Type 1.5 diabetes

Wheat and obesity

2011-09-14T12:16:00.010+02:00

I've been reading on Tu diabetes of a new book that appears to claim that the wheat consumption in the US and their obesity levels are associated. I decided to look out some figures . As I couldn't work out how to post the relutant graphs I've put them here.

I managed to find this graph of wheat consumption in a set of countries
(as the print doesn't show up clearly, they are in order:

China,India ,USA ,Russia ,France,Canada,Germany,Turkey,Pakistan ,Australia,Ukraine, UK,Iran ,Argentina ,Kazakhstan,Poland ,Egypt ,Italy,Romania ,Uzbekistan .

I used data from the WHO to show the obesity levels in those countries

I really can't see any correlation at all.

Souvenirs of the London Marathon

2011-06-01T15:46:00.004+02:00

A bit of an introspective post here.
It's taken over a month to get round to writing it and that's because it's taken that long to really want to think about it.
I had been looking forward to the VLM for a long time. I first entered within a few weeks of diagnosis and it's taken all that time to get in. The experience was a bit diasapointing.
Quite a lot of it was my fault. You have to put in the training and over the winter I didn't do enough. OK I can blame the weather, trotting backwards and forwards from the UK etc etc but basically I left it too late to build up the mileage. I managed some long runs in the month before the event but probably far too late and too big an increase in distance. The result was yes, I finished and I ran most of the way but in a desperately slow time. I knew I was running slowly but had hoped the event itself would help me to run a bit quicker, my fasted mile in recent years was done in the New Forest Marathon.

As for the event itself .
I really enjoyed the immediate build up.
We had a good day out at the Marathon Expo where you have to go to register . It was good knowing that my OH , daughter, son-in-law and grandchildren would be on the route to cheer me on.
The night before the marathon we spent in a Premier Inn near Tower Bridge. I'd booked it a year before. The hotel was full of runners and even served a carb loading pasta meal if you wanted it. I went for the normal menu. Next morning it was quite disapointing to be the 'healthy runner' and stick to muesli, red fruits and my nod towards extra carbs, a slice of wholegrain toast. OH had the full English cooked breakfast and very nice it looked.

I left early for London Bridge station and the train to Greenwich. Stupidly we followed advice and OH didn't come with me. The wait at the start was exciting but a bit lonely as most other people seemed to have someone with them. I almost spoke to a lady wearing a DUK vest but was a bit she, I wish I had now because I've now read her blog elsewhere and realise she was also wearing a pump. I tested BG whilst waiting and as I thought was fairly low, even though I'd had the extra toast at breakfast so I ate a cereal bar. I was determined to keep BG up during the run. The start of the race itself was a bit strange,. I was on the blue start, which isn't the one shown on the tele. After walking for a while I suddenly realised that I'd reached the start but it was hardly marked so it was a bit of an anticlimax.

I'm not going to go through a mile by mile analysis. Some things were great, the crowds as everyone tells you are fantastic, and a lot of them wait for the slower runners. I had the shock of my life when the first personyelled out my name, then I realised it was printed on my vest! It was great to see some of the character's There was a dinosaur . At one time I couldn't understand why sometimes a rhino overtook me and then I seemed to catch him up and overtake, there were several rhinos ! The man carrying a fridge, passed me somewhere on the course. He deserved far more than a medal. I passed the marching band, they were playing well at about 5 miles . I was glad to come across the centipede whilst they were taking a loo break, getting past a chain of 50 people cannot be easy!

It was fun running over Tower Bridge and great seeing the Houses of Parliament and brilliant running past Buckingham Palace with only a few yards to go but you see all the sights a lot better on the television than from the course.

Much of the course though goes through surburban London or Docklands and some of it is pretty boring. Also because so many bottles and gel packs are thrown down slower runners like me are surrounded by a sea empty bottles and the road gets wet from the spilt water and sticky from the gel. It's unpleasant.
The strangest part was I found it lonely. I've got used to running by myself, I don't even run with my OH much now. (and that's a mistake I think I was running faster when I ran with him). I also run in fairly isolated places, normally I might see a couple of tractors and the odd car but not much else. I think in consequence I run very much within myself , having lots of other people around me I just retreated into myself even more. Every 'official' photo of me has me with my eyes looking downwards. It didn't help when I missed seeing my husband , daughter and grandchildren. They weren't at the JDRF spot as I thought they'd be. I 'd been looking forward to seeing them and was really disappointed that they weren't there. (they had been at either end of Tower Bridge, OH had missed me when he tried to phone daughter. They saw me at that moment, but I didn't see them). For the next few miles my speed was really really slow , so it obviously affected me. I cheered up when I eventually saw OH at Docklands with about 8 miles to go and again when I at last heard the 'Go Granny' and saw everyone else about 4 miles from the finish.

Incredibly after the finish and a sandwich in St James's park. I felt fit enough to walk to Waterloo . My glucose levels were fine, I'd run with a reduced basal for the whole time and had taken in a lot more carbs than usual (about 100 including the cereal bar at the start) The lowest level was 5 and the highest reading was 7.8, though I doubt it was that high for long. So I really could have done better, I wasn't even sore the next day, just a bit down. In fact I was almost tempted to enter again for next year... but never again, I've done enough marathons. We have entered for the New Forest half though, it's my aim to get a bit quicker.

The fantastic thing about the London was the reaction of other people when I asked for donations for the JDRF. I was a bit reluctant to attempt to raise any money. I don't know many people so I didn't think I could raise much. I set up a just giving page and asked people. I was astonished by peoples generosity. When I saw the first few donations I cried, I was shocked! I managed to raise just over £400.

To all those people who gave can I again say thankyou.

To my anonymous donor, if s/he reads this thankyou also. I may not have totally enjoyed the event but knowing I was sponsored made it very worthwhile.

Diet Transforms Canadian Community or there's more than one way to skin a cat

2011-05-28T18:09:00.016+02:00

A little local trouble on a diabetes forum caused me to look the blog of a Canadian doctor. This particular blogger advocates the low carb/high fat approach. He has been working with groups from the Canadian First Nations.
On this blog I also noticed a favourable account of a doctor helping large numbers of people in his small community to loose weight. Stefan du Toit,a South African doctor now working in rural Canada is using a diet that is low carbohydrate, but at the same time not high in fat .The blog told me that he has so far helped over one hundred of his patients to, between them, loose over 3000lbs . Some have lost over 90lbs and many have managed to reduce medicines. Success indeed.

I thought I'd investigate this diet a bit more.
http://www.youtube.com/watch?v=EKOWp-GlH1A
and second shorter video from CBS adds a bit more information
http://www.cbc.ca/video/#/News/TV_Shows/The_National/Health/1244506052/ID=1778824999

Looking elsewhere ,I found a short article on the British Columbian Medical Journal. The results are impressive and there was a chart for one man with diabetes. It showed an HbA1c dropping from over 10% in January 2009 to about 5.4% in November 2010. His total cholesterol/HDL ratio dropped from over 6 to about 3.5 and his blood pressure also fell..
I learned that the diet had 1100 calories allocated for women and 1500 calories for men. Apparently, in spite of the fairly low calorie intake there is only about a 10% drop out. And it appears that some people at least have stuck to it for 2years.

The details of the diet are rather sparse , the doctor deliberately doesn't reveal very much . He stresses that it needs to be followed under medical supervision and of course that's really important if people need to reduce medications. He also suggests that the changes of diet may lead to electrolyte imbalances in some people
Nevertheless, as an exercise I had a go at working out what the diet might 'look' like.

From the info in the article and videos
it's a healthy eating programme
It's a low GI/low carb diet
Avoids processed /refined carbs
Its not a high protein diet or a' ketosis' diet.
It's a balanced diet that conforms to the Canada Food guide. Therefore can't be high in sat fat
Exercise isn't included whilst the person is losing weigh.(The doctor claims this is because it stimulates appetite but when the person has lost weight exercise is started. I assume this may help with maintenance.)
There may be some sort of induction, the man interviewed talks about the first month
In the original blog the author said he thought that people are started off with 80g carb per day.
It has a high success rate and seems sustainable for up to 2 years
I found an article that said it included 3 meals and no snacks..no confirmation of that though.

