My son has at last been given an NHS prescription for the Freestyle Libre sensors.
These make a big difference in the ease and frequency with which you can test your blood sugars. If you know how to adjust your insulin to meals, activity and sort out your basals, the added readings that you get help you stay in your target zone much more easily.
I bought the device and the sensors for my son very soon after they launched and have been funding them at £100 every four weeks since. Ouch!
This was worth it for the added peace of mind. The worry of a child never ends and is more so if that child uses insulin, lives alone, is a driver, and is 5 hours drive away.
My son was actually expecting to wait another four months as he was told there was an eighteen month waiting list for the diabetic clinic. He got a short notice cancellation some four months earlier. I know from Emma and other people with type one that getting the device and sensors is a post-code lottery and that although Theresa May thinks everyone who would benefit from them should get them, this is far from practice at present.
I can only hope that there is an increase in funding to help those of you who need them and that the scripts continue to be NHS funded, particularly when I retire.
Update: The Freestyle Libre System can now be used for drivers say the DVLA.
A year ago I was interviewed by Diet Doctor and after quite a wait, I’m delighted so say that my video interviews are now available at their site.
The subjects are tips for self management for people living with insulin dependent diabetes and addressing women’s issues with type one and type two diabetes.
The videos are in the MEMBERSHIP section.
You can access these by joining the site. You can take on a free months trial and decide if you wish to continue or not after that.
The charity Matthew’s Friends was set up by Emma Williams whose son Matthew got a great improvement in his epilepsy which did not respond to drugs but did respond to a ketogenic diet.
The charity aims to promote the ketogenic dietary option as an adjunct or alterative to drugs in children or adults whose epilepsy control is sub optimal. The hassle of following the diet often becomes much more preferable to facing a daily struggle with unpredictable and dangerous fits.
The website, Matthew’s Friends#KetoKitchen You Tube channel gives free ketogenic recipes, demonstrations and tutorials, which can be a great help to those embarking on ketogenic or low carb diets, including many diabetics.
Professor Helen Cross from Great Ormond Street Hospital writes: Epilepsy affects 1% of all children, and in 25% of cases there are continued fits despite considerable effort with medication. This can affect physical and mental ability, learning and behaviour. This not only affects the child but their family. The ketogenic diet has been used for almost one hundred years to treat epilepsy. There are different versions of the diet. The long chain triglyceride diet, the more liberal medium chain triglyceride diet, the modified Atkins and Low Glycaemic index diet. The best diet for an individual will be developed with the help of qualified and trained ketogenic dieticians in conjunction with the family. Such help is essential. In 60% of people who are resistant to anti-epileptic drugs, they respond, at least to some extent to a ketogenic diet.
A three month trial of the ketogenic diet is advised to see if there is a response or not.In many cases, the response is so marked that medication can be stopped entirely. Obviously, direct clinical supervision is mandatory.
Matthew’s Friends can advise parents or people who would like to improve their epilepsy and provide contacts and materials to get started on an appropriate ketogenic diet. They are always grateful for donations to further their work.
Serves 4 Ingredients Sauce Mixture
1 tablespoon dark sesame oil
1/2 cup chicken broth
2 tablespoons soy sauce
1 tablespoon rice vinegar
1 tablespoon chile paste (such as sambal oelek)
1 tablespoon honey
2 teaspoons cornstarch Stir-Fry
2 tablespoons peanut oil
2 cooked (poached) chicken breasts, shredded
Half of a large red bell pepper, cut into thin strips
2 cups broccoli florets, cut into small pieces
1 cup diagonally cut snow peas
1 tablespoon grated peeled fresh ginger
1 tablespoon minced fresh garlic
1/4 cup (1-inch) slices green onion Directions
Combine the sauce ingredients in a small bowl. Set aside
Heat a wok or large skillet over medium-high heat. Add the peanut oil; swirl.
Add bell peppers and broccoli and stir-fry for about 2 minutes. Add the next 4 ingredients (through garlic); stir-fry 1 minute. Add the shredded chicken, stir-fry 1 minute.
