps to deliver slightly more insulin than usual for a short time – but we were unaware of this when travelling and the boys’ blood glucose levels were fine. On arrival in the States, there was an interesting moment when the

The tranquil beauty of the Rockies. Inset: Getting into the cowboy spirit near Jackson, Wyoming: (left–right) Rebecca, Louis, Victor, Tim and Sidney boys’ pumps were taken away to be tested for explosives – thankfully they were quickly handed back with a clean bill of health.

On the road Our route was to take us from Denver, Colorado, north through Wyoming into Montana, then back south through Idaho and Utah, before heading back towards Denver. Denver is known as the Mile-High City on account of its 1,609m (5,280ft) altitude. The air was noticeably thinner than at home – but within two days we were camping in our RV at an altitude

March – April 2012 balance 55

from medical care (as well as a very real danger of bumping into grizzly bears), but we had packed every bit of diabetes kit known to civilisation, as well as large amounts of food.

The American diet

Dinner in the woods near Lake Como, Montana of nearly 3,353m (11,000ft), high in the beautiful Bighorn Mountains. Louis and Victor did have hypos [hypoglycaemia – low blood glucose] shortly after arrival here, but they were easily treated with dextrose and doughnuts. The hypos could have been caused by the high altitude, as all of us felt lethargic and short of breath until we retreated to lower altitudes the next day. However, the superb views over an isolated lake to huge pine forests, and a couple of successful fishing trips, more than made up for our slight sickness. We were to cover nearly 3,000 miles (4, 828km) in one month, but the driving never felt like a chore – on our route there was very little traffic, the roads were wide and the scenery fantastic. Most days we would arrive at our chosen campsite in the early afternoon, leaving plenty of time for hiking, swimming, fishing and general relaxing. The world-famous Yellowstone and Glacier National Parks were real highlights with their huge forests and astonishing wildlife (and, it has to be said, crowds of tourists), but some of the most memorable moments were in isolated campsites, many miles from civilisation. At Home Gulch campsite, in northern Montana, for example, we had the whole forest site to ourselves and spent happy hours hauling in rainbow trout from a mountain stream, with no company except the local wildlife including beavers, ospreys and mule deer. There were obviously a few worries about being so far away

56 balance

March – April 2012

We cooked for ourselves mostly; fresh ingredients are high quality in the USA and cheaper than in the UK. Louis, Victor and their little brother Sidney, 8, were impressed by the array of snacks and cereals on offer, though we had to keep an eye on the sugar content, as it was relatively high in some products. Luckily, there seemed to be a sugar-free version of just about everything – great for the long journeys in the RV – but the boys

We had the whole forest site to ourselves and spent happy hours hauling in rainbow trout from a mountain stream also got through masses of highsugar snacks when they were being more active. In restaurants the portions were, as expected, large – but not overwhelming, especially for our fast-growing and mainly ravenous boys. We were particularly taken with the Mexican-influenced food, from take-away tacos to authentic and very spicy dishes in the many excellent restaurants.

Walking the line Managing the boys’ diabetes all went swimmingly – and, indeed, water played a key part in our holiday, from splashing about in icy lakes and rivers to bathing in hot springs and plummeting down terrifying slides at water parks. We just disconnected the boys’ pumps whenever required – and, of course, kept testing their blood glucose levels as often as possible. Long hikes were probably more of a challenge – particularly when we climbed Mt Washburn, in

Yellowstone National Park. A gruelling four-hour climb to the summit meant frequent snackstops – and, on more than one occasion, topping the boys up with glucose. But we were rewarded with magnificent views over the National Park, as well as sightings of bison, elk, marmots, pika, ermines and a golden eagle. Later in the holiday we tried an excursion on horseback near the town of Jackson – and we can all confirm that it’s a much easier way to get up a mountain. We often felt we were living the cowboy lifestyle – particularly after buying suitable hats and a copy of ‘Johnny Cash at Folsom Prison’ (which got stuck in the RV’s audio player and became a soundtrack to our holiday!).

