Diabetes and the ol’ green monster

Me this week. Not attractive, I know

Ah, the green monster… It surfaced this week, startling me with its intensity. I’m talking about jealousy and the mean feelings I experience occasionally in relation to diabetes.

Every week, the mighty search engine that is Google picks out the week’s diabetes news for me. Most of the time, it includes new research, a dose of doom and gloom where scientists and doctors reinforce the lower life expectancy/increased likelihood of contracting a nasty side effect (Gee, thanks folks) and a Daily Express article telling you to eat this food to avoid diabetes*.

This week’s offerings included a video on the BBC where a teenage type 1 spoke about the pump she wears which uses artificial intelligence to monitor her blood sugars and keep them within normal range, and how it will allow her to soar through life. She’s one of the first type 1s to get this pump on the NHS.

Believe me, I know a one minute 55 second film clip tells nothing like the full story. I don’t know the extent of the teenager’s medical background. Her mother, the video showed, found it hard to sleep at nights because she was so worried about her daughter’s overnight hypos. I get it, I get it, I get it…

No awards for long service

But the horrible green monster reared up anyway. “It’s always the young ones,” I muttered, bad-temperedly. There might even have been a self-pitying tear or two. “What about me—don’t I get an award for long service? Thirty seven years with this ruddy condition! There are empty jelly baby packets in landfill sites all over Scotland to prove it**. I wouldn’t mind soaring myself.”

The nasty bout of whingeing was in part triggered by a letter I received this week relating to my progress on the flash glucose monitoring (FGM) waiting list. At my appointment at the diabetic clinic in September last year, the doctor put me on that oh so elusive list. The waiting list was only the start. After that, a mandatory half-day educational course takes place and then a letter wings its way to your GP requesting they prescribe FGM. Still there I was. ON THE LIST!!!

“Happy days, Emma!” I said to myself as I skipped out of the clinic, phoning my mum and then husband to share the good news. They whoop-whooped too.

Patience, not one of my virtues

I waited. And waited. Well, I suppose those half-day courses are over-subscribed,” I said to myself. Friends, patience isn’t among my virtues but I held off writing to the good doctor to request a situation update until the beginning of March. The letter I got in return said there is a cap on funding and until that increases, I’m on a static waiting list.

Again, I get it. Times are tight, but every other type 1 I know sports one of those FGM thingies on their arm, included blasted Theresa May. (Admittedly, I don’t know that many type 1s.)

Here’s the thing—I never envy other people their non-diabetes status. A long time ago, my brain must have told my heart jealousy over the impossibility/unlikeliness of a cure in my lifetime was too much of a wasted effort. But when I read of other diabetics and their access to the latest tools and tech, I glow so green I’m practically radioactive.

The blessings of perspective

Fortunately, perspective kicked in after twenty minutes or so of mumping and moaning to myself. In the US, two senators have launched an investigation into rising insulin prices (585 percent from 2001 to 2015 for Eli Lilly’s Humalog, for instance), and this in the world’s wealthiest country. Many people have tried swapping insulin types and brands, changing to something that might not work as well for them or worse, stopping it or rationing it.

In addition, part of my work at the moment involves communications for a health-based project in two African countries where access to any diabetic medication is seriously limited, and knowledge of how to treat the condition not as wide-spread as it is in the developed world.

I don’t have the latest up to date equipment, but I do have insulin (Brexit fears aside), plenty of test strips and all the other bits and pieces I need. The green monster surfaces from time to time, as I’m sure it does with you. Let it do its whinge-y bit and then remind Madam Monster we do live in the best of times for people with diabetes (country dependent of course). If I’d been born 100 years earlier, I wouldn’t have made my 11th birthday. So, Emma 1, Jealousy 0.5.

*Yet to click on that one as I assume it’s click bait.

**They will outlive me.

Imagine NOT having diabetes…

a picture of a blood testing machine on The Diabetes Diet
This will be my blood sugar levels from now on. All the time. Yes sirree.

When you’ve lived with diabetes as long as I have, it’s almost impossible to imagine what life is like without that constant round of tests, injections and mild anxiety around food as you eat something and hope it doesn’t result in postprandial blood sugar levels that are too high or too low.

Today, I read about people’s experiences of research or new procedures they’d taken part in. One woman wore the artificial pancreas when she was pregnant. Giving it back afterwards was, she said, “like losing a limb”. Another person received islet stem cells transplant because he couldn’t recognise hypo symptoms and was able to come off insulin altogether, although he did have to go back on small amounts four months later.

So, Emma B, I said to myself, say you woke up tomorrow without type 1 diabetes what would be the best thing about it. And is there anything you would miss?