Add the sauce mixture; cook 30 seconds or until thickened. Add the green onions. Cook until heated through. Serve with the Cauliflower Rice dish or regular rice if you are not low carbing. Asian Flavored Cauliflower “Rice”
Serves 4 Ingredients
10 oz pkg frozen cauliflower rice, defrosted or use the same amount of regular leftover cooked rice (or grate your own)
1 tablespoon sesame oil
1 teaspoon minced garlic
1 tablespoon rice vinegar
1 tablespoon soy sauce
1 teaspoon minced ginger Directions
Let the riced cauliflower drain in a colander for about 30 minute. Then place it on a paper towel.
In a wide-bottom skillet, heat the sesame oil over medium heat. Add the garlic and saute for about 1 minute.
Add the cauliflower rice. Stir-fry until the grains are dry and begin to crisp.
Stir in the rice vinegar, soy sauce and ginger. Stir-fry for another minute or two. Serve with the chicken.
My comment: I’m pleased to see that frozen cauliflower rice is available in the USA. I’m not aware that we have it yet in the UK. You can pulverize raw cauliflower in a food processor to get a similar product. Then you can have a taste of the orient with this lovely meal.
Simone is a chef living in San Francisco and she had numerous attempts to perfect pizza crust. She was keen to have the sort of base that would rise just like the flour based version.
She has some tips:
use a pizza stone if you have one
warm the bowl for the yeast mixture and measuring cup for the water by running hot water into it
You need to use high temperatures for this recipe to get the best result
You need to have the top almost completely cooked before you put your toppings on.
Ingredients:
1 tablespoon of gluten free yeast
1 tablespoon raw honey
1/4 cup of warm water
3/4 cup ground almonds
3/4 cup tapioca starch
3/4 teaspoon salt
1 tablespoon olive oil or other melted fat
1 tablespoon egg white (this is less than one egg)
In the warmed large mixing bowl combine the yeast, honey and warm water. Leave for 5 minutes to get frothy.
In another small bowl combine the olive oil, apple cider vinegar and egg white.
In another medium bowl combine the almond flour, tapioca starch and salt.
Once the yeast if foamy, add the wet and dry ingredients to the bowl and mix on medium/high for 30 seconds and scrape the bowl to mix it well.
Using a rubber spatula form the wet dough into as much of a ball as you can.
Cover the bowl with a tea towel and put in a warm (but not hot) place. All it to sit for 75 -90 minutes. Check it at 75 minutes. It doesn’t rise like conventional dough but it should have risen somewhat. If not leave it a bit longer.
Turn your oven to 500 F 250 C or regulo 10 (for many of us as high as our domestic ovens will go).
If you have a pizza stone put it in the oven.
Lightly oil a sheet of parchment paper and turn the sticky dough onto it.
Oil your hands and flatten the dough into a 9 or 10 inch circle or so.
Carefully transfer the parchment with the raw pizza base onto the stone or sheet pan.
Bake in the lower third of your oven for 6-8 minutes till it starts to brown at the edges.
Add the desired toppings and cook for another 2-3 more minutes. Allow to cool for a minute before slicing.
From letter from Dr Catherine Calderwood Chief Medical Officer Scotland 24 November 2017
New Recommendations on Vitamin D Supplementation
Vitamin D plays an important role in maintaining bone health throughout life. Vitamin D deficiency impairs the absorption of dietary calcium and phosphorous. This can lead to:
Infants having muscle weakness and bone softening leading to rickets;
Adults having muscle weakness and osteomalacia, which leads to bone pain and tenderness.
The most recent National Diet and Nutrition Survey shows that a proportion of the UK population has low vitamin D levels, which may put them at risk of the clinical consequences of vitamin D deficiency.
Last year, the Scientific Advisory Committee on Nutrition (SACN) made new recommendations on vitamin D and health. The full report is available at:
SACN considered all relevant evidence suggesting links between vitamin D and various health conditions and concluded that the risk of poor musculoskeletal health (e.g. rickets, osteomalacia) is increased with low vitamin D levels. SACN found insufficient evidence to draw firm conclusions on the impact of low vitamin D levels for non-musculoskeletal health outcomes.
