Diabetes - expert blog

One year on..

I have been diagnosed with type 1 diabetes for a whole year today. Its gone quickly!

I've gone from struggling to cope with hypoglycaemia and juggling dosage/exercise/timimgs to doing quite well. My HBa1c is steady at <6.5% and I have maybe one or two mild hypos >3.0 a week which is a marked improvement and periods of hyperglycaemia are rare now.

I'm pleased with how I'm coping lets hope it continues!

Now to convince my Dr that 300 needles is not enough in one prescription!

Bitter melon

By Nicky Moxey

For a chunk of last year, I had some Indian people working alongside me. One of their dietary interventions for T2 diabetes was bitter melon - which I adored pickled, when I could find it fresh and make it myself. It really stabilsed my blood glucose, too. Then my supplies dried up, and my friends went back home. I found a packet of dried bitter melon in a Chinese supermarket, but I didn't like it reconstituted, and besides - who knows what a safe dose might be? Or whether it's really safe? Now it looks like the second question might be answered, anyway:
Science Direct abstract

In celebration, I added a slice of dried bitter melon (Karela to my Indian friends) to my mug of green tea this morning. It tasted great :) Here's my favourite recipes for fresh karela, if any of you are luckier than me, and feeling brave! Karela recipes

antibiotics :(

By Mathew Hipwood

Somehow I have ended up with ulcerated tonsils, these are quite uncomfortable as the base of my tongue constantly rub on them. My doctor has prescribed antibiotics to limit infection, apparently I'll probably get tonsillitis on top, joy.

I've discovered that I am hopeless at remembering to take tablets, and the timing of them as well. I'm supposed to take them an hour before food or on an empty stomach but I'm so caught up in timings for blood tests and insulin peaks that I usually totally forget.

On the bright side he also changed my basal insulin prescription to the new Sanofi Avensis Solostar disposable pen. I'll report back once I have had a couple of nights use out of it.

"At this point, she's only two or three mintutes from death" - Scotsman Medical Matters Article

By Scott Gillan

Scotsman Medical Matters Article

A nice article that has some good points from someone who's partner has type 1.

Fat Burning?

By Tom Pewter

As my first post I find myself seeking advice. I attended the DAFNE course at the end of last year and the new regimen seems to have been working. I have been happier within myself, suffering less ups and downs of hypos. However, a company funded health assessment last week showed up something I knew has not improved. After carrying out the cycling test whilst linked up to a heart monitor the results showed that whilst my fitness is at a good level I need to improve my metabolism. One chart displays the source of where my muscles get their fuel from, as a combination of sugars and fats. My muscles draw most energy from sugars which is no good if I want to use exercise to control my weight. I tend to exercise over 40 minute periods rowing, cycling  or running or playing squash. To avoid lows I have found that I need to start off slightly high, sometimes with a small amount of insulin and then take occasional sips of Lucozade. Once the food source is used up I frequently have a low that necessitates stopping and resting while I load up on Lucozade again.
How do other people overcome this problem? A round of golf or a long bike ride includes carrying a veritable picnic. How can I burn fat and not residual sugar in the muscles?

Other info sources

I wonder what other blogs people read regularly? Here's my list, not in any particular order:

http://diabetesupdate.blogspot.com/
http://www.proteinpower.com/drmike/
http://high-fat-nutrition.blogspot.com/
http://weightoftheevidence.blogspot.com/
http://lowcarbohydrate.net/blog/3
http://www.healthcentral.com/diabetes/c/17/
http://www.healthcentral.com/diabetes/c/5068/

Nicky.

Fifty something's view of Type 1

By Neil Walden

The story begins in 1995, six months after our son was born, when I casually mentioned to my GP that I had lost some weight when consulting him about something else. He was sharp enough to run a urine test which was positive for the presence of sugar and the subsequent blood tests showed levels between 16 and 22.

So the diabetes gravy train began in a sense. They decided that I must be type 2 because I was 43 at the time and I was on tablets for about two years until they were less and less effective. I started on insulin shortly afterwards and have been on various regimes over the years. Control was reasonable but with quite a lot of swings and all the frustration which accompanies it.

I have learnt over the years that everyone is different, and some people have an HBA1c of 6 without breaking a sweat whereas other people struggle to keep below 8.0. I seem to be very sensitive to insulin and even one unit change in my dose can make a significant difference in blood level and response.

All this has taught me that the professionals can give you a lot of advice and help but it is really down to you and your motivation to find the best way for you.

A major breakthrough for me was the DAFNE course which I attended in January 2007, since I was then able to adjust for extra snacks or what might be called "no-nos" by some people.  I was also on the list for the insulin pump, but have so far continued with 6 or 7 injections a day and quite good control.