The Canadian recommended dietary intakes are very much the same as elsewhere in the world
:http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/nutrition/dri_tables-eng.pdf
Carbohydrate
Recommendations for macronutrients for people over 19
45-65% carbohydrates
estimated average requirement is 100g .
The RDA and AI ( adequate intake) is 130g
Protein
10-30% protein
The EAR for protein is .66g per kilo,
the RDA and AI is 0.80g per kilo
Fat
25-35% fat
men should eat 45g unsaturated fat, women 30g.
Saturated and trans fats plus dietary cholesterol should be kept low.

I did some figure juggling, using the woman's calorie intake example.
I tried 80g carb
80g carb = 320 calories : 29% of 1100 so already below guideline minimum, to get the rest of the calories would require either protein or fat to be above the levels of the guidelines: it wouldn't be a balanced diet. The figures don't work. So if the diet does start at this low level it is perhaps only for a short time.

A bit more juggling comes up with a distribution that seems to fulfil the criteria I found. (aprox figures)
130 g carb = 47% of 1100 calories = 520 calories
34g of fat = 28% of 1100 calories = 306 calories
68g protein = 25% of 1100 calories = 272 calories
That (if I haven't made a mistake) works out at 1098 calories and conforms to the guidelines and is low carb, low fat and not high protein..
(though protein is higher than that often suggested for people with reduced kidney function as it would work out at more than 0.8g/k of most women's ideal weight)

The Canadian guidelines also include advice on eating lots of fruit and veg , some grain with a preference for whole grains, plus fish/meat/alternatives ...it's suggested that pulses replace meat/fish for some meals, dairy and unsaturated fat (oil dressings)
It wouldn't be too difficult to work out the types of meals that you could eat. (my guess is that it will include lots of veg, some fruit, smaller portions of meat/fish and that he might make good use of low GI beans/lentils ) .

The difficulty with dieting; whatever the diet is sticking to it, to be honest I think a 1100 calorie would be hard for many people . Some people can stick with diets by sheer determination, you meet many such people on diabetes forums, the risks of high blood glucose levels forms the motivation. Not all people are that 'strong' though . I'm sure a charismatic doctor and the group sessions play a prime role in helping people maintain their diet. If a lot of people in a small community are following the diet, then this type of eating pattern becomes the norm. It must be much easier to stick t
Actually if I've got the type of diet right,(and this is only a paper and pen exercise to examine what it might look like.. Don't try it , I'm not a dietitian!), it doesn't seem that different to many commercial low calorie diets with support for example weightwatchers or Rosemary Conley.There are also lots of similar diets on the internet including one by Amanda Ursell, a well known member of the BDA, writing in the Times

Dr du Toit deserves big credit though, getting his community on board and been instrumental in improving so many of his patient's overall health. It would be great to see this sort of approach being tried elsewhere.
(I'm still not sure about the lack of exercise element though)

Monday 13th September 2010Day 3, Puivert – Espezel 9.72 miles climb 1783 ft descent :513 ft

2010-11-12T00:21:00.009+01:00

(Garmin says 3102 calories)
Awoke to a blood glucose of 4.8mmol, again not too big a drop. OH went into the village for croissants and bread . We had some boiled eggs with bread for breakfast, I saved my croissant for elevenses.
At last we were on the Cathare trail proper. Puivert nestles at the very edge of the Pyrenees; the way forward was clear, round the lake, across the fields and upwards towards the higher ground.

The lake and castle at Puivert

Thats where we were going

The first 1.9 miles had only 121 ft of climb so was a gentle start. Then it got tougher. As we started to climb I became very conscious of the weight of the rucksack, it was one thing of the flatter ground but going uphill it slowed me quite a bit .The trouble is I’m not one of those people who can get by with the bare minimum of luggage. We took it steadily with frequent stops for tiny jellies and choc apricots, glucose levels were on the low side but not too low . I soon discovered that if my right shoulder was beginning to feel sore my levels needed topping up. It was almost as reliable as using the meter.

We spotted this newborn just before we started to climb up through the woods

The trail went gradually upwards though because it was through woodland it was more enclosed than I like with few long vistas. We saw more people today including some mountain bikers riding hell for leather down the hill.
The woodland trail eventually lead to the village of Escale, our lunchstop.

The village like so many others in the area helped provision the local Maquis. In August 1944 it was totally destroyed, set alight by Nazi troops .It wasn’t rebuilt until the mid fifities and there is a display showing the harsh temporary living condtions suffered by the locals during the early post war years.
After lunch we regained the trail which continues further upwards, past the PC du Masquisards, the stone hut which was the base of the Maquis. This was also set alight by the Germans but the resistants had already fled. It was restored in 1993.
The path eventually stopped climbing. We had started in Puivert at about 1550 ft and had climbed to about 3,200ft. We had started out walk amongst cultivated fields, it was really odd to have climbed so far and to be again in an area of very flat, cultivated fields. This was the Plateau du Sault and we were able to speed up for the last few miles to Espezel where we were going to camp.

In spite of the flatter terrain, we were quite shattered when we arrived, we eagerly anticipated putting up the tent and a shower .
The campsite was on our way into town, but our faces dropped when we saw it; long grass, a few ancient caravans, no sign of life. We went in, found a building and pushed the door open. It was the sanitation block, one door opened to show a loo au Turque, in the corner was a sink that didn’t look much more modern than the lavoir in our village, and much dirtier. We don’t mind camping, but this was more like slumming it.
We walked out and wandered into town We met a young French girl, she and her boyfriend were also doing the Cathare Trail, they had decided to bivouac outside the village. We felt we were too old for that so investigated other possibilities. We soon found the gite d’etape, actually an Auberge . Yes they had room and we were soon installed in a comfy double room complete with shower. We were going up in the world!

If you want a fun evening, stay at the Gite at Espezel. Its owner sporting a typical French beret is a fabulous mine host. The food is good and in available in huge quantities, no one would leave hungry. The wine flows very freely. There is no choice, but it was all good, charcuterie, duck, salad, sauté potatoes, cheeseboard, tarte aux myrtilles. Our fellow guests at the gite were a group from Denmark on a week’s organised trip (the type where your luggage goes from place to place, (I sometimes got a bit envious) They spoke good English and we all got along well. From them we learnt that there was an English/Australian group staying at the hotel. We also met an older French couple. The two groups and the 2 couples were to become our companions on the journey, overtaking them, being overtaken and meeting up in the evening. I really enjoy this aspect of long distance walking in France. Mine host decided to initiate our Scandinavian friends into the intricacies of drinking from a poron (none of them seemed to have spent youthful holidays in the Costa Brava). I ended up impressing him by joining in with the chorus of the Occitan anthem . We rather staggered to bed, my meter tells me I remembered to test, it was 4.9 thought fortunately had risen slightly when I tested during the night. Meals like that take a fair time to digest!

The graph shows reasonable control during the walk, so far but I was still skirting the lows a bit, its difficult to realise just how much you need to reduce the insulin when you are using so many calories each day. The mountain at the beginning, well it was certainly odd, perhaps something on my fingers from packing, or perhaps raised adrenalin levels as I started the walk. Who knows?

Sunday 12th September 2010 Day 2 Ste Columbe sur L’Hers- Puivert 9.14 miles

2010-11-11T23:56:00.010+01:00

Great morning, reading, it dropped just a bit and was 5.3mmol.
After a breakfast of boiled eggs and bread we took down the tent. We had arranged to buy some croissants from the little shop but neither of us felt like venturing into the village before breakfast.. We picked them up on the way and they made a very satisfactory 2nd breakfast later in the morning.
Unlike the the first day we had to rely on out map reading skills, the route followed footpaths but not any official route. We met no other walkers all day so it felt a bit remote and off the beaten track. The path started on the green way

but soon turned into the woods to climb through the woods

Then sharply down into the valley to out lunchtime stop of Rives, a sleepy place with a tiny village square to have our lunch in. During the morning, my pump had been firmly down at 20% , every now and then we stopped checked levels and I ate a few chocolate apricot bits ( OH put them in at the last moment and they were excellent fairly low gi carb nibbles. Lunchtime though glucose was just below 4mmol so very much time to refuel. We ate what was to be a typical lunch of bread soft cheese, tomatoes and peaches washed down with water.

After lunch, having gone down we went up again. The path was at times even more difficult to follow than in the morning. At one time it had been ploughed up and moved to the other side of a field. Fortunately OH map reading skills came to the fore and we worked out where we were.

It wasn’t the most scenic route since for a lot of the time we were enclosed by trees but occasionally we got glimpses of the mountains ahead.