Energy

The main point that would strike me would be the energy. Imagine living with levels of energy that remain more or less constant. To the non-diabetics out there, please make the most of it this on my behalf. You have no idea how brilliant it is. I get days here and there when the energy is constant, and blimey you could put me in charge of Brexit and I’d sort it out… But some of those other days are tedious. Tiredness makes you grumpy and makes every task far more difficult, meaning you have to invest in willpower (a finite thing) for trivial rubbish.

It’s hard to over-estimate the impact that one single thing would make. Perhaps I’d turn into an extrovert. Tiredness often makes conversation an effort. Or I’d enter a full marathon instead of a half. My freelance copywriting business might take off because I’d be able to do far more work every day AND I’d be an excellent net-worker and pitcher, thanks to the whirling fizz running through my veins.

Injection-free meals

I’d also relish sitting down to meals without having to do blood tests and injections first. Oh the bliss of pulling up a plate without eyeballing its contents and doing all the calculations in your head—right, so that’s about 15g of carbs (I think), my blood sugar is a little raised so I need to factor that in, but I’m going for a walk afterwards so include 30 minutes of exercise, maybe allow for an hour because I’m going up that big hill… etc., etc.

I might never go near a doctor’s surgery again. A silly thing, I know, but we sugar shunners spend a lot of time in hospital waiting rooms, often wondering why the magazine collection is so rubbish and why all the posters on the wall are so out of date. There’s the clinics, the retinal screening and all the other appointments associated with diabetes. Not going along to any of them ever again would be a joy.

My abdomen would say an almighty big ‘thank-you’ for not getting stabbed seven or eight times a day. Granted, the needles we have these days are tiny (I use a 4mm version), but occasionally I hit a nerve and it HURTS. Ditto my fingers. As one of our regular readers said, doctors can always tell the folks who are conscientious about blood tests as they were the ones with tiny black marks all over their finger tips.

Pizza and chips anyone?

Would I dive into plates of chips, 15-inch pizzas and cakes and sweets? Probably not. I’m used to eating in a certain way, and I believe it’s healthy for most people, not just those with diabetes. I do eat chocolate and pizza from time to time because life’s too short to eat low-carb all the time.

And now for the things I would miss… wait for it…

Nothing? Diabetes doesn’t need to be dreadful. A sensible low-carb eating plan and a bit of exercise can work wonders. And it’s not the worst chronic health condition you can have, but honestly, truly and seriously I do not think there are any type 1s out there who wouldn’t say “goodbye” to diabetes without a backward glance.

 

PS – Do you remember my post about stockpiling insulin in case of a no-deal Brexit? There’s a post on Diabetes UK with the latest information here.

High dose Vitamin D improves cardiovascular health markers

Adapted from UK Medical News 17 July 2018

Several different health measures, all which improve your cardiovascular outcomes, have been found to result from high dose vitamin D supplementation. You are likely to need to take at least 4,000 iu a day though, depending on how much extra sunshine you are exposed to regularly.

A meta-analysis of 81 randomised controlled trials looked at almost one thousand patients randomised to taking supplements or to a control group who did not. The active and control groups were both roughly 5,000 each.  The durations of the trials varied but averaged out at ten months. The doses ranged from 400 iu a day to 12,000 iu a day. The average taken was 3,000 iu a day.

The outcomes were related to the blood level of vitamin D achieved. Levels had to be over 86 nmol/L to get benefits. You need to take over 4,000 iu a day to get vitamin D concentrations of 100 nmol/L or more.  My comment:This does mean that the minimum levels advised by the Scottish Chief Medical Officer last year are way too low to see the benefits discussed here.

So what extra benefits do you see?

lower systolic and diastolic blood pressure.

lower high sensitivity C reactive protein.

lower serum parathyroid hormone.

lower triglycerides.

lower total cholesterol.

lower low density lipoprotein.

high density lipoprotein increased.

All benefits were numerically small but did reach statistical significance. Cardiovascular outcomes were not measured directly, only blood markers and blood pressure.

Mirhosseini N et al. Vitamin D Supplementation. Serum 25(OH)D Concentrations and cardiovascular disease risk factors: A systematic review and meta-analysis. Front Cardiovasc Med. 2018 July 12.

 

 

 

 

The Five Best Low-Carb Hacks

Here at the Diabetes Diet, we’re fully on board with the making life easier message. Living with diabetes is like supporting a part-time job on top of everything else in your life.

And boy, if we were unionised, we’d revolt against the lack of time off and sick pay (ha!), and work conditions that are an uphill struggle all the time… One of the reasons low-carb diets make life easier for the sugar-challenged is that we don’t have to spend ages figuring out how many carbs are in particular dishes and how much insulin we need to cover them. Meat, sauce and salad is a lot easier to work out than meat, veg, roast potatoes and a Yorkshire pudding.