January 2007 was also significant for my family becuase my son was also diagnosed with Type 1 diabetes. In my mind this confirmed the change of heart which the professionals had over my diagnosis, and their later admisssion that I had probably been Type 1 all along.

Life is always interesting in our household with a teenaged diabetic as well as a "grumpy old man" also with diabetes, but on the whole we get on with life.

I have changed jobs twice since diagnosis and travelled both in Europe and to the US and have been able to show that life is what you make it with diabetes, even though at times it really stinks!

I would suggest that the families of those with diabetes deserve a great deal of encouragement and praise for their role in keeping them as healthy as possible, and am grateful for the help my wife and daughter give to us both.

Well maybe that is enough for my first post.   I would be interested to hear from other skinny type 1 diabetics who cannot put on weight however much they eat, so if any of you know any please put us in touch.

Until the next time.

Kids and diabetes (and their parents!)

by Richard Surridge

My biggest concern at the moment is not to do with myself, or even anyone in my family.  I'm worried about my class.

I'm a teacher of 10-11 year olds in East London.  Two of the kids in my class have Type 1 diabetes, one of them being diagnosed about a year ago.  These two worry me, but for completely different reasons.  Obviously, I can't write about them in too much detail, but I can give you an overall picture.

The lad is completely in denial, not testing, not talking about it, letting his mother do his injections.  He suddenly has flashes of taking it seriously, normally when I'm on his back, but this never lasts the week.

The girl is much happier with it, injects and measures at school, has snacks at the right time, all of that.  However, neither she nor her family have any apparent idea how to work the equipment or how to look after her things.  Her brother is also newly diagnosed, and they seem to end up sharing most of their equipment.  I know that this is going to affect her readings, but I can't get this through to them.  She has recently ended up back in hospital due to her incredibly high sugar.

I'm in contact with their nurse, and we've both spoken to their families, but there's a general feeling of not taking it seriously and no evidence of any change.  Maybe the problems aren't that different after all.

The main thing that I try to do is be completely open about my own condition and management with the whole class.  We always start the year with a "What to do if Mr Surridge collapses" talk.  This has helped, and the children can also understand what their classmates are going through, and they are happier to talk about it with their friends.  I'm also trying to monitor and give advice as much as I can.

However, this leaves me with the feeling that I'll have failed them if they aren't properly controlled by the time they leave me and go to secondary school.  I know this is an unreasonable pressure, but what else could I do?  Somebody has to look out for these kids.

Type 2 dilemmas - so what's safe to eat?

by Nicky Moxey

After about a month of testing after I ate, and still getting too-high post-meal readings on my trusty meter, I asked for a referral to a dietician. They have to know what they're doing, right? Well, not necessarily - at least, not what's right for you. The problem seems to be that every T2 diabetic seems to be an individual when it comes to food; you simply can't rely on a theory of healthy eating. I learnt a lot from the dietician - not least, the importance of reading labels - but I already knew enough to know that she and I had different ideas on a suitable diet when she handed round the cereal packets as good breakfast food. The next morning, I gave it a go; I ate the exact portion she recommended, of proper porridge oats cooked with water the way my Gran used to - what she said was the best possible breakfast for a diabetic. One-hour reading; 33. Oops; maybe not.

For the next few weeks, I tested like a loony - before every meal, and one and two hours after. I built up a database of foods that I could, and couldn't, eat. Carrots, yes; cooked or raw, any quantity. Tomatoes; cooked, fine - raw, treat with more caution. Parsnips, no way; don't touch them. Oats - nope; not at any time of the day. Bread; small quantities at supper, not earlier in the day, and not with any other kind of carb load. Time of day makes a huge difference to me; I can hardly tolerate any carbs at all at breakfast, but can cope with a LOT more as the day goes on.

So I went to the diabetic newsgroups with my shiny new database, and started to compare notes with the people there. To my complete amazement, just about every other person who'd done a similar exercise had come up with a different list! Some can eat oats. One friend of mine eats his breakfast museli as a bedtime snack, and has stew for breakfast. Most people seem to be able to eat parsnips, mutter...

The one constant seemed to be that breakfast is the most difficult meal. Fats generally slow down the height of a blood glucose rise, but may keep it higher longer. Fibre is generally a good thing - slowing down the rate that carbs are absorbed into the body - but can't be relied on always. Aha! This is beginning to sound like the Glycemic Index diet, I thought - until I tested some more. The GI, or better, the Glycemic Load - seems to be a reasonable guide; but there's still foods that in theory should be fine but spike me, and again there's a wide variation.