Well worth it Spotting wildlife became something of an obsession throughout our trip – the boys kept a list that grew on a daily basis, and there were two highlights that will live long in our memories. In Glacier National Park, with a backdrop of spectacular mountains, deep blue sky and crystal-clear lakes, we watched a family of grizzly bears amble across a hillside, gorging themselves on fruit in preparation for the coming

USA contacts The equivalent to Diabetes UK is: American Diabetes Association (ADA). Travellers can freephone 1-800-342-2383 (Monday to Friday, 8.30am to 8pm) for assistance, or email AskADA@diabetes.org. • www.diabetes.org Emergency numbers Ambulance, Fire and Police: 911 Tourist board Since the US is so large, there is no centralised tourist board for the entire country. Instead, visit the tourist boards for individual states or cities.

Wyoming wonders (left–right): traffic jams Yellowstone style; sunset at Flaming Gorge; Lower Falls of the Grand Canyon in Yellowstone National Park winter. Just a few days later, on a hike in Grand Teton National Park, in western Wyoming, we stumbled on a massive bull moose noisily chomping its way through the greenery – seemingly oblivious to the crowd of camera-wielding humans standing barely 12m (40ft) away. Now that’s not something you’ll see in Norfolk. All in all, it was a fantastic trip – the area is like one huge playground

and there’s never a shortage of things to do, at least for those who like the great outdoors. Such a holiday certainly involves a lot of planning for families with children with diabetes, but there was never a point when we felt we’d bitten off more than we could chew. In fact, we found the destination and style of our trip had its advantages when managing the boys’ diabetes: the temperatures are pleasant but not

extreme, and we were able to set our own itinerary and meal times, which made a great difference. To coin a phrase, our advice would be: go west! i Download Diabetes and Travelling, a balance guide, at www.diabetes.org.uk/ diabetes-and-travelling. • For countryspecific information, download a free country guide at www.diabetes.org.uk/ shop-country-guides and visit NHS Choices at www.dh.gov.uk/travellers.

SENSING YOUR WAY • • • •

Are you having problems with your glucose levels after you eat or when you exercise? Do you feel your glucose levels are a “roller coaster”? Do you fear your glucose levels will go low while you’re asleep? Do you want better overall control of your diabetes?

The Dexcom SEVEN® PLUS can help give you a more complete picture of where your glucose is, was and where it’s going.

Take Charge, Take Control… Contact Dexcom Distributor: Advanced Therapeutics (UK) Ltd.

info@advancedtherapeuticsuk.com or 019 2649 4222 0050

Dexcom, Inc., 6340 Sequence Drive, San Diego, CA 92121 USA +1.858.200.0200 www.dexcom.com Outside US: Contact your local distributor. EC REP

MediTech Strategic Consultants B.V., Maastrichterlaan 127-129, NL - 6291 EN Vaals Tel. +31.43.306.3320 Fax. +31.43.306.3338

LBL-011187 Rev01

London’s 1908 Olympic Stadium

to the area by Victorian poet Robert Browning. At the bridge where Westbourne Terrace Road crosses the canal, take the footbridge and follow this footpath, initially signposted to Warwick Avenue tube station. To your right is Browning’s Pool – after the poet, again. The Grand Union Canal continues on to Paddington Basin, but you are now on Regent’s Canal. Soon you are forced onto Blomfield Villas as this stretch of towpath is not open to the public. After around 400m (1,312ft) the canal passes under busy Edgware Road. Café Laville sits on the bridge over the canal.

Going for

gold

Cross over Edgware Road into Aberdeen Place, where a blue plaque on the left marks the former home of Guy Gibson, leader of the famous Dambusters raid during World War II. As the road bends left, head straight across into an alleyway and descend a steep set of steps back onto the towpath. The canal now continues into Regent’s Park, and then through London Zoo.

As London gears up to host its third Olympic Games, Graham Clewes uncovers a scenic canal walk from where the first stadium once stood to the brand new Olympic Park

his year, London becomes the first city to host the modern Olympic Games three times (in 1908, 1948 and 2012). As the new Olympic stadium and park rise dramatically from what was largely derelict land in Stratford, east London, the stadium used for the capital’s first Olymic Games – in the west of the city – has long been replaced by the BBC’s White City building. Thanks to London’s extensive canal network, the 16-mile (25km) walk from the first Olympic site to the new one is almost entirely off-road. The towpaths pass through some of London’s most affluent and deprived areas, and provide an interesting take on the patchwork of communities that make up the capital. Turn right out of White City tube station along Wood Lane. The site of the 1908 Olympic Games lies almost opposite the station. Demolished just 25 years ago, there was a swimming and diving pool at the centre of the running track and a cycle track around