The Scottish Government has now updated its advice on vitamin D in line with the new SACN recommendations as follows:
Everyone age 5 years and above should consider taking a daily supplement of 10μg of vitamin D, particularly during the winter months (October – March). Between late March/early April and September, the majority of people aged 5 years and above will probably obtain sufficient vitamin D from sunlight when they are outdoors, alongside foods that naturally contain or are fortified with vitamin D.
From October to March, everyone aged 5 and over will need to rely on dietary sources of vitamin D. Since vitamin D is found only in a small number of foods, it might be difficult to get enough from foods that naturally contain vitamin D and/or fortified foods alone.
Children aged 1 to 4 years of age should be given a daily supplement containing 10μg vitamin D. We recommend Healthy Start vitamin drops for all children in health.
A new-born baby’s vitamin D level depends on their mother’s levels near the birth and will be higher if the mother took a vitamin D supplement during pregnancy. Some mothers and babies have a higher risk of vitamin D deficiency, including those born to mothers who habitually wear clothes that cover most of their skin while outdooors and those from minority ethnic groups with dark skin such as those of African, African-Caribbean and South Asian origin.
However, as a precaution, we are now recommending that all babies from birth up to one year of age should be given a daily supplement of 8.5 to 10μg vitamin D. Babies who are formula fed do not require a vitamin D supplement if they are having at least 500ml per day, as infant formula already has added vitamin D.
We recommend Healthy Start vitamin drops for infants. Neonatologists and paediatricians may recommend alternatives for premature infants, children with clinical conditions or clinical presentations of vitamin D deficiency.
Advice for parents on vitamin D supplementation for breastfed babies must be carefully considered as there is a risk that infant formula could be viewed as superior to breastmilk. Breastfeeding is the normal way to feed infants. It has an important and lasting impact on the public health of the population and it is vital that we protect and support breastfeeding. It is recommended that you emphasise that the potential problem is related to a lack of sunlight in the UK, and that it affects the whole
population, not just breastfed babies.
It is recommended that those at greatest risk of vitamin D deficiency take a daily supplement all year round. These groups include:
pregnant and breastfeeding mothers children under 5 years of age people who are not exposed to much sunlight, such as frail or housebound individuals, or those that cover their skin for cultural reasons; and people from minority ethnic groups with dark skin such as those of African, African-Caribbean and South Asian origin, because they require more sun exposure to make as much vitamin D.
General information leaflets on vitamin D for both the public and healthcare professionals have been updated to reflect these new recommendations and are available online at: http://www.gov.scot/Topics/Health/Healthy-Living/Food-Health/vitaminD
New guidance has been developed for parents and healthcare professionals to support parents to follow this new recommendation. This includes advice on how to administer vitamin D drops to young babies. It is available at: http://www.gov.scot/Topics/Health/Healthy-Living/Food-Health/vitaminD
From April 2017, Healthy Start vitamins for women (which provide Vitamin D, folic acid and Vitamin C) are provided free of charge to all pregnant women in Scotland for the duration of their pregnancy, regardless of their entitlement to the Healthy Start scheme.
Breastfeeding women and children up to age 4 who are eligible for Healthy Start can also get free supplements containing vitamin D. Further information on the Healthy Start scheme can be found at http://www.healthystart.nhs.uk
Healthy Start vitamin drops for babies and children currently contain 7.5μg per 5 drops of vitamin D, as well as vitamin A and vitamin C. The new recommended dose for vitamin D is 8.5-10μg and vitamins containing the new recommended dose will be available from October 2018. In the meantime, parents should be advised to continue to give the current dosage of 5 drops per day.
In Scotland, NHS Boards are responsible for supplying Healthy Start vitamin supplements universally to pregnant women and to breastfeeding women and children who are eligible for the Healthy Start scheme. NHS Boards are also able to sell Healthy Start vitamins to families who are not eligible for Healthy Start. Some Health Boards have chosen to provide additional free vitamins for infants.
We are not currently in a position to extend universal provision of vitamin supplements to the whole of the Scottish population or to additional at risk groups including the elderly, women in the pre-conception period, infants or young children.
