Before you fly print out your Medical Devices awareness card

The Civil Aviation Authority are asking that all passengers who have medical devices such as Insulin Pumps and Continuous Glucose Monitoring  systems carry a card to remind themselves and the security officer about what precautions both sides must take to travel safely and securely.

For passengers the card can be printed by clicking on the link below or simply googling Medical Devices awareness card.

You should also have a letter from your GP or hospital doctor saying that you are wearing the device.

These devices should not be put through  X ray scanners whether on your body or not. You shouldn’t be required to remove them from your body either.  You may need to check what security alternatives exist in foreign airports but the UK has other ways of determining your safety to fly.

https://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Chttps://www.caa.co.uk/uploadedFiles/CAA/Content/Standard_Content/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdfontent/Passengers/Before_you_fly/Health/CAA_AOA_MedicalDeviceAwarenessCard.pdf

Diabetic complications that affect your tendons and skin

BMJ 1 Dec 18 Diabetic Dermopathy

Shin spots occur in 17-40% of people with type one and two diabetes. The spots can also be seen in the forearms. They tend to be irregularly shaped, brown and they don’t itch or bleed.

The older you are and the longer you have had diabetes, the more you are likely to have. They are thought to be due to small blood vessel changes similar to the kind that cause other complications like retinopathy and neuropathy.

Comment: Do any of you have them? I haven’t even noticed them before but I will keep an eye out for them now.

British Journal of General Practice December 18

Adapted from Tendinopathy in type 2 diabetes by Richard Baskerville et al

People with diabetes have three times the risk of all musculoskeletal conditions and particularly tendon problems. Tendon problems are also more resistant to treatment in diabetics.

Half of people with type two diabetes who are given exercise programmes for a variety of health conditions drop out due to musculoskeletal symptoms. Tendon problems can be for example, Achilles tendinopathy, rotator cuff problems in the shoulder, tennis elbow and trigger finger.

In a typical GP practice 18% of diabetic patients will be affected for around three months for each episode over a five year period.

Tendonitis means that the person has an acute condition with inflammation of the tendon. Tendinopathy is a degenerative process that lasts weeks or months.

Tendinopathy is due to too much wear and not enough repair of the tendons. Diabetics also have the added problem of sugar molecules binding onto collagen. Instead of the collagen fibres running over each other like silk sheets, they get stuck together like Velcro. Blood supply, collagen production and healing are impaired. Obesity, high blood pressure, ageing, alcohol and smoking are all independent factors that worsen tendon healing.

Tendinopathy is more likely in people who are on insulin or who have had the condition more than five years. Other conditions which are related such as bursitis, carpal tunnel syndrome, Dupuytren’s contracture, frozen shoulder and plantar fasciitis are also more common in diabetes.

The onset of tendinopathy tends to be gradual but a trivial event can bring it to light. The symptoms are of unusual pain and stiffness on certain activities. If the condition is not better by two months it is usually due to a tendinopathy.

The tendon is painful when pressed or moved. The area does not have increased warmth. There is often reduced muscle strength. Tendonitis on the other hand is usually an acute condition with redness, warmth and a crackling feeling under the examining finger.

Early physiotherapy is the mainstay of treatment. The aim is to improve general fitness, stretch the muscles and load the muscles in a controlled way. Recovery is often painful and slow.

Acute tendonitis can be managed with non steroidal anti inflammatory drugs and gels. Renal, gut, cardiac disease and hypertension can limit treatment. Steroid injections can help in the short term.

Tendinopathy is often recurrent. It is best to keep HbA1c and blood glucose variability low. If an episode has not settled  in six weeks physio is recommended.

 

 

 

Inventor awarded £2m for diabetes invention

This week’s diabetes-related news includes a story about an inventor finally awarded the compensation he deserved following a 13-year legal battle.

Professor Ian Shanks built the first prototype of the electrochemical capillary fill device (ECFD). The technology* eventually appeared in most blood glucose testing products—a huge boost to those of us with diabetes. Professor Shanks was working for Unilever at the time.

The registration of patents by Unilever earned the company £24 million, though Professor Shanks argued it could have earned royalties for as much as one billion US dollars, had his invention been “fully exploited”.

Patents Act

He told the BBC that when he first applied for compensation, not one employee had benefited from the introduction of the Patents Act introduced 30 years earlier. The Act entitles workers who invent something that gives their employer an “outstanding benefit”, a “fair share” of the benefits.

At the Supreme Court in London, the judges unanimously agreed Professor Shanks was entitled to compensation because he had provided his former employer with an “outstanding benefit”.

Professor Shanks said most of the compensation would be taken up by his legal costs, but that he was happy on behalf of future inventors. If something they make turns out to be significant and really profitable, then it was only right they stood the chance of a reward.