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March – April 2012

it. It was here that the modern-day marathon began, when the race was extended to its current length of 26 miles and 385 yards (42km) to ensure a start from Windsor Castle, and a finishing lap of the running track. After the Games, it was used mainly for speedway and greyhound racing, with occasional spells as home to Queen’s Park Rangers football club. The easiest route, but not the most direct, turns left into Uxbridge Road and over the roundabout at Shepherd’s Bush into Holland Park Avenue. Turn left into Ladbroke Grove, then right into Westbourne Park Road, before going left into Great Western Road and left just past Westbourne Park tube station into Tavistock Road. Turn right into Meanwhile Gardens and right onto the Grand Union Canal towpath.

Continue along the towpath until an increase in moored narrowboats indicates the fringes of Little Venice, a name thought to have been given

The next landmark is Camden Lock, the epicentre of Camden Market. Pass right over Camden Lock and up to Camden High Street. Turn left, back across the canal, to meet the towpath once more. Soon you will see the St Pancras Eurostar terminal, and

Little Venice: an oasis of tranquility in the heart of London

Bird’s-eye view of the walk

3 2

walk For a change from the canal, enter Victoria Park at the first gate you find and follow the park’s southern border until its junction with Wick Lane in the far south-eastern corner.

Bustling Camden Lock

the iconic King’s Cross gas-holders. Shortly afterwards, the canal reaches the 878m (2,881ft)-long Islington tunnel, where the towpath comes to a halt. The above-ground route is signposted, but not very effectively. The route to return to the canal is left along Muriel Street, right into Carnegie Street, left into Charlotte Terrace, right into Copenhagen Street, right into Barnsbury Road, left into Chapel Market, across Liverpool Road and Upper Street into Duncan Street, and right into Colebrooke Row, where there’s an entrance to the towpath.

From here, follow the towpath along the edge of the City and Hackney to Victoria Park. The East End’s answer to Regent’s Park was designed by Sir James Pennethorne, a student of architect John Nash.

discover hidden london

If you fancy exploring the charm and history of London’s waterways, try getting your hands on one of five copies of Walking London’s Waterways that balance is giving away. To enter, send your name and address on a postcard or sealed-down envelope to: ‘Walk giveaway’, balance, Diabetes UK, 10 Parkway, London NW1 7AA, by 2 April. Winners will be picked at random and notified within seven days.

Rejoin the Hertford Union canal, also known as Ducket’s canal, and turn left. Continue along the canal as it bends left, then cross the bridge in front of you over the River Lee. Here, turn right and continue towards the stadium, until you reach Old Ford Lock. On the left is the lock-keeper’s cottage, made famous as TV’s The Big Breakfast house in the 1990s. Across the lock stands the former Percy Dalton peanut processing factory.

Turn left up onto the Greenway urban path, which affords a remarkable view of the site of the new Olympic Park to the north, and Canary Wharf and Docklands to the south. The site sits on an ‘island’ bordered by the Bow Back Rivers – the Old River Lee, Pudding Mill River, and City Mill River – which are all different branches of the River Lee. Turn right along the Greenway to the Olympic site information centre, and then turn right behind this to descend and pass under the Docklands Light Railway to the station at Pudding Mill Lane. A version of this article was first published in Walk, the magazine of the Ramblers. Visit www. walkmag. co.uk.

Distance 25km/16 miles Time 6–8hrs WHERE Linear walk between London’s 1908 Olympic stadium in White City to the new 2012 Olympic Park in Stratford. START White City Underground Station. END Pudding Mill Lane DLR station. TERRAIN Flat, easy walking on pavement and towpath, with one set of steep steps. MAPS OS Landranger 176 & 177; OS Explorer 173. GETTING THERE White City is on London Underground’s Central Line; Shepherd’s Bush is the nearest overland station. Stratford has both underground and mainline train services. Visit www. tfl.gov.uk for further travel information. EATING AND DRiNKING Caffe Crema, Camden Lock Place (020 7284 1890) and The Narrow Boat Pub, 119 St Peter’s Street (020 7288 0572). VISITOR INFORMATION Britain and London Visitor Centre, Lower Regent Street (08701 566 366; www.visitlondon.com).