Puivert castle came into sight, to our left. It was a little strange realising that this was one of the Cathar castles but we wouldn’t be getting any nearer.

Puivert itself was a busy little village . The municipal campsite was beside the lake and for once we weren’t the only people on site. We were given a large pitch for our tiny tent but had the luxury of our own electricity to recharge the garmin and mobile phone. (on other campsites we used the plugs in the sanitary blocks)
Tent up we collapsed for a while, unused muscles were beginning to protest but not for long as we had to find food. Glucose levels with the reduced basals, extra breakfast and the odd handful of chocolate apricots had been reasonable all day but a good dinner was a welcome prospect....Tonight it was at an Afghan restaurans , a rather odd thing to find in this part of France. Sadly we were a bit conscious of expenses so didn’t go for the specialities and I went for the menu fixe of salade with lardons (OK but not as good as the night before) and steak frites. OH went for a curry which was much better than they usually are in France. It was just light when we got back to the tent but it wasn’t long before darkness fell One thing about this walking is to remember to cut the bolus insulin with evening meals, the first night was a bit low considering the large meal and it had been a less hilly day. So I reduced the bolus by a couple of units. It didn’t make much difference as when I checked at bedtime, only about an hour after the meal but it was almost dark so it had to be bedtime it was 6.3mmol. Hoping that it wouldn't drop to far during the night I slept.

Day 1 Lavelanet to Ste Colombe sur L'Hers (8.29 miles.)

2010-09-22T18:43:00.019+02:00

When we picked it as base we knew nothing about Lavelanet It was simply central and on some major footpaths.
We found it’s not a particularly beautiful town but seems like a good place to live with lots of things going on , some good shops and what seems to be a lot of communal/regional investment. We noticed two sports stadiums, a little theatre, a gym, outdoor pool, even the judo club had dedicated premises. The municipal campsite had a really good new, clean sanitation block, absolutely vital for making camping a reasonable experience. The site was managed by a very helpful lady who agreed that we could leave our car inside the site for the week.
The town used to be a centre of the textile industry. It grew up alongside a fast river. In early times the water was important for washing and dyeing the fabrics; later the water was used to power the looms. Many of the old factory buildings still exist and when we peered through the windows of one near to the textile museum we realised that it was still equipped (or reequipped for display?) with looms.

We slept the night in the ‘monstrosity’ , a tent that gives us loads of space but offends my artistic sensibilities , tents should be nice quiet colours not loud orange and reds. Unfortunately neither of us had a good night as we both felt a bit cold.

It took us forever to pack up the tent, pack and repack rucksacks trying to make sure we didn’t leave anything behind and then get going. It was 11.20am by the time we walked out of the campsite. As soon as I was out of the gate I realised I hadn’t checked glucose level, stop take off backpack; check. ...11.4mmol. I’ve no idea where that came from but decided not to correct Because it was so late we decide to stop for a coffee when we got into town but on arrival the cafe is shut with a , notice on the door ‘en greve’ .(.on strike), momentary panic...what if we get to our first stop and everywhere is shut because of the strike, will we get anything to eat? A quick look around reassures us as the cafe is the only business closed. About 20min later we find an open cafe (Lavelanet is a long town) and check glucose level which had descended to a more reasonable 7.4mmol. In fact at this point I lower my basal rate on the pump to 50%.
Restored (we’d done less than 2 miles!) we shouldered our packs and found our way out of Lavelanet onto the Voie Vert; an old railway track.

We were sensible to choose this route for day 1. It was a fairly easy, flat walk but with a backpack it took us far longer than it would do normally.

We went through a number of small towns once industrially important, now merely sleepy. It astounded me to learn that one industry horn working was big enough to necessitate the importation of horns all the way from New Zealand. I was a bit nervous as we approached a long tunnel, but I had no need to be,it contained movement activated lighting!

By lunchtime I knew that exercise was working it's magic on the glucose levels and I was in the high 3s by the time we sat down on the grass to eat. I cut the insulin for lunch in half and reduced the basal to 20% (0.1unit per hour). Even so I was sub 4 later and needed to stop for a snack before we got to our days campsite.
The site, just next to the track was basic but that didn't matter, we had it to ourselves. We set up camp and went out in search of food. First we found a little shop and checked they would be open the next morning so no worries about picnic for the next day.

We found a very unassuming looking restaurant and booked a table, then back to the site to rest a bit.

The restaurant was a brilliant surprise, A la Bonne Table was a cafe at the front , but at the back, a huge dining room. Since there were no windows the room was dark but was heated by a huge open fire (rather incongrous after the hot day) Later on we noticed it was used to grill steaks.
The meal was fantastic value for money. The portions were generous and everything was beautifully presented. To start a salad with lardons , this was big enough for a main course on it's own, a mixture of leaves topped with a mountain of crisply cooked lardons. To follow I had trout. It came scattered with almonds and accompanied by mussels, prawns and a creamy sauce...with a large number of slightly spicy baked potatoes (sans skin)...my glucose levels were good and I knew I had no fears about the amount of carbs but I couldn't manage all of them. After that a local sheeps cheese and to finish a thin slice of 'Opera', a gateau filled with a chocolate mousse.
A brisk walk home and to bed in our lightweight tent. A structure altogether more tasteful than the monstrosity

and whether it was the food and wine, or the temperature both of us felt very much warmer than the night before. Glucose level was 5.9 mmol, just a little worried that it might be too low.

Hi Ho, Hi Ho, It's Off To Walk We Go.

2010-09-10T09:57:00.005+02:00

All packed including the kitchen sink.

This is my first multi day walk since the pump, hopefully fewer hypos than last time on MDI. Being able to reduce background insulin is my main reason for having it.

And meanwhile, here is one of the ups on our journey.

Montségur *this photo was taken by User:Gerbil from de.Wikipedia in August 2006 Category:Montségur)

Kit list

2010-09-07T16:44:00.002+02:00

Ok, this is what I've worked out so far. I've also got a second list of things that can go in the car for a more relaxed camp in week 2. I find it very difficult not to try to cover every possibility so I end up with far too much so this maybe more than we take....although I still might think of some essentials we can't leave behind!

Proposed Personal Kit
(until I weigh it and
decide what I don't really need)
Walking poles ***********************Rucksac 50 litre
Sleeping bag ultralite**sleeping mat****Silk sheet sleeping bag
Survival blanket*********************1.5 litre water bottle
Lightweight towel********************Toothbrush/flannel etc
Pants 5***************************** Bras 3
Pyjama top and shorts*************** 3 pairs walking socks, 2pairs ordinary socks
1 pair shorts*************************1 pair convertible shorts/trousers
3 breathable t shirts***************** 1 smarter blouse + 1 t shirt
1 lightweight zipped fleece*************Waterproof Poncho
Sandals ****************Walking boots *********** hat
Camping spoon/knife/forkPlate/cup
Book to read/pen/notebook************ Medical alert bracelet

Diabetes Supplies
Frio ; 1.5 vials insulin; 3 reservoirs; 4 infusion sets; 4 vials chlorehexidine;4 pkts gauze squares ; 2 spare batteries; Meter with new battery ; 3 tubs strips;
3 packets dextrose Small plastic bottle for sharps lancets
In case of pump problem emergency telephone number
Pump failure kit needles ; 2 apidra pens; 2 novorapid pens

And these things have to be divided between OH and I.

Tent Mckinley moonlight 3.2 kg************* Campin Gaz 206 stove with bottle
2 person cook set *************************Wooden spoon/spatula
Plastic egg cups ***************************Egg container with 6 eggs
Tiny salt pepper **************************Small bags with spices/herbs
Dehydrated curry for emergency ***********350g packet wholemeal wraps(If we can't get bread)
Teabags,coffee sachets, sweetner ************100g Dried milk in ziplock
50g Choc drink powder in ziplock************ 200g Muesli in ziplock
200g wholemeal pasta *********************Packet parmesan
Cereal barres ***************************** Matches/lighter
In small plastic bottles, cooking oil, washing up liquid, clothes washing liquid, tiny pegs
Shampoo/shower gel. toothpaste Small tube sunscreen Loo paper
Small first aid kit/ibuprofen/immodium/blister plasters
Camera Spare xd card ; Garmin fore runner and charger; Mobile phone and charger;
Swiss army knife; pan scourer
Maps : 1:25 2247 OT Lavelanet Montsegur 2147 ET Foix

Books: Le Sentier Cathare Barthes ; The Cathar Way Mattingly
Compass/whistle ; Bank cards ; Cash ; Carte vitales./prescription

Oh last but not least a portable, foldable kitchen sink!