“Disappointed”

Unilever told the BBC they were “disappointed” because the company had already given Professor Shanks the “salary, bonuses and benefits” when he was employed to develop new products for its business.

My t’upporth—gotta love a David Goliath battle, right? Though it seems peculiar to me Professor Shanks needed to take his claim to the highest court in the land when those preceding courts knocked him back… (A comment on the legal expertise Unilever can afford as compared to an individual.) 

I am with Professor Shanks. I want brilliant people out there working on technology and medical care that will change the lives of millions of we diabetics. And those individuals should be rewarded for the outstanding benefits they bring.

Read the full story on the BBC.

*Confession. I can’t work out the exact nature of his invention.

Kris Kresser: Lesser known symptoms of wheat intolerance

The Symptoms of Gluten Intolerance You Haven’t Heard About
by Chris Kresser
Last updated on April 18, 2019

Brain fog, skin issues, depression, and even anemia are all symptoms of gluten intolerance.
You just don’t feel good. You’re tired and get frequent headaches, have ongoing skin issues, or struggle with depression—or all of the above. Maybe you’ve wondered if gluten could be the culprit, but because you don’t experience gastrointestinal upset, you’ve since put the thought out of your mind and haven’t mentioned anything to your doctor. Or perhaps you’ve shared your suspicion, but conventional testing ruled out celiac disease (CD) and thus, supposedly, any issues with gluten. In either case, your diet has likely stayed the same … and so have these often-overlooked symptoms of gluten intolerance.
Yes, all of the symptoms mentioned here—and many others you may not have heard about—can be signs that you have a significant degree of gluten intolerance. Even if you don’t run to the bathroom right after enjoying a plate of pasta, and even if standard lab work says otherwise, your body (and brain) may be having serious problems with gluten. Let’s explore these lesser-known symptoms and discuss if going gluten free is right for you.
You’ve heard of the havoc gluten can wreak on your digestive tract, but did you know that gluten intolerance can cause skin problems, depression, and frequent headaches? Check out this article for more symptoms of gluten intolerance you’ve never heard of.