So, with that in mind, here are our favourite hacks:

Make your home carb-proof

bar of chocolate on the diabetes diet
Get thee behind me, Satan…

If it’s not there, you won’t miss it. Temptation comes in many forms, but it’s much easier to ignore the siren call of crisps or chocolate if you don’t keep them in the house*.

Have easy meals

If you can master the omelette, fried fish, steaks, burgers or open a tin of tuna, mix it with mayonnaise and tip it on a bed of crispy salad, you’re laughing. Diabetes makes you tired. Have some go-to super-fast meals you can make quicker in the time it takes to order and wait for a take-away.

Eat two starters when out

Starters tend to be lower in carbs than main courses, so go for two of them. Three, if you are very hungry.

Stock up on low-carb snacks

Cheese, olives, unsalted nuts, hard-boiled eggs… all help satisfy cravings and have plenty of protein for satiety.

Try some of the substitutes

To be honest, I’ve yet to meet the low-carb bread recipe that convinces me, but some of the baking ideas might work for you. Bread, cakes, biscuits and even fudge are out there so why not give some of them a try?

*Reader, all too often I slip on this one. Or do that thing where I buy crisps or chocolate for my other half, kidding myself that they are for him. No, no, not me oh luscious purple-foil wrapped packet…

Should I stockpile insulin ahead of Brexit?

insuline supplies on the Diabetes Diet website

I picked up my repeat prescription this week, and asked the all-important question. By the time I’m ready for the next one, Brexit is supposed to have taken place*. Will the UK’s insulin supplies run out?

As one of life’s optimists, I tend to ignore worst-case scenario planners, which makes me either naive, stupid or just someone who prefers to live in the now, as worrying about the future and events I have little control over seems pointless. It’s likely I’m all three.

Anyway, at the pharmacy I asked the chemist if I should stockpile insulin, seeing as very little of it is manufactured in the UK and insulin seems to get mentioned in the same sentence as food whenever people talk about stockpiling. As it happens, I have lots of one particular insulin, the rapid acting stuff, while my supplies of the long-acting stuff needs regular replacing. If the worst comes to the worst, I can beg an insulin pump from someone and use that…

No-one’s talking about it…

“If they are stock-piling, no-one’s talking about it,” the chemist told me, “And we’ve heard nothing officially.”

She didn’t then add, “If I were you, though, I’d make sure you’ve got four months’ supply at least and contemplate taking your diet as low-carb as possible so you don’t need as much.” I’ve made that advice up, obviously, but she didn’t add any caveats so either someone higher up in the medical supplies chain has decided on a policy of silence or the fears aren’t justified.

Ms Stupid/Naive/Live in the Moment has decided to leave worrying about her insulin supplies for now. There are many other factors which could affect insulin supplies in the future too—climate change, fuel shortages, war or the Zombie apocalypse, coming to a town near you all too soon.

And of course, the biggest factor is the soaring rates of type 2 diabetes. According to a recent report, about 33 million people who need insulin currently do not have access to the drug. That figure is expected to rise to 41 million by 2030. A lot of these shortages apply to people in Africa and Asia where increasing urbanisation, more sedentary lifestyles and changes to diet have led to soaring numbers of type 2 diabetics. In the States, however, insulin shortages also affect the population as prices have risen sharply over the last few years. Three companies dominate the market, and proof once again that free market systems seldom contribute to the greater good.

*And goodness knows what will happen on the 29th.

Making Sundays Special

roast pork on the Diabetes Diet
Roast pork – eat this to make your Sunday special… (recipe Ministry of Food, Jamie Oliver).

New Year’s resolutions? Pah! One, you can makes changes any time you want, and two, most of us see them as miserable—the lose weight, take up punitive exercise regimes kind. In this part of the world, January is a challenging month. The weather’s dreich, the nights are long and the pennies few and far between. Who wants to add starvation and exhaustion to the mix?

One resolution I do intend to stick to is my campaign to Make Sundays Special again. Years ago, my husband and I used to make a point of doing something on Sundays. He works most Saturdays, so the Sundays were the one day a week we could visit castles, go to Edinburgh, take the motorbike out for a spin, bike to Balloch, drink too much and cycle back via the main road while piddled*. Last year, we fell into the habit of doing nothing. He’d be downstairs catching up on Colombo (why, why, why?), and I’d hide away upstairs working or writing. We added doing the supermarket shopping to a Sunday. As I love food, I don’t mind the supermarket shop but does it belong on a precious day off? I think not.

Cut the screen time

In 2019, I’ve vowed to spend less time in front of a screen. I’m there for work and as a hobby, and I dread to think how many hours I spend hunched over my laptop. On the plus side, I use a standing desk so it’s not as sedentary as it could be. On the other hand, it’s still not healthy. Time to reinstate the Sunday activities, such as:

Ben Lomond

I have Ben Lomond in my sights. Hill climbing is one of the best activities you can do in Scotland. The Munro is right on my doorstep, and the shame is I’ve yet to climb it.