More ups and Downs

2010-09-07T12:10:00.006+02:00

I'm back, to blog some more ups and downs.

This time not glucose levels, but I'm sure that will come into it. We're off on Friday for a long walk in the Pyrenees . We're doing seven days inclding part of the Sentier des Cathares and then we'll stay at a campsite and do some day walks to some of the other Cathare Castles. We had intended to walk the whole Cathare way but after looking at the logistics found that it would cost far more than we would afford so this is our compromise.

We will drive to Lavelanet on Friday . Next morning is quite a gentle start following the Voie Vert, an old railway now converted to a footpath to Ste Columbe sur L'Hers . Next day we walk to Puivert where we join the Sentier des Cathares walking to Espezel, Comus, Monsegur and Roquefixade. The last stage of our walk will take us back to Lavelanet. Some nights we are camping, others staying in gites d'etape (bit like a youth hostel). We've tried to plan quite carefully as some places are miles from the nearest shop or restaurant. We need to make sure that we can get the ingredients for each meal.(and not have to carry too much).

The map shows an aproximate route, and isn't actually that far at about 75 milesbut I think there are some wiggles missing. I hope to use the garmin I use for running to get an accurate trace of each days stage

The elevation profile shows why daily distances are relatively short. According to Mapmywalk there is one HC climb (the hardest) and 1 Cat 1, 2 cat 2, 1 cat 3, 3 cat 4 and 5 cat 5 climbs on the route but as I put the route in fairly roughly it might be very inaccurate, we shall see.

Whole Blood or Plasma?

2009-12-06T15:04:00.008+01:00

Mary, Mary quite contrary
How does your meter read?
With millimoles ,
Or milligrams
And clinical accuracy?

Mary Mary quite contrary
What does you meter mean?
Glucose in blood whole?
Or from the plasma sole
It's average your A1c?
With Apologies to Northerner: imitation is the sincerest form of flattery! (I don’t think it scans as well as your poems)

Any PWD on the internet soon realises that different parts of the world use different measurements for blood glucose readings. In the US, some parts of Europe and the Middle East they use milligrams per decilitre. In the UK , some parts of Europe and many places that are English speaking (Canada, Australia etc) they use millilmole per litre. To be awkward in France they use grams per litre.
It’s easy to change between the two, there are many convertors on the web but all you have to do to convert mmol to mg/dl is to multiply by 18, if you want to convert mg/dl to mmol/l you divide by 18. After a while you become bilingual.

But there is another difference that isn’t so obvious. When we measure our glucose we use whole blood from a capilliary. When a laboratory measures blood they measure the levels in the plasma.
For many years all the blood glucose meters reported the glucose level as in whole blood but this was not the same as a laboratory measurement would be. A laboratory plasma measurement would be about 12% higher than a whole blood one. In recent years some manufacturers have included a calculation (done automatically) that works out what the plasma reading would be and displays that as its reading.

Imagine you have 2 meters, both perfectly accurate (of that later) one whole blood, one plasma calibrated. You do a test with same spot of blood.
If it were plasma calibrated and it read 72mg/dl, the whole blood meter would read 64.3mg/dl.
So what constitutes a hypo depends upon what meter you are using.

When people in different countries are writing about their levels, they may not be using meters calibrated in the same way.It is important to know what type of meter you have because some blood glucose targets are written to reflect whole blood readings whilst others are written for plasma, if you are reading targets written for whole blood, they may be too low for people using plasma calibrated meters.

In the US all modern meters give plasma readings but in Europe some give plasma and some whole blood, and it’s not always easy to find out which does what. If you want to find out you may have to search.The place I found mine was not with the meter instructions but in very tiny print in the leaflet that comes with the testing strips.

In the UK, the manufacturers have been changing over the years and now according to DUK they all use plasma except for for those made by of of the largest manufacturers Roche ie Accu chek meters. DUK says that ‘ Roche is in the process of adjusting their meters to give results as plasma values, which they hope will be completed before the end of 2009.’ So if you have an Accu chek in the UK read the strips leaflet carefully.

I think that France may well be in the exactly same postion as the UK but I haven’t been able to find out about all makers. My old Meter, an Accu chek go used whole blood measurements, this is no longer made and I don’t know what the newer ones use. (in France they market the Nano and the Nano-performa). The newer Lifescan meters are plasma calibrated (one touch ultra meters). I couldn’t find a definitive answer for the Abbott meters (Optimum plus and Freestyle Papillon). In the UK all Abbott meters are plasma calibrated and I found this statement on the Swiss site ‘ont déjà programmé leurs systèmes de mesure de glycémie pour indiquer des valeurs plasmatiques comme celles relevées sur les lecteurs de laboratoire.’

This chart shows equivalents in mg/dl and mmol for both whole blood and plasma calibrated meters.

Of course even when you know what the meter reads, it’s not necessarily very accurate. They are allowed to be up to 20% out,. There is a convertor on the Lifescan website which demonstrates this clearly.So with that reading (4mmol) you could either be quite hypo and need some glucose quickly , just at a ‘safe’ level or have a very normal blood glucose reading!
And if you find that your HbA1c doesn’t really reflect what your meter has been telling you, perhaps this built in inaccuracy is a possible reason.

This post isn't really applicable to the UK anymore as all new meters are plasma calibrated

Chocolates

2009-11-30T16:38:00.004+01:00

Christmas is coming and I decided to try to make the lowest carbohydrate truffles I could (without using lots of 'chemical' ingredients)

This is what I did.

Ingredients

110grm dark choc (72%) (might get away with 1 bar at 100gm)

125 ml whipping type cream (it would be better in the UK as I can only get longlife/slightly soured here)

30gm unsalted butter.

a few teaspoons of liqueur, I used mandarine

Method

Chop the chocolate finely

put cream in saucepan and bring to boil

Add the chocolate a little at a time beating hard with each addition.

(When I got to the last addition I must have had the heat too high and it split. I got the electric whisk out and whisked the mixture, this saved the day.)

Put in fridge to cool for about 10-15 min

Cut butter into small bits, gradually whisk into the chocolate.

Add some liqueur to taste.

For presentation

A few walnuts chopped

some cocoa powder

some more melted chocolate (to make 'filled' chocs.)

Let harden in fridge for a while, then use a teaspoon to make rough balls onto a clingfilm covered plate.

to make filled chocs, melt chocolate and spoon into bottom to moulds, cool, then pipe in blobs of mixture, and cover with more melted chocolate.

(this can get very messy, with chocolate everywhere, including on the floor, on the taps and on the fridge door, just cross your fingers that the phone doesn't ring and that the postman doesn't choose this moment to arrive with a parcel .)

Put in fridge for a couple of hours to harden again. Then roll in chopped nuts or cocoa.

The number of carbs depends upon the quality of the chocolate and how sweet your liquer is. The higher the quality of the chocolate, the lower the carb content. For some people they may be too rich and too bitter. They're what you would have with an after dinner coffee, not for nibbling.

For less bitter chocolates, you could use a lower percentage chocolate, you could add a little icing sugar (but both would result in higher carb content) or if you don't mind using it you could try adding some splenda.

I was pleased with the chocolate moulds, it was the first time I'd used them. Now to think of some alternative fillings.

Oh and because they're made of fresh cream, they won't keep and lowish carb or not, I can't eat that many!

Anyone want a chocolate?

Mutiny to Monastery (an afternoon stroll)

2009-11-19T17:11:00.024+01:00

I love walking, the area round here is great for reducing blood glucose levels, it's very hilly.Yesterday was a lovely day so we decided to stop being lazy and make use of the unseasonable weather.It was just a local walk, using a guidebook from the tourist office.10k (and 300m climb)
We started in a corner of town containing solemn reminders of events that took place in WWI

Le Champ des martyrs croates.

It is a little known fact that Villefranche de Rouergue was the first town in France to be liberated from the Germans in 1943!

Unfortunately, the freedom only lasted a day, but some feel that it was instrumental in demonstrating that resistance was possible and leading to the development of resistance in the Aveyron.