The new stadium rises dramatically out of the landscape

March – April 2012 balance 59

fundraising focus Arctic stunt

A perfect partnership Diabetes UK’s partnership with Bupa got off to a great start on 7 January, when more than 130 runners, including Thomas Wilson (above), ran the Bupa Great Winter Run. The 5k course took runners through Holyrood Park in the centre of Edinburgh, and those running for Diabetes UK raised a fantastic £1,382. Mark Fox, Events Manager at Diabetes UK, said: “To have so many people turn up was amazing, and we really can’t thank everyone enough for all of their efforts.” i See Diabetes UK’s events brochure inside this issue of balance for details of this year’s Bupa Great Runs and other activities you can get involved with while raising vital funds for Diabetes UK.

Trainee stunt man Olly Rowland (pictured) and his friend Rob Mills began racing an old Russian Ural motorbike across Siberian wastelands on 13 February, in a two-week fundraising challenge for Diabetes UK. The Pioneers Ice Run is a 16,000km (9,942 mile) bike trip through Siberia and into the Arctic Circle along a frozen river. Olly, 23, who has Type 1 and is a regular on blockbuster filmsets, said: “Keeping my insulin from freezing and exposing flesh to inject into in -40°C is going to be a big challenge. My big mission is to prove that having diabetes doesn’t need to stop you doing anything!” i There will be more on Olly’s adventure in a future issue of balance. To sponsor him, visit www.justgiving.com/numbnutsdiabetesuk.

Photo: SW Photos

Real inspiration On 28 January, Michelle Buckle (left), who has Type 1 diabetes, became the first woman on record in the UK to complete a 24-hour treadmill run, raising more than £4,000 for three charities, including Diabetes UK. Michelle, 42, ran and walked continuously, from 10pm Friday to 10pm Saturday, only stopping for toilet breaks. She covered more than 80

miles (129km) in 24 hours and checked her blood glucose every hour, controlling her diabetes with nutrition. Michelle said: “Four years ago, I was 7st (44kg) heavier and could barely walk 100m (328ft) without stopping for breaks. I wanted to prove that diabetes shouldn’t stop us from achieving our goals in life.” i For more information or to donate, visit www.two4run.com.

Miss Unstoppable Inverness PE teacher Amanda Croall (pictured, centre) helped raise more than £6,000 for Diabetes UK after putting together a team of 35 runners, including herself, to take part in the Baxters River Ness 10k Run last October. Amanda also organised an after-party, complete with a raffle and auction, bringing the total money raised to twice the original target. Amanda said: “I hope to motivate others with diabetes to challenge themselves to stay fit and healthy, prevent complications and live life to the max, because you can!” i The next 5k and 10k River Ness runs, and the Loch Ness Marathon, take place on 30 September. For details, call Diabetes UK Scotland on 0141 245 6380.

60 balance March – April 2012

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.

Midlands Success The Chesterfield and North Derbyshire Diabetes UK voluntary group donated a massive £5,063 to Diabetes UK in January. Meanwhile, the Birmingham voluntary group organised a collection after a performance of Dick Whittington at the Oldbury Rep theatre in Sandwell. With the help of Doreen Bastable from the Oldbury Rep, collectors Eddie Evans and his daughter Eithne, 11, (pictured), Daphne Vernon and Shirley Lee raised an impressive £767. Joy Tootell, Diabetes UK Regional Fundraiser, said: ”A very big thank you to the voluntary groups – we simply couldn’t do what we do without them.”

Cycling superstars Last June, 12 Year 11 students (above) from Garstang Community Academy, Lancashire, rode 125 miles (201km) over four days, raising a fantastic £3,000 that was evenly split between Diabetes UK and Alexandra House, a local respite care centre for children and young people with additional needs. Led by their tutor, Simon Hopkins-Millward, the students rode along the South Downs Way from Eastbourne to Winchester, staying at youth hostels and camping along the way.

Up for the challenge? Keen cyclist Dave Sprinks (right), who has Type 2, is seeking intrepid fundraisers to join him on a 280-mile (450km) cycle across Vietnam to raise funds for Diabetes UK. The challenge will take place in September 2013, and Dave is planning to lead a team of 16 cyclists from Hanoi to Ho Chi Minh City in 11 days. “I’ve done a Vietnamese cycle challenge before and it was amazing,” said Dave. “I’d really encourage people to join our team in support of Diabetes UK.”. i To find out more, email Dave at dave-sprinks@hotmail.com.

