Better quality of life reported for young type one diabetics with lower HbA1c levels

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Better quality of life reported for young type one diabetics with lower HbA1c levels

Summarised from Independent Diabetes Trust Newsletter Sept 17

An international study of almost 6,000 young people showed that lower HbA1c levels were associated with a higher quality of life scores between the study age range of 8 to 25 years.
Those who reported the lowest quality of life scores were aged 19 to 25 and females had lower scores than the males across every age range.
The study showed that advanced ways to measure food intake, more frequent blood sugar testing, and taking exercise for 30 minutes a day, were all associated with higher satisfaction scores.
The researchers concluded that if young people have trouble controlling their diabetes, they should focus on the three factors that they can potentially control to make life easier.
Measure your food accurately
Test your blood sugar frequently
Exercise for at least 30 minutes a day

(Diabetes Care May 26 2017)

Jovina cooks: a magnificent Mexican feast

Planning a Mexican themed party is a great way to entertain. Much of the organization can be done in advance and guests can serve themselves. Offer options for toppings and sides that you think will appeal to your guests. If you know someone is vegetarian, then plan a vegetable filling along with fish and meat fillings. Don’t forget the margaritas and ice cream is great as a dessert for this type of meal.  You can provide tacos and tortillas for friends and family who are not low carbers. Plan on 2-3 tacos or tortillas per person. The beans are also a high carb item so eat sparingly or not at all if you are low carbing. As you can see there are some great options for you in this selection.
For the lime-cilantro sour cream sauce
1 cup sour cream
1/2 cup mayonnaise
1 scallion, minced
3 tablespoons minced fresh cilantro
Grated zest of 1 lime
1 tablespoon fresh lime juice

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For the Pico de Gallo
2 large plum tomatoes, chopped
1/4 cup chopped scallions
1 jalapeno, chopped
1 small clove garlic, grated
2 tablespoons fresh cilantro, chopped
1/2 teaspoon chopped fresh oregano
2 tablespoons freshly squeezed lime juice
Salt and pepper to taste
For the shrimp marinade
2 teaspoons ground Ancho chili powder
1/2 teaspoon ground cumin
3 cloves garlic, minced
1/2 teaspoon kosher salt
1/4 teaspoon freshly ground black pepper
2 tablespoons olive oil
1 pound large shrimp (about 24), shelled and deveined
For the swordfish marinade
1 teaspoon Ancho chili powder
1 teaspoon Chipotle chili powder
1/2 teaspoon dried oregano
1/2 teaspoon ground coriander
2 garlic cloves, minced
1 tablespoon olive oil
12 oz swordfish fillet
For the steak marinade
1 garlic clove, minced
1/4 teaspoon finely grated lime zest
1 tablespoon fresh lime juice
Kosher salt to taste
1 teaspoon smoked paprika
1 teaspoon ground cumin
1 teaspoons Chipotle chili powder
Two 12-ounce, 1-inch thick, boneless Ribeye or New York strip steaks
For the tacos (optional) 
12 6-inch corn tortillas or more depending on the number of guests