The insurrection was started by a small group of conscripts from the present day countries of Bosnia and Croatia They had been rounded up and forced to join the German army. They were sent to a training camp in Villefranche. The instigators persuaded their compatriots to support them in a mutiny against their German officers. Their goal was to approach French liberation movement and Anglo-America, and then to go back to their homeland

On the night of September 16th, the mutiny began The mutineers executed five German officers, held many other Germans, and successfully established control over the entire garrison. By 08:00 a.m. they controlled the town. Unsurprisingly,the Germans quickly sent in reinforcements and fighting went on for a day. An Iman was also brought into persuade the less committed mutineers to return to the fold. At least 16 of the mutineers were executed , five or 6 escaped, one of whom joined the fledgling local resistance, over 800 were sent to labour camps, some 565 volunteered to join labour gangs on the Siegfried line, the remaining 250 were sent to concentration camps: few survived the war. The dead were buried in what became known as the Martyrs field.

In the 1950s a Yugoslavian sculptor created a memorial to the dead.. a woman bringing the first apples of the season to the grave of her dead son. The politics of the day prevented the statue leaving Yugoslavia and it wasn't until 2006 that it came to Villefranche and the area turned into a memorial garden

After the a few moments of quiet reflection we were on our way. Our route, was a bit like that followed by the Grand Old Duke, we went up the hill, we went down, then after skirting round the bottom of the hill we went back up it and back down again!

Some views.

The Bottom of the hill.

Half Way up

Almost At the top

The view towards the medieval village of Villeneuve from the other side of the hill.

On the way back we met an very noisy donkey... who was it decided that donkeys say 'hee haw'? this one most definitely roared.

And then the strangest of signs to spot in the Aveyronese countryside

And it wasn't someones sense of humour!

Towards the end of the walk we passed through the the necessary but ugly industrial area which is a common feature on the outskirts of most French towns. We took no pictures of fromage de france or the sausage factory .We were drawn to what appeared to be a monastery overlooking the prefabricated factory buildings. As we got closer we heard the sound of music from the church. It was the community singing the office. We didn't go in, but stood outside for a while, finishing out walk as we started with quiet reflection.

World Diabetes Day

2009-11-15T15:48:00.019+01:00

It was good fun to join in with people from all over the world and take part in the Big Blue Test . I'm very certain that exercise plays an important part in my control. My glucose levels tell me when I've been lazy but I've often got the impression that, I'm a bit unusual, that other people don't really think it makes much difference. Diet is what matters most, not what you do. In fact, when I posted details of the test on one forum, I was really disapointed, the only response. was a couple of metaphorical yawns concerning the whole idea of World diabetes day

Here are my results.
Before 14 minutes exercise

After 14 minutes exercise

So a drop from 6mmol to 4.3mmol, a distance of 5.5 laps, thats 1.39 miles and 67 kj -I think that was about 160 calories.Just slightly under 10 min miles, which is very fast for me. The test was probably a bit close to lunchtime but I was pleased to only fall to 3.8 later in the afternoon (so a small bit of aero with a cup of coffee was all that was needed to keep me going 'till dinner.

I uploaded my results to the site, at that time there weren't that many so it was great to log back on this morning and find lots had taken part. There were of course lots of results from the US, but there were lots of other countries represented Saudi, the Philipines, Germany, the Netherlands, the UK and South Africa were some I noticed.What struck me straight away was that so many people had seen falls in such a short period of time. Some were totally surprised, others very happy. There were all sorts of activities. People were hula hooping on the wii fit, walking, biking, running , stair climbing, house cleaning, playing with children, skipping, chopping wood and doing exercises in a chair. Some people did far more than 14 minutes, long bike rides, runs and walk

What an eye-opener. Before exercise, 147, after walking on treadmill for 14 minutes, 108. What an incentive to take care of myself while I am in early stages
My exercise was folding laundry as I am not able to exercise heavily, started with 8.6 mmol/L and after 14 minutes it was 6.7 ;
how amazing112 and 106 after 14 minutes of walking on the treadmill. With one added note, I had a late lunch ( I was less than an hour post meal) so my BG should have been going up.
I was 139 and after 14 minutes on the exercise bike was 93! I find that if I pedal really, really hard I can get my BG down in about 10 minute.
Well Done Everybody
Looking at all the figures I thought I'd try and put them together to show how effective the short period of exercise had been, It's not a scientific exercise, people whose levels had gone up might not have posted their results, others might not have paticipated because they had previously seen their levels rise with exercise. I only included people who seemed to have done the 14 minutes (I left out those that said they did longer)
Then I put the results in order of the first reading and plotted the results on a graph.

I think this exercise really showed how well exercise works for many of us with Diabetes, thankyou Manny Hernandez andTu Diabetes.
http://tudiabetes.com/forum/topics/the-big-blue-test-on-world?id=583967%3ATopic%3A794026&page=5

World Diabetes Day Part 2
In the evening we went to Cahors to see the lit up Marie and bridge. Unfortunately the filters weren't really strong enough for the job and my camera wan't really up to it either. It was also pity that there wasn't anything to tell people why the lighting had been altered. When we crossed the bridge a local was obviously a little puzzled. He kept stopping and peering over the parapet at the lights perhaps wondering as to why they weren't as bright as usual. Later in the restaurant we talked to the waitress. She knew about it as it had been on the local radio.

Pont Valentre

Blue Tree (It was in front of one of the main floodlights)

Blue Town Hall

Just a spoonful of sugar.

2009-11-13T16:02:00.017+01:00

The other day I looked up my blood test result for my first fasting glucose test. My French lab reports the results in mmol/l and in g/l . Using grams per litre rather than the milligrams per decilitre is the norm here. In the UK, they use mmol/l, in the US mg/dl; 5mmol/l in the UK would be 90mg/dl in the US. I get used to reading and using those units on the internet, but when I visit my French doctors they get really confused if I say 90 rather than 0.9.

When I reminded myself that my fasting blood glucose on diagnosis was 3.85g/l. I started thinking what exactly did that mea? Somehow grams and litres, being everyday measurements makes it clearer.

Here's a litre of blood!

Our bodies contain about 5-6 litres of blood

The teaspoon below contains just under 4 g of sugar, so about the 3.85g/l that I had in my blood the morning I was diagnosed. Not very much really, disolve it in the litre of water and it would barely sweeten it to taste. I would have had about 5-6 times that in my whole body

This spoon contains about 1.26g thats enough in a fasting test to diagnose a person with diabete

Its incredible, how such small amounts make such big differences.

Tomorrow is World Diabetes Day, I'm going to join in the 'big blue test' http://tudiabetes.com/forum/topics/the-big-blue-test-on-world : testing my blood glucose, followed by 14 minutes of exercise, I'm going to see how far I can run on the treadmill in that time.

Later if the weather's not too atrocious , we're driving to Cahors, where they're lighting the the Marie and the Pont Valentré in blue. It's about 60km and not the best of roads, but OH was easily persuaded as it's a good excuse to visit our nearest Indian curry house.

(I'll get back to the glucose variations soon, it's a hard one to write)

Ups and Downs.

2009-11-08T15:36:00.008+01:00

How much do they matter? (part 1)
In an earlier blog I pointed out some of the reasons that people using insulin can have rollercoaster blood glucose levels from time to time, is it these variations that lead to complications?

I got interested in this after seeing a study in this month’s Diabetes care which investigated the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy and how well the two measures discriminated between people with and without retinopathy. Out of the 1,066 individuals, 11% them had retinopathy. (Retinopathy was defined as level 14 or above on the Early Treatment Diabetic Retinopathy Study severity scale. Level 14 equates with mild non proliferative retinopathy.) They found that HbA1c was the better discriminator and that the steepest increase in retinopathy prevalence occurred in people with a relatively low A1C of ≥5.5%.

At first sight it seems quite shocking, retinopathy with a Hb A1 of 5.5%, that’s well within my laboratories normal range . On reflection, it shouldn’t really cause any surprise as the DCCT (Diabetes Control and Complications Trial) showed a small number of subjects with complications at this level. The probability of it progressing is small, but that ‘chance’ still exists.
A small number, but it represents real people who wonder why it had to happen to them.

It happened to me, I was horrified to be told that I had some mild background retinopathy. I had been diagnosed for 4 years, I had checks every year for 3 years with nothing found. Then, before going on the pump. I had to have an extra check using fluorescein dye. This was a compulsory part of the procedure in France, and is because many people going onto pumps have quite high glucose levels. The change to pumping can lower levels rapidly and this can cause rapid progression of retinopathy. The angiogram, would show if care was necessary in reducing levels. My 'problem' wasn't high levels though but hypos and an active lifestyle. Both my doctor and I thought that it would be a formality. Fortunately, the changes were slight, but they were clearly there.