Swim22 This year’s Swim22 Channel swim pool challenge runs from 22 April and 22 July, so get your goggles on if you fancy improving your fitness while raising vital funds for Diabetes UK. Participants are required to swim the length of the English Channel (22 miles/35km) in the comfort of their local swimming pool. Swimmers can complete the distance individually or as part of a team, in days or over three months. i www.diabetes.org.uk/swim22; swim22@diabetes.org.uk London to Paris Cycle Challenge The fourth Diabetes UK London to Paris Cycle Challenge will take place between 7 and 10 September. This fantastic fundraising challenge will see participants cycle 200 miles (322km) from London, through beautiful English and French countryside, to the glamorous capital city of Paris. i www.diabetes.org.uk/londontoparis; events.fundraising@diabetes.org.uk

DIARY 1 April Forest of Dean Half Marathon, Gloucestershire i 01823 448260 • south.west@diabetes.org.uk • www.diabetes.org.uk/fodhalf 1 April South Hams Cycle Sportive – The Hammer, 130km (80.7 miles), South Devon i 01823 448260 • south.west@diabetes.org.uk • www.diabetes.org.uk/ thehammer 22 April Walk for Diabetes, Cardiff Bay (3–4 miles). The first in this year’s ‘Walk for Diabetes’ series. i 029 2066 8276 • wales@diabetes.org.uk 22 April Midlands Big Bike Ride, Cannock Chase, Staffordshire i 01922 614500 • midlands@diabetes.org.uk 29 April Spring Bike ‘n’ Hike, Moors Valley Country Park, Dorset i 01823 448260 • south.west@diabetes.org.uk • www.diabetes.org.uk/ springbikenhike 29 April Milton Keynes Marathon • 01372 731361 • fundraising.southeast@ diabetes.org.uk 25 May Yeovil Golf Day, Yeovil Golf Club i 01823 448260 • south.west@diabetes.org.uk 26 May Great London Swim 2012 i 020 7424 1126 • www.diabetes.org.uk/ great-london-swim 8 july British 10k London Run i 020 7424 1126 • london@diabetes.org.uk • www.diabetes.org.uk/ british-10K

M March – April 2012 balance 61

fun&games

Win

This exceptional grill with its unique probe allows you to accurately monitor food temperature while it cooks, ensuring that your meat or fish is perfectly grilled to your specific taste every time.

Morphy Richards Intelligrill

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

balance address (see page 3) marked ‘Crossword’. The first correct entry drawn after 2 April will win a Morphy Richards Intelligrill (see right), worth £99.99. Congratulations to last issue’s winner, Mrs Irene Nelson from Birkenhead.

www.morphyrichards.co.uk 1

22 23

Name Address Postcode

Wordworkout How many words can you make from this box of letters? Each word must have at least four letters, using the centre letter each time. No letter can be used more than once in each word. Names and plurals are not allowed. There is one nine-letter word in the grid. Clue: shape. 20 = Average; 25 = Good; 30+ = Excellent.

64 balance

March – Arpil 2012

O S E E H U P N T

ACROSS 1 Characteristic spirit (5) 6 Prelude (8) 7 Citrus fruit (4) 9 Ovum (3) 10 Bottom of foot (4) 12 Oily fish with high vitamin D content (6) 13 Salvage (6) 15 Canopy (6) 17 Supernatural (6) 18 Mediterranean island (4) 20 Hail (Latin) (3) 21 Ale (4) 22 Old woman (in Poland and Russia) (8) 23 Tennis score of 40-40 (5)

DOWN 1 Currant-filled pastry confection (6,4) 2 Man-eating monster (4) 3 John Gay play, The ___ ___ (7,5) 4 State of inactivity (6) 5 River in Russia (4) 6 Study of the sea (12) 8 Fleshy fruit (5) 11 People entitled to vote (10) 14 Slide (5) 16 Son of Daedalus in Greek myth (6) 19 Fertile soil (4) 21 Tree trunk (4)