if not using tacos put these items out on the buffet table:
2 cups finely shredded green cabbage
Grated Cheddar cheese
4 limes, quartered
Directions
To make the lime-cilantro sour cream sauce:
Combine all the ingredients in a 2-cup serving bowl and whisk until smooth. Refrigerate, covered, up to 4 hours until ready to use.
To make the Pico de Gallo:
In a medium bowl, mix together tomatoes, scallions, jalapeno, garlic, cilantro, oregano and lime juice; season with salt and pepper. Let sit at room temperature, covered, until serving time.
To prepare the shrimp:
In a small bowl, combine the Ancho powder, cumin, garlic, salt and pepper and stir to mix. Add the oil and whisk until a loose paste is formed. Add the shrimp and mix well to cover the shrimp in the spices. Let marinate in the refrigerator for at least 30 minutes and up to 4 hours.
To prepare the swordfish:
In a small bowl, combine the chili powders, oregano, coriander and garlic. Stir in the oil to make a paste. Rub on all sides of the swordfish and set on a plate. Marinate in the refrigerator for at least 30 minutes.
To prepare the steak:
Combine all the ingredients for the steak rub in a small bowl and rub over the steaks. Place the steaks on a plate and refrigerate for at least 30 minutes.
To grill the shrimp, swordfish and steak:
Light a charcoal fire or preheat a gas grill on high. Oil the grill’s cooking surface. Let the coals burn down to a medium-hot fire or adjust the gas grill burners to medium.
Place the swordfish on a section of the grill and cook for about 10 minutes, turning the fish half way through the cooking time. Let rest on a plate.
Place the steaks on another section of the grill and cook for about 10 minutes, turning the steaks half way through the cooking time. Let rest on a plate.
Thread the shrimp on skewers. Grill over direct heat, turning once, until lightly charred and cooked through, about 4 minutes. Remove the shrimp from the skewers and transfer to a serving platter.
Cut the swordfish and steak into thin slices. Transfer to the serving platter with the shrimp.
Divide the tortillas into 2 stacks and wrap each in aluminum foil. Place on the grill until heated through, about 5 minutes.
To assemble the tacos:
In each tortilla place 3 grilled shrimp or swordfish slices or steak slices, a tablespoon of the sour cream sauce, a tablespoon of the Pico de Gallo and some of the cabbage and cheese. Squeeze a wedge of lime over the filling and fold the tortilla.
Guacamole Salad
Ingredients
1/2 pint grape tomatoes, quartered
Salt and pepper
4 scallions, sliced thin
1 small garlic clove, minced
½ tablespoon grated lime zest
2 tablespoons fresh lime juice
2 tablespoons olive oil
2 jalapeno chilies, seeded and finely minced
1 ripe avocados, pitted, skinned, and cut into 1/2-inch pieces
2 tablespoons finely chopped fresh cilantro
Lettuce leaves
Directions
Mix together the tomatoes and 1/4 teaspoon salt in medium bowl. Transfer to paper towel-lined baking sheet and let drain 15 minutes.
Combine the scallions, garlic, lime zest, lime juice, 1/4 teaspoon salt, and 1/4 teaspoon pepper in large bowl. Let sit 5 minutes, then slowly whisk in oil.
Add the jalapeno chilies, avocados, cilantro and drained tomatoes to the bowl with the dressing and toss to combine. Season with salt and pepper. Serve in lettuce cups.

Beans On The Side (optional as also high in carbs)
The beans taste better if made the day before serving.
Ingredients
To cook the beans:
1 ½ cups orca beans (white and black colorings), washed
1 onion, quartered
3 cloves garlic
1 teaspoon kosher salt
1/4 cup chopped cilantro
To finish the bean dish:
½ cup finely diced onion
½ cup finely diced celery
½ cup finely diced red bell pepper
1 garlic clove, minced
1 tablespoon olive oil
½ teaspoon chili powder
Directions
Place the beans in a medium-sized saucepan and cover with cold water by two inches high. Cover and soak overnight.
The next day, add the onion, garlic and salt to the soaking liquid and bring to a boil. Lower the heat to a simmer and cook for about 1 ½ hours until tender.
Chill the beans overnight in the refrigerator in their cooking liquid.
The next day, drain the beans. Stir in the cilantro and set aside.
Heat the oil in a large skillet. Add the onion, celery, bell pepper, garlic and chili powder. Saute until tender, about 10 minutes. Add the beans and heat. Serve as a side dish.