In her blog,* Jenny Ruhl discusses some theories why a person with a lowish HbA1c might develop retinopathy. She points out that an HbA1c can be the result of very different day to day patterns of glucose levels.

Two patterns that would result in the same Hb A1c, one clusters around the mean, the other has far larger glycemic excursions

She suggests that the ‘normal people’ in the study who had early retinopathy might have higher postprandial levels (fuelled by a high carbohydrate diet) followed by lower levels, such people could be be experiencing ‘oscillations that veered between 75 and 150’.( 4.2 and 8.3).
In contrast she suggests that people who control their diabetes well might different patterns. She describes a ‘ pattern in which the blood sugar stays near 112 (6.2mmol) all day long,' or alternatively , one with a relatively high fasting glucose of about 110 (6.1mmo) ,very narrow fluctuations at meal time, perhaps up to 120(6.6mmol) and then back down to 90(5mmol) . This she suggests is a pattern achieved by reduced carbohydrates plus necessary oral medication or insulin..
She implies that day to day and within day glucose variability as characterised by the first pattern might help to explain the incidence of retinopathy at relatively low HbA1c levels . In other words the ups and downs are important.

Jenny Ruhl advice is to’ keep track of your post-meal highs and keep them under 140 mg/dl as much as possible’ and this is surely the safest course and what most of us try to do. By doing this the overall average blood glucose level and presumably the Hb A1c is kept down. Yet increasingly some doctors and diabetes authorities are saying that those people who don’t need to adjust insulin doses should be concerned with the overall HBA1c and not the day to day variation. Moreover, there are many people, particularly type 1s who find it very difficult to limit their glucose excursions to a narrow band, too low post prandial levels, too low levels before exercise or before bed can result in serious hypos, a much more immediate complication. Thinking about this lead to some big questions
· Is day to day and within day glucose variability more significant or as significant as HbA1c in the development of complications?
· Is it the same answer for both micro and macro vascular complications?
· Is there a difference between type 1 and 2 (LADA, MODY???)
Back to my personal interest.
When background retinopathy was discovered my HbA1c taken a week before was 4.9% Since diagnosis it had been in the low 5s. I rarely had recorded glucose levels over 140, I had a fair number of hypos, almost always during exercise and very quickly remedied. At the time I was going to bed at about 80mg/dl...so for at least 10 hours of the day my level was ‘normal’ .
Now it is possible that the retinopathy was there before diagnosis and only became visible with the more detailed examination. Was I simply unlucky, or did the blood glucose excursions to below 70mg/dl and back up to normal levels play a part?
I’ve been trying to find the answers to those questions.
Like everything, it seems to depend on who you ask! (Or rather what you read)
To be continued...........!

* http://diabetesupdate.blogspot.com/2009/10/does-55-a1c-predict-retinopathy.html

Toussaint

2009-10-31T18:05:00.006+01:00

Happy Halloween!
A poster with a grinning pumpkin welcomed us to the supermarket for the weekly shop. Unlike in the UK, it's rather incongruous,the US traditions for Halloween haven't yet become commonplace here. Inside the supermarket there is one stand with an assortment of witches hats, skeletons and plastic spiders,but one feels that they aren't big sellers. There are pumpkins on sale but most will get used for soup. The parents of children with diabetes here are lucky.They don't yet have to cope with the problems of what to do about the tacky sweets associated with trick or treating

But this time of year is very important here. November 1st is Toussaint, All Saints day.In English , All Hallows,(the origin of Halloween). The following day is All souls. Half a century ago it was celebrated as a solemn festival in Anglican churches, the service finishing with a rousing chorus of 'For All the Saints'. Today its less evident , times have changed. My grandchildren will attend a church party set up to counter the attractions of more secular Halloween activities with their emphasis on witches, ghosts and evil.

It is the church festivals which dominate here.
Outside the supermarket, in a large area of the market and outside every florist are pots and pots of Chrysanthemums. The beautiful displays look lovely in the autumn sunshine.
(If you visit at this time, please don't buy a pot for a French friend). These flowers have one destination;the cemetery. The chrysanthemum is a symbol of immortality. It flowers in the last quarter of the year and resists frosts. Toussaint also marks the turn of the year towards winter,
'A la Toussaint le froid revient,
et met l'hiver en train'
The chrysanthemum's bright petals will be sign of hope in the autumnal fogs to come.

In the week leading up to Toussaint families visit the family graves, and sepulchres, weeding the surrounds, cleaning the stonework, making everything spick and span . The new pots of flowers are placed around the tomb.Those who are too far away from home do not forget, often organising a florist to do the job for them. The cemeteries gradually become a blaze of colour.

As November 1st is a bank holiday, family gatherings take place with those that can, returning to their home towns and villages for the day.
Traditionally, on the day itself masses take place in the churches followed by prayers for the dead in the cemeteries, though in villages like ours, the priest has to spread his services thinly so some services now take place later in the week.

This is a lovely festival, bringing together the generations. It's not sad, not so much a day of mourning. There is no sense of evil or fear connected with the cemeteries. It's a time of remembrance, a time to honour one's dead ancestors and celebrate the family.
Will it survive the pressure of consumerism with it's plastic spiders,dangling skeletons, swag bags and tacky sweets?
I hope so.

Osteoporosis ,No Joking matter

2009-10-23T14:38:00.022+02:00

Sadly on some diabetes forums , some posters, mainly men, think that as they have no signs of osteoporosis now, they’re not at risk. The very idea has become a joke Some of them may not be at high risk but unfortunately their comments may well be read by those most definitely at risk.

Osteroporosis means porous bones. Your bones lose internal strength through demineralisation. Inside they become like a honeycomb with gradually less and less strength. Even slight falls or bangs can result in a fracture, Spinal bones become squashed or compressed because of their reduced strength.resulting in curvature of the spine and loss of height.

I don’t find it funny when I see my mother . She suffers from a combination of osteoporosis and osteoarthritis. She’s tiny, fragile, she no longer looks like my mother. She has lost about 10 inches in height through the disintegration of her spine. In daily life it is the arthritis that causes the pain but it is the osteoporosis that has sapped her confidence and destroys her quality of life. She lives in fear, she’s scared to move, afraid of a hip fracture. She’s right to be, her mother died following a hip fracture as do the incredible number of 1150 people a month in the UK.

Many people are at risk even without considering their diabetes. Conditions such as celiac disease , hyperthyroid or a mismatched dose of thyroxine for hypothoid, a genetic history, an early menopause are just some of the risk factors. All women have a 50% chance of some degree of it in old age; the risk for men is less at about 10%. Most won’t know they’ve got it until they start to lose height, or suffer their first break. Saying,’ well I’ve been on this diet for 6 months and don’t see any sighs of osteoporosis is meaningless.’

What’s this got to do with diabetes?
Diabetes however may be an additional risk factor In the case of diabetic women a study found women with Type 1 were 12 times more likely to have had a fracture compared to women without diabetes. Studies have found long term bone loss in type 1 so it does seem that people with Type 1 are at risk of osteoporosis

The studies are less clear for type 2 If you are male and have been overweight, you may have some protection as the extra weight may have strengthened your bones in the same way as weight bearing exercise . Men as a whole are less likely to develop it as they tend to have bigger frames

However, the Iowa study found that women with type 2 on oral medications, or insulin had an increased risk of fractures. A meta analysis in the BMJ covering both diabetic men and women , type 1 and 2 also showed an increased risk of fracture for both genders, but why is unclear. It could be because of diabetic retinopathy, peripheral neuropathy, and cerebral stroke or hypoglycemia, increasing the risk of falling.
http://care.diabetesjournals.org/content/24/7/1192.full
http://aje.oxfordjournals.org/cgi/content/full/166/5/495#BIB42

If you are at risk you can do something about it?

1) The best thing is to work on prevention whilst young by building up strong healthy bones. It is in childhood that most bone development takes place but peak bone density may not be reached until 30. So what you do in your teens and early twenties is important. If you build stronger bones in the first place they are less likely to become osteoporotic.
2) Even if you’re older you can do something. Bone loss is gradual, the same factors that build healthy bones also protect against loss.

Factors that may help increase bone strength

Exercise:
weight bearing exercise like walking, running , dancing, even walking from the shops carrying the shopping . This seems to be really important. Good for bones, for heart and for blood glucose contro.For bones exercise such as cycling and swimming are less good as they are non weightbearing.