SOLUTION to Jan/Feb 2012 ACROSS 1 Titbit, 4 Rhyme, 9 Browser, 10 Arras, 11 Tae kwon do, 12 Text, 13 Gravy, 16 Isle, 19 Unitarian, 21 Gouda, 22 Anchovy, 23 Besom, 24 Fondue DOWN 1 Tablet, 2 Thorax, 3 Inset, 5 Headway, 6 Marina, 7 Free radical, 8 Ascot, 13 Guanaco, 14 Fungi, 15 Figure, 17 Second, 18 Enzyme, 20 Nacho

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

SE WA

ER LE

DE AS

ND CT

HE MU

IT UR

DE CR

EN TY

CO PA

NA DY

BI CO

W IN 3 8

balloon FLIGHT FOR TWO

Looking for an amazing Mother’s Day or birthday gift? Thanks to Virgin Balloon Flights, balance is giving readers the chance to win a champagne balloon ride for two. The adventure includes: • a 3–4 hour experience, with around an hour’s flight • a traditional champagne toast after landing • a certificate signed by your pilot and endorsed by Sir Richard Branson • one of 100+ launch sites across England, Scotland and Wales • 18 months to book a flight (flying season is March to October) To enter, see box below right and mark your entry ‘Balloon flight giveaway’.

1 9

3 2 6 5 8 2

8 1

2 9 4 3 8 7 5 9 8

1 4 6

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

6 5 2 4 7 3 1 9 8

1 4 8 2 9 6 3 5 7

9 3 7 8 1 5 2 4 6

2 7 5 3 4 1 8 6 9

3 9 6 7 5 8 4 2 1

8 1 4 6 2 9 7 3 5

7 2 1 9 6 4 5 8 3

5 8 9 1 3 2 6 7 4

Last issue’s solution

4 6 3 5 8 7 9 1 2

WIN TICKETS TO GRAND DESIGNS LIVE 2012 Design guru Kevin McCloud (pictured) brings his leading home show, Grand Designs Live, back to London’s ExCeL Centre from 5–13 May, and balance has 10 pairs of tickets to give away. If you’re looking for unique products and inspiration for your home, Grand Designs Live is the must-see show this spring. To enter, see box below left and mark your entry ‘Grand Designs giveaway’. If you’re not lucky enough to win, you can buy tickets at www.granddesignslive.com or by calling 0844 854 1348. Kids go free. Terms and conditions: This offer is only open to UK residents. Competition winners’ tickets are valid for any one day of the show between 5 and 13 May to Grand Designs Live at Excel London. Tickets are non transferable. Complimentary tickets obtained through this offer may not be duplicated. All tickets will be scanned on entry to the show.

SAVE MONEY

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READERS’ OFFER

For a limited time, Virgin Balloon Flights is offering balance readers national 7-Day AnytimePlus flight vouchers (RRP £199 per person) for just £139pp – a saving of 30 per cent. Every customer who takes up this offer will also receive a free box of Virgin Balloon Flights champagne truffles* (RRP £3.49, 60g). Be quick, this offer ends on 6 April. Call 0844 844 8070 or visit www.virginballoonflights.co.uk and quote ‘balance magazine’. * Free chocolates offer is subject to availability. One per household. Please visit www.virginballoonflights.co.uk for full terms and conditions.

HEALTHCARE

COSTS A balanced life John Byrne HOW TO ENTER Send your name and address on a postcard or sealed-down envelope to: balance, Diabetes UK, 10 Parkway, London NW1 7AA, to arrive no later than Monday 2 April. Don’t forget to state which giveaway you are entering! Winners will be picked at random and notified by Monday 9 April.

• With a cash plan you can claim up to £200 towards dental treament, £200 towards optical care, £400 towards therapy treatments, plus many more benefits • Cover starts from as little as £8.50 per month • No medical required

For further information call:

0800 731 743 (quote ref: DUK0212) or sign up online at www.bhsf.co.uk/diabetes Maximum benefits quoted based on Level 4 individual policy at £32.00 per month. Subject to policy terms and conditions; copies available on request. Underwritten by BHSF Limited, Gamgee House, 2 Darnley Road, Birmingham B16 8TE. Authorised and regulated by the Financial Services Authority.