 

Virtual reality has changed my attitude to computer games

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I was never into computer games. My sons certainly are and since X box first made an appearance they have drove numerous vehicles, shot armies of opponents, and have died a thousand times.
This year, Steven brought his new super powerful computer, the headset and hand controls to match, back home for ten days over the winter holidays so that the rest of us could marvel at the worlds you can explore from your living room or bedroom.
I am now hooked.
Although I am as clumsy as a two year old with the hand controls there are plenty of games where you can get involved without needing to use your hands much. So far I’ve been on roller coasters, flown various aircraft around futuristic towns badly, and entered Mexican fiestas. I’ve been killed a great many times over the last week but have also dished it out. When it comes to dexterity and the ability to figure out what button or fingers I should be pressing I’m even less good. I’ve broken nearly all my toys, set fire to my office, and fallen off a few mountains. I now understand why two year olds should never handle small animals no matter how well intentioned they may be. I’m a two year old again.
I can see why kids don’t come out their bedrooms for days now.
As if this wasn’t enough to blow my mind, Steven gave me an Amazon Echo dot for Christmas. Surprisingly it was easy to programme since we have home wi fi set up already. Very soon we were asking Alexa all sorts of questions. She comes in handy for playing music, telling stories, telling you the news and weather and setting timers and alarms. This backfired a bit. I had told Alexa to get me up at 8am. I was already up getting my breakfast by this time. She woke up my husband on the dot, but for some reason he couldn’t remember her name to get her to shut up! He had to open his tablet and find the amazon site to get her name. Of course, he could have come down stairs and asked me….same issue as the directions!
So how will this help the people with diabetes who read our posts? A little bit perhaps. There are apps that can tell you the nutrient content of various foods including the carb count per 100g. There are some exercise apps. There are meditation and relaxation apps. Have you found out any apps for Alexa that you have found helpful?

 

Hilda’s fit to serve: Lemon curd cheesecake

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Hilda has done it again! She can produce a low carb version of nearly anything. You can also used the lemon curd as the filling in a low carb sponge cake or put different fruity toppings on the cheesecake. The cheesecake itself is not a baked one. 

Low Carb Coconut Crust

1 ½ cups of sugar-free coconut flakes
¼ of almond flour or 2 tablespoons of coconut flour for nut free version
½ cup of melted butter
Low Carb Lemon Curd Filling
½ cup unsalted butter
¾ cup of sugar substitute I used Swerve
¾ cup of lemon juice about 3 large lemons
7 egg yolks
1 tablespoons of lemon zest
¼ tsp of sea salt
Low Carb Cheesecake Filling
1 package of cream cheese
½ cup sugar substitute
½ cup sour cream
1 teaspoon of unflavored gelatin I used Great Lakes unflavored gelatin
3 tablespoon of cold water
Low Carb Lemon Curd Instructions
1. Melt the butter in a small saucepan on low heat.
2. Once the better is melted, remove the saucepan from heat and whisk in the sugar-substitute, lemon juice and lemon zest. Keep mixing until well combined.
3. Return the saucepan to stove and whisk in the eggs yolk one at and cook on low heat until the curd starts to thicken.
4. Remove the lemon curd off the stove and strain into a small bowl.
5. Allow to cool at room temperature and then store in the refrigerator and chill for 30 minutes to an hour.
6. Spread the low carb lemon curd evenly to the coconut crust.
7. Pour the sour-cream topping to the pie and allow to set for at least 30 minutes before slicing and enjoying.
Low Carb Coconut Crust Instructions
1. Combine all the ingredients until well mixed. Press the coconut mixture into a 9-inch pie crust pan.
2. Bake at 350 degrees for 20 minutes.
3. Once the pie crust is cooked and while it is still warm, press the crust with the back of a metal spoon. I find that pressing the crust soon after it’s been cooked allows for a crispier crust.
Low Carb Cheesecake Filling
1. Mix the gelatin with the cold water and set aside.
2. Combine the cream cheese, sour cream, and sugar substitute.
3. Fold in the prepared gelatin into the cheesecake batter.
Pie Assembly Instructions
1. Once the pie crust is fully cooked and cooled add cheesecake filling.
2. Next spread the lemon curd topping to the cheesecake.
3. Allow for pie to fully set in the refrigerator for at least 30 minutes before consuming.
4. Store pie in the refrigerator.