Undiagnosed Intolerance Is More Common Than You May Think
First off, I want you to know that if you eat gluten and you feel lousy but you don’t have digestive issues—and you have tested negative for CD and been told it’s all in your head—you are not alone. In fact, undiagnosed cases of gluten intolerance are incredibly widespread. Here’s why.
As I’ve written before, wheat contains several different classes of proteins: gliadins (of which there are four different types, including one called alpha-gliadin); glutenins; agglutinins; and prodynorphins. Once wheat is consumed, enzymes in the digestive tract called tissue transglutaminases (or tTGs) help break down the wheat compound. During this process, additional proteins are formed, such as deamidated gliadins and gliadorphins (also called gluteomorphins). Stick with me here—these terms are worth knowing so that you can understand the pitfalls of conventional testing for CD.
CD is a serious form of gluten intolerance, one that can do real damage to the tissues in the small intestine (though its symptoms aren’t merely gut related). CD is characterized by an immune response to one specific gliadin (the aforementioned alpha-gliadin) and one specific type of transglutaminase (tTG-2). But people can—and very much do—react to several other components of wheat and gluten.
Therein lies the problem, because conventional lab testing for CD and gluten intolerance only screens for antibodies to alpha-gliadin and tTG-2.
If your body reacts to any other wheat protein or type of transglutaminase, even severely, you’ll still test negative for CD and intolerance.
Statistics suggest that for every one case of CD that is diagnosed, 6.4 cases remain undiagnosed—the majority of which are atypical forms without gastrointestinal symptoms; even many patients who are eventually diagnosed don’t experience an upset stomach after consuming gluten. (1)
What’s more, the distinct autoimmune response to wheat proteins and transglutaminase enzymes in the gut that defines CD is just one possible expression of gluten intolerance. The many other ways a sensitivity to gluten can affect the body are collectively referred to as non-celiac gluten sensitivity, or NCGS. Cases of gluten intolerance classified as NCGS involve both intestinal and non-digestive reactions to gluten that are not autoimmune or allergic in nature and that resolve when gluten is eliminated from the diet.
There is no definitive diagnostic test for NCGS, making it difficult to put a number on its prevalence. By some estimates, it may occur in as many as one in 20 Americans. (2) And although your doctor and plenty of others out there might still insist that NCGS doesn’t truly exist, several studies have validated it as a distinct clinical condition. (3) As I’ve explained previously, gluten sensitivity is very real. Stories painting NCGS as a collective delusion have gotten it wrong.
Decoding Your (Real) Symptoms
Gluten intolerance can affect nearly every tissue in the body, including the brain, skin, endocrine system, liver, blood vessels, smooth muscles (found in hollow organs such as the intestines), and, yes, stomach.
That’s why it can manifest either in the classic presentation of digestive distress—abdominal pain, bloating, gas, and diarrhea or constipation—or in any of the following, likely surprising, non-digestive symptoms.
Anemia
Although it’s discussed infrequently in popular articles, iron-deficiency anemia is well documented as a symptom of gluten intolerance in scientific studies. (4, 5) In fact, research suggests that it may often be the first noticeable symptom of CD and that up to 75 percent of those with an anemia diagnosis may be gluten intolerant. (6, 7) Gluten intolerance can interfere with the uptake of iron from food, causing malabsorption of this important nutrient. (8) What’s more, because anemia generally saps one’s energy, it can trigger or worsen the next non-digestive sign of gluten intolerance on this list.
Fatigue
Many gluten-intolerant individuals report feeling tired and fatigued, especially right after eating, you guessed it, gluten. (9) Research has linked NCGS to chronic fatigue symptoms in some people. (10) As with chronic fatigue syndrome, symptoms of gluten intolerance can also include muscle fatigue and muscle and joint pain.
Brain Fog
This type of cognitive dysfunction can be a sign of gluten sensitivity. Those affected often describe experiencing “foggy mind” symptoms such as an inability to focus and concentrate; some also describe feeling mentally fatigued. (11, 12)
Headaches
Headache is a frequent finding in NCGS, with one recent study reporting the symptom in more than half of its participants. (13, 14, 15) Migraine in particular is an associated symptom. (16, 17)
Eczema and Other Skin Disorders
As with fatigue, brain fog, and headaches, people with NCGS may notice a worsening of skin symptoms such as eczema, rash, and undefined dermatitis after ingesting gluten-containing foods. The most commonly reported skin lesions include those similar to subacute eczema, as well as the bumps and blisters indicative of dermatitis herpetiformis, or Duhring’s disease—to which CD is closely linked. Those who are gluten intolerant may also experience scaly patches resembling psoriasis. Lesions are typically found on the muscles of the upper limbs. (18, 19, 20)
Depression and Anxiety
One of the main reasons gluten sensitivity often goes unrecognized and untreated, researchers theorize, is because mental health issues can be a hallmark of this condition. Data suggests that up to 22 percent of patients with CD develop such dysfunctions, with anxiety and depression occurring most commonly. One study found that CD patients were more likely than others to feel anxious in the face of threatening situations, while additional research has linked conditions such as panic disorder and social phobia to gluten response. Depression and related mood disorders appear to occur with both NCGS and CD. (21, 22)
Here’s the good news: The majority of studies cited here not only investigated whether or not these symptoms are signs of gluten intolerance, but also whether or not they can be addressed by going gluten free. And it turns out, these problems improved or completely resolved with adherence to a gluten-free diet.
But more on that in a minute.
Beware These Surprising Consequences of Intolerance
While the symptoms mentioned above are what will most likely clue you in to your body’s negative response to gluten, they aren’t the only effects of intolerance to be aware of. In fact, a variety of chronic diseases may develop due to long-term CD or NCGS, including: (23, 24)
Epilepsy
Attention-deficit hyperactivity disorder, or ADHD
Autism spectrum disorders
Schizophrenia
Type 1 diabetes
Osteoporosis
Multiple sclerosis
Hashimoto’s
Peripheral neuropathy
Amyotrophic lateral sclerosis, or ALS
In one study, researchers found a strong link between gluten sensitivity and neurological complications—especially those in which the cause was unknown. (25) Research has even shown that, for some people with gluten sensitivity, the primary symptom they experience is a neurological dysfunction. (26) The data suggests that nearly 60 percent of people with neurological dysfunction of unknown origin test positive for anti-gliadin antibodies. (27)
Challenge Yourself: Do You Feel Better on a Gluten-Free Diet?
If you’re currently experiencing any of the symptoms of gluten intolerance I shared in this article and can’t seem to find relief, or if you have received a diagnosis of any of the above linked diseases or disorders and you and your doctor have not found a probable cause or resolution, gluten could very well be a trigger for you.
Because of the limitations of current testing for CD and the lack of diagnostic options for NCGS, the most reliable test for gluten intolerance is a “gluten challenge.”
This involves removing gluten from your diet completely for a period of at least 30 days—60 days is best—then adding it back in after that time has elapsed. If your symptoms and/or diagnosis improve during the elimination period and return when gluten is reintroduced, let your healthcare provider know. You have NCGS or atypical CD.
Though I consider this to be the gold-standard test for gluten intolerance, Cyrex Laboratories does offer a comprehensive blood panel that screens for all of the wheat and gluten proteins and transglutaminase enzymes discussed earlier. It can be a helpful diagnostic tool, but it shouldn’t replace a gluten challenge. (Note: It must be ordered by your physician or another healthcare provider.)
How Will You Deal with Your Symptoms of Gluten Intolerance?
If you experience improvement on a gluten-free diet and plan to continue eating this way, you can feel confident that there is no risk in terms of nutrient deficiencies to removing gluten from your diet. (28) If anything, my experience has shown me that people who eat gluten-free are more likely to increase their intake of essential nutrients, especially if they replace breads and other flour products with whole foods.
Have you experienced any of these symptoms? Are you planning a gluten challenge to determine once and for all if gluten is the culprit? Let me know below in the comments!