My bottom line is that I do not want to go outside normal blood glucose levels, ever - specifically, to go no higher than 7.8, I'll say why in another post. Going low is an obvious no-no, too. To stay within the 4-7.8 range at all times, I could either eat vanishingly small portions of stuff the dietician wanted me to eat - a portion of starch at every meal, sound familiar? - or replace them with foods that didn't spike me, but left me satisfied. One thing about testing a lot, is that I noticed that a lot of carbs would often drop my blood glucose too low, even if I didn't catch a spike, leaving me feeling like something the cat threw up. Nowadays, I generally have a LOT of veggies on my plate, some fats, and a moderate amount of protein - a combo that ticks all the boxes I've looked at for a healthy diet; and as an unexpected benefit, one that has completely reversed my neuropathy, and keeps the doctor and optician happy too.  Oh, and I've also lost, and maintained a loss of, 25Kg - without ever going hungry.

I expect that if you do the same approach, with the same aim of minimising blood glucose excursions, that you'll come up with a similar kind of diet - but the exact proportions of what turns out to be a no-spike diet for you may be very different from mine. Here's how I went about it - and if getting hold of test strips is a problem in your part of the postcode lottery, you could apply the principle one meal at a time, starting with breakfast: Newly Diagnosed advice from alt.support.diabetes newsgroup

Be well,

Nicky.

My name's Nicky and I'm a Type 2...

By Nicky Moxey

...Being diabetic became one of the defining ways I think about myself on 31st May 2004. I was 43, was (and am) happily married, with two kids. Holding down my full-time job was becoming more and more difficult, as I couldn't get through the day without a nap; sleep was becoming a preoccupation, as I had problems getting to sleep at bedtime, then woke a couple of times a night to go to the loo. Sometimes when I did wake, it was out of a bad dream, and the bedclothes would be soaked in sweat. It was hot, and I was very thirsty; I was going to the loo a LOT, but I thought nothing of it. I was a large lady - but we went on mountain walking holidays; and I could still buy clothes on the high street. Anyway, I'd recently lost a bit of weight, after struggling for ages on a low-fat diet. The breath smelling of pear drops rang vague alarm bells from 6th form chemistry days, but another symptom was loss of intellectual powers - I dropped a measured 50 IQ points - and worries never hung around long. Anyway, I was too tired...

Nowadays, that reads so classically of the diagnosis, of diabetes and hypothyroidism, that I wonder how I could possibly have been so blind. But all I knew of diabetes was that either kids or elderly people got it - and that wasn't me on either count. My doctors had been telling me for years that I was fine, too - and you have to trust your doctors, right? Actually, that was a pretty bad idea, in hindsight. The signs of diabetes went back to the borderline glucose tolerance test when I was 10; a low-carb diet (all the rage in the 70s) had sorted that out. The really big babies - 8lb 10oz then 10lb 3oz - and the 12+ fasting blood glucose reading during the last pregnancy that everyone ignored should have tipped someone off. My  Mum had been hypothyroid for a little while by then, on thyroxine pills, then pills for her angina. When she died, about 8 years before my diagnosis, my GP at the time tested my TSH. He said it was normal. Actually it wasn't (hindsight again...), but it wasn't much above normal; problem was, it kept on increasing steadily over the next 8 years, whilst I got more and more tired and stupid, and fatter and fatter.

So, by 31/5/2004, I was clinically obese (just), had had a minor heart attack a couple of years before following a car accident, and scored an A1c of 10.3%. Actually, I was lucky - no-one had tested my blood glucose for years. I was sitting in the surgery waiting to see the nurse about a recurring UTI (hindsight...). Her procedures said that she did a urine glucose dip; it couldn't go any blacker, so I got to see the doctor instead. 

He cheered me up no end. His advice was to take up squash (I had a BMI of 33, remember), and to lose weight - but on no account to go on an Atkins-type diet, or go on that desperately unreliable Internet for information. Oh, and by the way, I'd die at least 15 years earlier than otherwise, and I'd be on insulin in 3 years. Take these leaflets, and we'll see you again for the diabetes in 6 months. He was more proactive on the thyroid front; I was given a very low starting dose of thyroxine, and told to come back in 6 weeks for another blood test for that. So, I now had two chronic diseases - one of which the doctor had just told me would kill me early, and the other had contributed to my mother's early death. Great.

The next 6 weeks were a huge mental rollercoaster. Luckily, I'm a stubborn person, and decided that I was NOT going to quit on this, and leave my kids in the lurch. I read everything I could get my hands on; joined a bunch of newsgroups and diabetic chat rooms; and bought a meter and some strips.

And that is quite long enough for a first post - but as a teaser, my last A1c was 5.5%, my BMI is normal, and I have reversed the neuropathy that the doctor failed to spot. I'm controlling my diabetes with diet and exercise, having come off metformin after a few months, and apart from 100 micrograms of levothyroxine daily, am on no other medication. My gran lived to be 96, and my dad's heading the same way; I intend to follow them.