Hilda’s fit to serve: Berry Pie

Still looking for a low-carb dessert for your Christmas? Try this one…

Low Carb Nut-Free Crust
Ingredients
1 cup (2 sticks of butter melted and cooled)
4 large eggs
½ teaspoon sea salt
1 ½ cups coconut flour
¼ baking powder
1 tablespoon of water
Crust Instructions
1. Mix all the ingredients of the low carb crust just until dough forms.
2. Divide dough in half to make the top and bottom of the pie crust.
3. Roll out with between two sheets of parchment paper. Set aside.
4. Transfer one crust into a 9-inch pie pan. Being careful to smooth out any cracks.
5. Once you add the filling to the pie and the top crust.
Filling Ingredients
1 ½ cups of berries (I used mulberries)
2 tablespoons of sugar substitute (I used Swerve)
1 8 ounce package of room temperature neufchâtel cream cheese or regular cream cheese

Many people miss such items as apple pie after going low carb. Hilda shows you here what she does with the mulberries from her mum’s tree in the garden.  In Scotland you can use brambles in the autumn that you can pick for nothing. Now you know the secret of the pie crust you can experiment. I wouldn’t use mincemeat as in our Christmas pies though as that is too sugary for a low carb diet. 

brambles

 

 

 

 

 

 

 

 

 

Pie Instructions
Pre-heat oven to 350
1. Place half the rolled low carb dough into a 9-inch pie pan.
2. Spread the cream cheese to the bottom of the crust.
3. Add the berries that have been mixed with the 2 tablespoons of sugar substitute over the cream cheese layer.
4. Top the pie with the other half of the rolled-out dough. Make sure to add vents to the top of the crust.
5. Bake for 25 minutes until the topping is lightly brown.
6. Allow to cool before slicing.
7. Store in the refrigerator.

 

BMJ: Regular, physical exercise is the miracle cure to ageing

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Adapted from Scarlett McNally’s article in the BMJ 21 Oct 17

The NHS and social care are inextricably intertwined. The rising number of older people is frequently blamed. The rising social care costs in this age group can be modified however. NICE in 2015 said, “disability, dementia and frailty can be prevented or delayed”.
The need for relatives or paid carers arises when someone can no longer perform the activities of daily living such as washing, dressing and feeding themselves. For some people the ability to get to the toilet in time is the critical thing between having carers come to their own home twice a day and being admitted to a full time care facility.
The cost of care rises five times for those admitted to residential facilities. An average residential placement costs £32,600 a year and may be needed for months, years or decades.
A cultural change is needed so that people of all ages aspire to physical fitness as a way of maintaining independence into old age. There just doesn’t seem to be the local or national infrastructure to support this however.
Ageing is a normal, if unwelcome, biological process that leads to a decline in vision, hearing, skin elasticity, immune function and resilience, which is the ability to bounce back.
The decline in fitness with age starts around the age of 30 and accelerates after the age of 45. Things move downhill even faster if someone has a sedentary job that involves car driving and computer work. Diabetes, dementia, heart disease and some cancers become more common.
Some may think that fitness in old age is down to genes and luck but social strata differences exist with good nutrition and exercise as major factors in enhancing health and fitness into old age.
Apart from getting older, environment and lifestyle affect disease onset. At the age of 40, some forty percent of people have at least one long term condition and the rate goes up by ten percent each decade. As environmental and behavioural factors stack up over time, more people develop an increasing number of diagnoses. Yet, small habits such as cycling to work, can mitigate the effects of a sedentary job.
As time goes on, a person’s independence can be compromised by well -meaning carers and relatives doing more for their charges rather than letting them do things for themselves.
Genetics are thought to play only 20% of the part in the development of modern diseases. Lack of fitness has more of a part to play than disease and multiple morbidity.
Pain can lead people to limit their activity because they think it could make their illness worse, but strength, stamina, suppleness and balance training are usually needed more rather than less as you get older and accumulate illnesses.
These factors improve cognitive ability in midlife through to a person’s 80s. They can reduce the onset of dementia. Increasing independence results.
The Academy of Medical Royal Colleges go as far as describing exercise as “the miracle cure”. Improving the time to stand from sitting down, walking, and resistance training exercise all produce a dose response effect with the most frail benefitting the most. Any exercise or activity such as gardening that gets you slightly breathless and is done in ten minute bursts or longer counts as the 150 minutes minimum as recommended in the UK.
Stopping smoking and limiting alcohol are also worthwhile interventions. Gyms, walking groups, gardening, cooking clubs and volunteering have all been shown to improve the health and well- being of people of all ages with long term conditions.
When people are admitted to hospital they often experience a rapid decline in function. Patients are not allowed to move about or go to the toilet themselves in case they fall. The numbers of these are considered adverse incidents and are strongly discouraged. Thus the ambulant end up chair or bedbound. Most inpatients spend 80% of the time in bed and more than 60% come out with reduced mobility.
All patients should be encouraged to start an activity programme and gradually increase the frequency, intensity, and time that they do it.
The outdoor environment can be improved by even pavements, open spaces, tables and seating in public areas, safe cycle lanes and restriction in car use.
Money may need to be shifted from passive care and polypharmacy to activity and rehabilitation services.
People need to concentrate on being active every day. A quarter of women and a fifth of men do no activity whatsoever in a week never mind the minimum recommended 150 minutes a week.
In the UK the total social care bill is over £ 100 billion which is virtually the same as spent in the NHS.
The cost of care doubles between the ages of 65 and 75 and triples between 65 and 85. If everyone was just a bit fitter, the savings would add up.
Individuals need to see it as their responsibility to stay fit or improve their fitness. There needs to be more national coordination regarding the environment, transport and our working schedules so that we can all stay that bit functionally younger into old age. We could be making the difference between staying at home or depending on social and residential care.