Calcium
Women between the ages of twenty to forty typically require a recommended daily allowance (RDA) of 1000 mg/day in the UK, as age increases so does the recommended dose of calcium required. For women over 40 years of age, who are not taking hormone replacement therapy the recommended calcium dose is 1200 mg/day in the UK . For Women 40 and above who take hormone replacement therapy the recommended daily allowance of calcium is slightly lower at 1000 mg/day. The recommended calcium daily allowance for women over sixty is 1200 mg/day. 20% of women don’t have nearly enough in their diet.
Good sources of calcium are dairy products such as milk, cheese and yoghurt. Calcium is also found in canned fish with bones, such as sardines. Other sources of calcium include green leafy vegetables (such as broccoli and cabbage, but not spinach), soya beans and tofu
So eat your dairy and your greens!

Vitamin D get outside in the sun during the summer months (but sensibly. The Cancer research organisation says that the amount needed to synthesize vit D is less than the amount needed to cause sunburn. A British study by the Health research forum recommends that people in the UK should put on sun-cream only after they have been in the sun for five to ten minutes, in order to allow vitamin D to be made in the skin)
Good food sources are oily fish and eggs.
Protein :
People need sufficient protein to establish strong bones and studies have shown that low protein diets in older people are associated with fractures.

Factors that may cause increased bone demineralisation (bone loss)
(the controversial bit)

Smoking (thats not controversial)

High protein diets
Some high protein diets have been shown to cause people to excrete more calcium than normal through their urine. Over a prolonged period of time, this may increase a person's risk of osteoporosis. However, it might depend upon the actual diet. (how much protein, what type and what other things are eaten)
There was a recent study where subjects ate a reduced- calorie, high protein diet which included 3 dairy servings. The results showed increased urinary calcium excretion but at same time provided improved calcium intake and attenuated bone loss. This continued both during the 4 month weight loss phase and the following 8 months of 'weight maintenance' The principle researcher said 'The combination and/or interaction of dietary protein, calcium from dairy, and the additional vitamin D that fortifies dairy products appears to protect bone health during weight loss. NB Fresh milk is not fortified with vit d in the UK
(Thorpe)
People at risk who adopt this diet need to investigate very carefully there is a plethora of contrary information. Some high protein diets have very little calcium intake. (but I think it's the same message as above..... Eat your dairy and greens!

Ketogenic diets
These are also very controversial and may be high protein as above or normal protein and high fat.
Children on ketogenic diets for epilepsy (high fat, adequate protein and low carb) even though carefully supervised have had problems with bone demineralisation. A six year study at John Hopkins university showed of 28 patients, 6 experienced fractures( Groesbeck) .Morbidly Obese children on a similar diet wee also found to have experienced bone loss.( Willi)

Personally I'm not a dietitian or a doctor but I'd be very wary of putting a child with diabetes on this type of diet without expert advice . I'd also be very careful if I were a young person in my teens or twenties and still to reach peak bone mass.

In older adults there very little evidence available , certainly no long term evidence. and whats available is equivocal. A 3 month study of the effect on bone turnover and a low carb diet found no difference (Carter). However a 6 month one led by Westman found there wa an increase in urinary excretion of calcium and uric acid, possibly resulting from ketosis, proteinuria, or weight loss. (Yancy et al)
A paper by SA Bilsborough and TC Crowe discusses the possible problems (p401). It’s worth reading if you’re considering this type of diet.
Low-carbohydrate diets: what are the potential short and long-term health implications?
Shane A Bilsborough and Timothy C Crowe
(available in full but PDF doesn't seem to link why??)
References:
Matthew P. Thorpe et al, A Diet High in Protein, Dairy, and Calcium Attenuates Bone Loss over Twelve Months of Weight Loss and Maintenance Relative to a Conventional High-Carbohydrate Diet in Adults1–3, Nutr. 138:1096-1100, June 2008
DK Groesbeck, RM Bluml, EH Kossoff Long-term use of the ketogenic diet in the treatment of epilepsy. Developmental Medicine and Child Neurology, 2006 - Cambridge Univ Press
Steven M. Willi*, et al The Effects of a High-protein, Low-fat, Ketogenic Diet on Adolescents With Morbid Obesity: Body Composition, Blood Chemistries, and Sleep abnrmalities Pediatrics: 1998, pp. 61-67
Eric C. Westman et al: Effect of 6-Month Adherence to a Very Low
Carbohydrate Diet Program The American journal of medicine, 2002
J. D. Carter The effect of a low-carbohydrate diet on bone turnover
Osteoporosis International. Sept 2006

I was very lucky!

2009-10-21T11:49:00.006+02:00

If you have frequent urination,
If you drink a lot, have a dry mouth
If you have recurrent thrush
If you are losing weight

EVEN IF YOU ARE THIN,TAKE EXERCISE,AND THINK YOU EAT A HEALTHY DIET
GO TO YOUR DOCTOR. DON'T PUT IT OFF .

if you have previously been diagnosed with type 2 (particularly if you were not overweight at diagnosis) and find it difficult to control your diabetes with oral medications and diet, ie you have very high glucose readings, and are rapidly losing weight without really trying.
Insist that you see a specialist and are checked properly.

I know of several people who like me ignored diabetes symptoms, finding reasons to explain them away because they didn't fit the right categories.. Recently I came across Lees story as
told here in Mens Health 'Undiagnosed diabetes nearly killed me' 'http://www.malehealth.co.uk/userpage1.cfm?item_id=2891 I read it and realised how similar his story was to mine. Sadly his diagnosis came perhaps at a slightly later stage.
He hadn't heard of LADA, nor had I.
Why should we ? Unless you actually search for ityou're unlikely to find it on the general information sites . I did check my symptoms of various websites and realised they were those of diabetes but even then I was confused. I read statements like this
The ADA says:
'Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes.'
I was in my 50s
The site also has a risk test for type 2, I did it
I was low risk.

Diabetes UK says:
'Type 1 diabetes develops if the body is unable to produce any insulin. This type of diabetes usually appears before the age of 40. '
I was well over 40.
Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance). In most cases this is linked with being overweight. This type of diabetes usually appears in people over the age of 40.
I was over 40 but was not overweight, I was thin and getting thinner.
Other sites stress the rapid onset:
About .com
'The symptoms of type 1 diabetes usually develop quickly and over a brief period of time. '
The longer I left it, the easier it was to rationalise, it did not cause a rapid crisis

I've explained my rationalisations in an earlier post , but basically they were that I was too old, too thin , too physically active. I hadn't ended in hospital, I couldn't have type 1. If I had by any chance got type 2, the treatment was to lose weight(I'd done that) and eat a healthy diet and exercise (I did that ) so why bother the doctor. Besides the symptoms came and went.... this latter seems to happen frequently from anectotal reports but I have only seen it once mentioned in the scientific literature.

None of the statements from the Diabetes organisations and information sites are completely true. By trying to give simple information, they omit the common exceptions.

‘The incidence rate of insulin-dependent (Type I) diabetes mellitus is bimodal: one peak occurs close to puberty, and the other in the fifth decade.’ (Karjalainen et al New England Journal of Medicine 1983.. pre definition of LADA !)
There is a percentage of people (can't find the figure at the moment) diagnosed with type 2 who are not overweight. (A proportion of these may have LADA)
The classic rapid onset is often seen in childhood type 1, but even then not always. In older people the onset is very ofen (but again not always) a slower onset . LADA is defined by slow onset.

Perhaps LADA affects such a small number it would only confuse

Well if this were the case, one could understand not mentioning the possibility, but according to Swansea university 10-13% of those people diagnosed with type 2 in the UK have the antibodies connected with LADA. Action LADA says 'This form of latent autoimmune diabetes of adults (LADA) is found in about 10% of initially non-insulin requiring diabetes patients and is therefore probably far more prevalent than classic type 1 diabetes. Joslin puts the figure at between 5% and 30% depending on the population. Its not rare.