Three Lochs Walk

I’d also like to walk from Balloch to Helensburgh with Sandy. I’ve done it a couple of times with my friends, and it’s a fabulous walk because of the views you get of Loch Lomond.

Linlithgow Palace

We’re members of Historic Scotland and we’ve yet to visit Linlithgow Palace so a train trip there and a pub lunch is in order.

Uni tour

The University of Glasgow offers walking tours. As I work there, it will be fascinating to find out more about this iconic Glasgow building. Another tour that has always piqued my interest is the one you can do of Glasgow Central station. If I book now, we might get there in the summer. (It’s terrifically popular.)

Sunday roast

Roast pork, the before version.

Finally, it’s nice to include special meals in your Sunday plans. As a child, I didn’t like the Sunday roast—probably because it meant sitting at the table waiting for adults to finish so we children could be excused, and I have memories of thick slabs of meat and nasty bits of under-cooked fat. These days, I’m a fully paid up member of the Sunday roast forever club. While the meat is nice, the best bits are the accompaniments – home-made gravy with a decent amount of wine thrown in, roasted parsnips and carrots, crackling if you’re making pork (or just make it as a side dish anyway) and one roast potato as a treat.

Bring on the special Sundays!

What’s your idea of a treat on a Sunday? Is cutting back your time online part of your plans for 2019, and if so what do you intend to do instead?

*Don’t do this at home, folks!

BMJ: How to get a better sleep if you work night shifts

From Optimising sleep for night shifts by Helen McKenna and Matt Wilkes 3rd March 2018

Night shift work happens when your body would rather be asleep. Alertness, cognitive function, psychomotor co-ordination and mood all reach their lowest point between 3am and 5am.

After a night shift is over, the worker has to try to sleep when the body would prefer to be awake. This shift away from the circadian phase compounds the fatigue and can lead to chronic  sleep disturbance. There is  more likelihood of occupational accidents, obesity, type 2 diabetes, heart disease and breast, prostate and colorectal cancers. Psychological and physical well being is affected and accidents or near misses when travelling home are much more likely to occur.

Performance on the night shift gets worse as people get older and it takes longer to recover from a night on.

On average most people sleep about 8 hours a night.  Some people cope with sleep deprivation better than others. Performance will be impaired after two hours of sleep deprivation and gets worse as sleep debt accumulates. Therefore before starting a set of night shifts it is wise to sleep in the morning before, avoid caffeine that day,  and if you can take a nap in the afternoon between 2pm and 6pm.  For a nap to be most effective you need 60-90 minutes asleep.

When you start the shift, try to fit in a nap of about 30 minutes if this is the sort of job that allows this, but have a coffee immediately before the nap, and don’t have any more caffeine after the nap.  Sleeping longer than 30 minutes can make you feel groggy as you move into deep sleep and are the roused from it. Caffeine can help performance but you also want to try to sleep the next morning. Avoid it for the 3-6 hours before you plan to go to sleep in the morning. If you are doing critical tasks especially between 3-5am it is wise to build in more checks to your work.

Working in bright light can perk you up on the night shift.

When it comes to eating you are probably best to eat your main meal immediately before the night shift then eat just enough to feel comfortable as the shift goes on.

Jet lag improves at the rate of one day for every hour you are out of phase.  Circadian adaptation is therefore impossible during short term rotating shift work. Therefore you have to do your best to optimise your sleep between the shifts so as to keep the sleep debt minimal.

If you can possibly arrange lifts home or travelling home on public transport after a night shift, do so.

You can try to improve the situation by wearing sunglasses in daylight on the way home, avoiding electronic device screens, using blackout blinds, ear plugs and eye masks or even white noise generators.  A warm bath and then sleeping in a not cold but cool room and wearing woollen nightwear may help. Melatonin taken in the morning after a night shift has been shown to improve sleep duration by up to 24 minutes. Avoid alcohol and caffeine as these won’t help. Drugs such as Zopiclone can improve sleep if taken during the day but it can be addictive and needs a prescription.

After a run of night shift work you may get into the swing of your regular routine by having a 90 or 180 minute sleep, as this is one or two sleep cycles,  or sleeping in to noon and then getting up and getting outside for some exercise in bright light. Do your best to include meals at the usual times and socialise a little.  You will also need to pay attention to paying back your sleep debt by going to bed earlier than usual and sleeping in later than usual for a few days. It is best to avoid day time naps during the recovery from shift phase.

The path to sleep optimisation is an individual thing. Feel free to experiment.