Vitamin D supplements for adults and children are also available to buy from most major supermarkets, high street pharmacies and health food stores.
Adapted from Glucagon like peptide-1 receptor agonists for the management of obesity and non-alcoholic fatty liver disease: a novel therapeutic option.
Obesity is a major risk factor for type two diabetes and a cluster of metabolic factors that lead to poor cardiovascular outcomes. The amount of fat stored in the liver tissue closely mirrors insulin resistance and metabolic health.
Non alcoholic fatty liver disease (NAFLD) is now the commonest form of liver disease in the western world and can lead progressively to non alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma.
NAFLD is present in two thirds of obese people and promotes type two diabetes. NASH is present in half of these. NAFLD is expected to become the most common cause of liver transplantation by 2020.
Pioglitazone and the newer drugs such as Liraglutide (Victoza) can be used, as well as various dietary therapies.
If a weight loss of 10% can be achieved, there is a significant improvement in the inflammatory process that results in cell death and fibrosis in NASH. But weight loss is difficult to achieve and maintain. Pioglitazone can improve NASH in two thirds of non- diabetic patients and by around half in those with diabetes or pre-diabetes. Vitamin E has also been shown to have some success in non diabetic patients.
Liraglutide and drugs of the same class affect insulin secretion in response to meals, beta cell proliferation, inhibition of glucagon secretion, delayed gastric emptying, and making you feel fuller with less to eat.
These effects result in worthwhile clinical outcomes in overweight or obese patients whether they have diabetes or not. Body weight is reduced by at least 5% in 30% of patients and by at least 10% in 30% of patients. Over three years this can result in complete remission of the diabetes or pre-diabetes in 30% of the patients. Cardiovascular outcomes are also improved.
Triglyceride accumulation in the liver cells is the mechanism that has been recently shown to cause insulin resistant adipose tissue. After 48 weeks of high dose Liraglutide (1.8 mg a day), resolution of NASH was seen on biopsy samples in 39% of the treated group compared to 9% in the placebo group.
The main side effects are nausea and diarrhea. There could possibly be more gallstone development but no increase in pancreatitis.
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.
In Scotland 5.4% of the population is registered as having diabetes. 10.6% have type one and 88.3% have type two. 1.1% have other types such as Maturity Onset Diabetes in the Young.
In type ones 37.3% are overweight and a further 26% are obese. So 36.7% are of normal weight. In type twos 31.6% were overweight and 55.6% were obese. So only 12.8% were normal weight.
The annual HbA1c was done in over 90% of diabetics in both groups. 24.5% of type ones and 58.6% of type twos met the target of less than 58 mmol/mol which is equivalent to 7.5%.
Over 84.9% of both groups had their blood pressure measured that year and 45% of type ones and 32.7% of type twos met the target of less than 130 mmHg systolic.
Cholesterol levels were done in 86.4% of patients and this met the target of less than 5 mmol/l in 69.1% of type ones and 78.4% of type twos.
22.9% of type ones were current smokers compared to 17.2% of type twos.
Eye screening was undertaken in 85.4% of diabetics that year. 59.1% had had their feet checked and the score recorded.
When it comes to end stage disease in type ones, 3.5% had had a heart attack, 2.6% had had coronary revascularisation, 1.4% had end stage renal failure and 1.1% had had a major limb amputation.
In type twos, 9.7% had had a heart attack, 7.5% had had revascularisation, 0.6% had end stage renal failure and 0.7% had had a major amputation.
Overall 10.8 of the diabetic population use insulin pumps.
My comments: It can be seen from the data that screening is doing very well. We have an average number of people with diabetes and the distribution between types one and two has not changed. Smoking is an issue in only about 20% of diabetics which probably compares favourably with social norms.
We have lost the battle of the bulge. Only 12.8% of type twos are of normal weight. Type ones are more like the “norm” for Scotland with just over a third being of normal weight.
Blood sugar control is very poor particularly in type ones with about three quarters of them with blood sugars over 7.5%.
When it comes to complications, type twos are much more likely to get cardiac problems whereas type ones are more likely to get renal failure and amputations.
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.
Diabetes Diet 