My comments: My anaemia, post wheat meal fatigue and brain fog, irritable bowel, and mouth ulcers all went away when I stopped wheat. And they recurred after four days of eating wheat after a long period of abstinence.  We discuss how you can meal plan and bake without wheat on this blog site and in our book.

Food 4 your mood: Crustless Quiche

Woah! Savour the goodness of Crustless Quiche! *Recipe Time*
by Ema Jones

We have made your dinner plans sorted with the easy recipes of Crustless Quiche. Binge on this low carb yumminess with the super easy recipe.
Get set go!
YIELDS:6 SERVINGS
TOTAL TIME: 40 MINS
Ingredients Required
1 tbsp. butter
8 oz. cremini mushrooms, thinly sliced
1 shallot, minced
2 c. loosely packed spinach
Kosher salt
Freshly ground black pepper
8 large eggs
1/4 c. whole milk
1/4 c. oil-packed sun-dried tomatoes, finely chopped
1/4 c. freshly grated Parmesan
Method to Prepare
Preheat oven to 375°. In a medium skillet over medium heat, melt butter.
Add mushrooms and let cook, undisturbed, for 2 minutes. Stir and continue to cook until mushrooms are tender and golden, 5 to 6 minutes.
Add shallot and cook until fragrant, 1 minute. Add spinach and cook until wilted, 1 minute more. Season with salt and pepper and remove from heat.
In a large bowl, whisk together eggs, milk, tomatoes, and Parmesan. Fold in the mushroom mixture and season again with salt and pepper. Pour into a 8″ to 9″ pie dish and bake until eggs are just set, 18 to 20 minutes.
Let cool 3 minutes before slicing and serving.

Yum Yum Yum!

My comment: This can also be a useful breakfast dish and many different vegetables can be used.

 

Jovina cooks Italian: Pork chops with Puttanesca sauce

Puttanesca Pork Chops
2 servings
Ingredients
2 boneless pork loin chops, each about ¾ inch thick
1/2 teaspoon ground black pepper
1/8 teaspoon salt
1 tablespoon extra-virgin olive oil
4 cloves garlic, chopped
2 anchovy fillets, minced, or 1 teaspoon anchovy paste
1/2 teaspoon crushed red pepper flakes or more to taste
2 cups cherry or plum tomatoes, diced
1/4 cup pitted black olives
1 tablespoon capers, rinsed
1/4 cup dry white wine
! tablespoon chopped fresh oregano
¼ cup chopped fresh parsley
Directions
Sprinkle pork with salt and pepper. Heat the olive oil in a medium skillet over medium-high heat. Reduce heat to medium and add the pork. Cook, turning once until browned and an instant-read thermometer registers 140°F, about 8 minutes. Transfer to a plate and tent with foil to keep warm.

Add the wine and cook for one minute. Add the garlic and anchovies (or anchovy paste) to the pan. Cook, stirring, for 30 seconds. Add tomatoes, olives, capers, and crushed red pepper; cook, stirring, for 1 minute. Add the tomatoes and simmer until the tomatoes break down and the sauce is thickened, 2 to 4 minutes. Return the pork and any juices to the pan, turning to coat with the sauce. Top the pork with the sauce.

Diabetes and the roller-coaster ride

Just a quickie from me this week… I thought I’d share an interesting info-grab with you. The flash glucose monitoring system collects all sorts of info which is easy to see at a glance, such as your daily graph.

The graph shows you how often you have been in or out your target blood sugar range. The Monday one here (right) is me on holiday. Happy days, eh? Let’s loosen the reins on low-carb eating as boy, do the Cretans know how to do miraculous things with potatoes. While over there, I tasted what must count as the BEST CHIPS IN THE WORLD. A bold claim, I know.

And Wednesday is me back from holiday, determined to jump back on the low-carb wagon*. Goodness me, those graphs tell their own story, hmm? From wild jumps—the roller-coaster ride, to a far more sedate and steady line. A week’s potato bingeing is fun, but long-term I prefer to stick with the graph that doesn’t soar and plummet all over the place.

 

*Sorry for all the mixed metaphors.