INSURANCE SERVICES

different types

Arthur Smith

Mari Wilson

Confessions

1. I do not test my blood sugar six times a day and have, occasionally, gone a whole day without testing at all. 2. When I do test, I don’t bother to load up the little pricker machine, I just plunge the tiny lancet into my finger. 3. Sometimes, I have a bath in water that is more than tepid – all right, I always do. 4. Grapes. These evil little fellows are known to some diabetes experts as ‘sugar bombs’, but I like grapes and, yes, I like to eat them. 5. Needles. I do not put a new needle on my insulin pen every time I use it and have, a few times, used the same needle for up to six separate injections. 6. While I do apply moisturiser to my feet regularly, I do not examine them every night for any cuts. Furthermore, there has been the odd moment when I have walked about the house not in steel-capped boots to guard against potential abrasions, but in just my socks. 7. I know I should only drink semi-skimmed milk, or even better, skimmed (‘white water’, as I call it) but, from time to time, I will have – gasp – full-fat milk. 8. When I buy a new plate I do not, as all dietitians seem to suggest, draw dividing lines on it and put all the carbohydrates in one sector, vegetables in another, etc. 9. I do not read every single word of balance. 10. Once, I pretended to have a hypo in order to derail the furious telling-off I was getting (Sorry Beth! I won’t do it again, I promise.) 11. When I am asked to run across the Gobi desert or climb the Matterhorn to raise money for a diabetes-related charity I say I am busy – but the truth is I am not busy. I just don’t want to do it. Well, there we are, I’ve said it all now and feel better. I have, like the woman removing her bra, got it off my chest. You probably have a few similarly appalling confessions, because, however much we may wish to be perfect, or even just to conduct ourselves according to the rule books, this is not always possible because we are human beings. Mea culpa, and meya have a fine spring too. • Please ensure you follow the manufacturers’ advice for your diabetesrelated devices, and the guidance of your diabetes healthcare team. i Arthur Smith is a comedian, writer and broadcaster with Type 2.

66 balance

March – April 2012

hen I heard of Whitney Houston’s death last month, I posted my thoughts on Facebook, which started a lively debate about addiction. I was even asked how I’d managed to make it this far without getting involved in drugs. My response was that when you have a chronic condition like Type 1 diabetes, you spend most of your time ensuring that you feel as good, healthy and as full of life as possible – checking your blood sugar, taking your insulin, eating all the right things. Yes, it’s a fulltime job, but I would never want to go back to that preinsulin place of utter exhaustion, thirst, and feeling and looking absolutely dreadful. I am utterly grateful for every day that I feel good – ‘when you have your health, you have everything’ – it may sound corny but it’s so true. Maybe for some people who have their health there is a feeling of being indestructible, but, unfortunately, that really isn’t the case, certainly not for Whitney, Amy or Michael. I met my good friend Kate for lunch recently – she also has Type 1 and we always compare notes when we meet up. We discuss our current HBA1c and then we both get out our test kits before ordering our food. On this particular day, I’d been rushing around all morning and by the time I got to the restaurant I felt a bit low – my blood sugar test was 3mmol/l. Kate offered me some Haribo but, of course, I also have coeliac disease (I’m such a show-off), and I wasn’t sure if those sweeties were gluten-free, so I got out my Jelly Babies instead – they are ideal for low blood sugar – pure glucose and fastacting. So there we were, the two of us – insulin pens, test kits, Haribo, Jelly Babies, oh how very rock and roll… So, do I have my jabs at the table? I’m usually OK (as long as I’m not wearing a dress, of course), as I can discreetly have a jab in my tummy – nobody seems to notice, I’ve got so good at it now. It reminds me of when I used to breastfeed, which I also did expertly, without offence and with great panache! Finally, can anyone recommend a glamorous evening bag that can contain insulin, glucose, blood sugar test kit, keys, purse, comb and lipstick? All these gorgeous clutch bags are everywhere, but I just can’t use them because I have to cart around my life support system. There I am – cocktail dress, heels and hairdo – hapless with a huge sack chucked over my shoulder – more coalman than chanteuse. i Mari Wilson, ‘The Neasden Queen of Soul’, has Type 1 diabetes. Her new album, Cover Stories, is out soon; www.mariwilson.co.uk.

Photos: Mari: Claire Lawrie; Arthur: SteveUllathorne

can no longer bear the guilt and self-loathing, so I have decided to confess to some of the terrible things I have done, and, shame on me, continue to do, since becoming diabetic. I doubt you will ever find it in your heart to forgive me but, for my own sanity, I need to come clean…

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