BMJ: Diabetic ketoacidosis is the biggest threat to type ones

 

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Adapted from BMJ Minerva 23 Sept 17 and BMJ Learning Module Clinical Pointers in Diabetic Emergencies Oct 17

Type ones under the age of 30 have a mortality rate three times that of their non- diabetic friends.
This rather shocking statistic was discovered by Welsh paediatricians who have been tracking their children with diabetes since 1995. Furthermore the death rate has not gone down over all this time despite improvements in monitoring and therapy. Ketoacidosis is the leading cause of death. Although microvascular and to a lesser extent macrovascular complications can occur, they do not affect mortality rates in this age group.
Out of a hundred or so type one adult diabetics approximately 3 or 4 will develop diabetic ketoacidosis each year. Currently 3-5% will die. Not all deaths will occur in hospital because not everyone is identified as having ketoacidosis prior to death. Recognition by relatives, friends, police and medical professionals would be an important factor to improve transfer to hospital.
Ketoacidosis is also be the presenting sign of diabetes in 6% of the total number of ketoacidosis patients. It may have been precipitated by a viral infection and can be confused by a variety of illnesses such as gastroenteritis, flu and alcohol intoxication and withdrawal.
Assuming a person can be recognised as ill and needing hospital assessment, recognition of DKA is improved by always checking a blood glucose in an acutely ill person in the A and E department.
If levels of glucose are high, and the characteristic symptoms are present eg dehydrated looking, tired, nausea, vomiting, abdominal discomfort and breathing rapidly, then the diagnosis can be further explored by checking the blood electrolytes.
The immediate treatment is re-hydration with a litre of normal saline and the administration of intravenous or subcutaneous insulin usually 0.1 u of insulin per kilogram body weight. As the potassium level can be affected, particularly a tendency to go too low after treatment has started to work, this needs monitored every hour or two. The problem is that irregularities of the heart beat can occur if the potassium level is not adjusted correctly.
It can be seen that management of DKA in the established case is tricky and time consuming. Therefore it is wise to seek medical advice while you or the one you are concerned about, is still relatively well and can for instance still tolerate oral fluids and give a coherent history.
Early recognition and treatment is the key to a good outcome in DKA.