OK but if you had gone to the doctor then you would have found out sooner

Possibly, and some people are very lucky and find a doctor who investigates. As my French doctor immediately diagnosed LADA this might well have been true....but I was in DKA by the time he saw me and he was a specialist.
Sweet Magazine this month tells of a young woman diagnosed at 28 . She was a yoga teacher and was losing weight, felt hungry and dizzy. She visited her GP several times but he thought that she was too old to develop type 1. Eventually she looked so ill her mother(a nurse) went with her to the GP and her glucose level was tested. She had a level of 30mmol but amazingly the GP didn't believe the result and sent her away again. Her sensible mother took her to A&E where she was immediately put on an insulin drip.(Sweet, Oct/Nov 2009)
Hopefully cases like this are rare, but this young woman wasn't even 30 yet deemed by her doctor to be too old for type 1. Unfortunately,I've read of many people who have had problems in getting a diagnosis. There are several similar stories told on the various diabete's forums to the one above. Quite frequently people are at first diagnosed with type 2 and then find that oral medications don't work for long. Sometimes they are considered to be uncompliant. On more than one occasion I have read that a person has ended up in hospital with DKA before they were diagnosed correctly.

GPs are not specialists, information on LADA is available but you need an interest and time to investigate. I feel strongly that the diabetes organisations should do more to make both the public and GPs aware of the possibility of LADA (and other possibilities such as MODY).

Why Wholegrains?

2009-10-14T18:03:00.011+02:00

On a forum a poster wrote the following question.

Can someone please tell me the secret ingredient that's found in in wheat that I can't get from far healthier sources elsewhere? It must be a secret, no one has been able to answer that question up till now. Are we really advocating that refined carbs are better than fibrous, organic vegetables?

Of course it was a loaded question, I don't think anyone advocates refined carbs not yet wheat as the sole grain. What is frequently suggested is to eat whole grains. My answer was quite long, probably too long and took a long time to write (twice because Windows decided to switch off to install upgrades in the middle of it) so as I had intended to blog today I'm using my answer with a bit added as a blog .

I don't think I've ever read it suggested to substitute refined grains for vegetables. What is suggested is that there are health benefits from minimally processed whole grains*(see Slavin below for definition, history of processing , summary of possible benefits and mechanisms) This is far too difficult to summarise so you'll have to read the paper.

Wheat is of course only one type of grain, there are many others. Some I've never heard of , let alone used. I've included the latin names to help me, because the French names are bound to be different!
Amaranth* (Amaranthus spp.),Barley (Hordum vulgare) ,Buckwheat *(Fagopyrum esculentum) Bulgur (Triticum ssp.)(derived from wheat), Corn* (Zea mays mays), Farro / Emmer (Triticum turgidum dicoccum); Grano (Triticum turgidum durum) (Durum wheat 'berries') ;Kamut® Grain (triticum turgidum turanicum) an 'ancient' variety of wheat ;Montina* (Indian rice grass) ;Millet* (Panicum miliaceum) ;Oats (Avena sativa) ;Quinoa* (Chenopodium quinoa)not botanically a true grain but normally counted as one. ;Rice* (Oryza sativa) ;Rye (Secale cereale) ;Sorghum / Milo *(Sorghum spp.) ;Spelt (Triticum aestivum spelta) ;Teff* (Eragrostis tef)(principle source of nutrition for 2/3 of Ethipians!) ;Triticale (x triticosecale rimpaui) modern hybrid of durum wheat and rye ;Wheat (Triticum aestivum; Triticum turgidum) ;Wild Rice *(Zizania spp.)
With all those to choose from, wheat is definitely not the only source of wholegrain. Anyone with coeliac or a gluten intolerance might like to know that according to the wholegrain council those marked with an asterick are gluten free.

It is possible that the suggested health benefits are entirely due to their fibre content. If so then it is of course possible to eat enough vegetables to do this.
I decided to work out just how much:First problem, how much fibre is recommended? The UK suggestion is 18g; however the BNF feels that this is too low suggesting 30g. The WHO recommends an RDA of between 20g and 40g. I have rather arbitrarily used 25g; this is higher than the UK suggestion but the median rec. for women from WHO, though still lower than that suggested for men .
Using a British online source (and different sources will produce different figures) I chose a selection of common vegetables, mostly green but added red peppers and aubergine to widen the variety. After selecting 800gm worth I had reached the British target amount but widened my source to include nuts as these are another nongrain source of fibre. Fifty grams of nuts and still there was still less than 25g of fibre, so I turned to fruit choosing avocado , low in carb but high in fibre. I also counted the carbs; this selection has a carb content of 33 so just over Bernstein’s limit.
Spinach 100 g fibre 2.4g carb 3.75
Broccoli 100g fibre 2.6 g carb 2.1
Cauliflower 100g fibre 1.6 carb 2.7g
Aubergine 100g fibre 2.3 carb 2.8g
Red pepper 100g fibre1.6 carb 6.4g
Savoy cabbage 100g fibre 2.8 carb 3.5g
Courgette 100g fibre 1.2 carb 2.2g
Mixed salad 100g fibre 3g carb 3.4g
Almonds 50g fibre 4.2 carb 4.25g
Avocado 100g fibre 3.4 carb 1.9g

But how many people eat this amount ? The five fruit and veg a day, advice assumes a total of 400grams a day but is set alongside advice to eat starchy carbs, preferably whole grains. You have to eat an awful lot of 'fibrous organic vegetables'.
Even with a mixed diet including grains, legumes , fruit and vegetables many of us probably fall short but it is certainly much easier.
I realised I was a bit low and have tried to include more high fibre legumes recently.

It maybe that not all fibre is beneficial for all purposes. Possibly different types of fibre are useful in specific areas. Beta glucans seem to be beneficial in cardiovascular health, major sources are barley and oatmeal. Residual starch may be beneficial for lipid control and glucose stability, and probably is important for colonic health, this is chiefly found in whole or partly-milled grains and seeds, pulses, and cooked and cooled (retrograded) potatoes. (and some processed breakfast cereals)This becomes difficult to test and to separate out and often results in fairly artificial types of experiments but there have been many. of varying quality. (and the literature search would take a long time!) some of these are summarised by Oldways and the Wholegrain council in the link below.
One recent study did attempt to separate the effects of fibre from wholegrain to that of fibre from other sources in the incidence of colonic cancer. (Schatzkin et al)In this prospective cohort study, total dietary fiber intake was not associated with colorectal cancer risk, whereas whole grain consumption was associated with a modest reduced risk.According to the researchers ”These findings suggest that whole-grain components other than fiber — e.g. vitamins, minerals, phenols, and phytoestrogens affect colorectal carcinogenesis.”

As suggested above .There may be health benefits in whole grains caused by something other than the fibre. It maybe a combination of phytonutrients or vitamins, or minerals etc acting synergistically , ie the whole package (and of course different whole grains will vary, it’s not just wheat!) The Slavin paper discusses this.

Slavin J Nutrition Research Reviews,Vol17:99-110, May 2007Whole Grains and HealthReprinted @http://www.wholegrainscouncil.org/files/SlavinArticle0504.pdfSchatzkin et al., Am J Clin Nutr., 85: 1353-1360, 2007Dietary fiber and whole grain consumption in relation to colorectal cancer in the NIH-AARP Diet and Health Study[urlhttp://www.wholegrainscouncil.org/files/WGResearchSummary_WGCJan09.pdf]Recent research into wholegrains and health from Oldways and the Wholegrain Council (up to you to decide on validity,and check out its origins and funding)http://www.ajcn.org/cgi/content/abstract/85/5/1353[/url]

Windsor Half Marathon

2009-10-07T16:30:00.004+02:00

Exercise alone might not make you lose weight but it certainly helps.
I was a proud Mum when I got to the finish sometime after my daughter and OH. She completed the Windsor half marathon in 2hr 26min. Since February she has lost 60lbs in weight by eating a healthy diet (Weightwatchers) coupled with regular training for this event. Like many women she had put on weight during her first pregnancy and didn’t lose it before the second. After three pregnancies she had become very overweight. She started training with 2 min walk, 30 seconds run. Gradually, as the weight came off and she got fitter the running times increased. On event day she ran the whole 13 miles with no walking breaks,. She crossed the finish line side by side with her father.
As for me, well I finished but was very,very slow(though there were still quite a few finishing after me). I hadn’t really trained properly and I was hampered by poor glucose control. The event started at the difficult time for me of 1pm ie lunchtime. I had breakfast at about 9.30am and had planned to eat a cereal bar before the start. With 20 minutes to go, I tested my levels...3.9mmol, far too low but on top of this no cereal bar: OH had checked my bag into the baggage store and I'd forgotten to take it out. I set a low temp basal and took some dextrose but it wasn’t a good way to start. Psychological or not I felt low and very heavy legged. For the first five miles I did a lot of walking. When I spotted my family at the side of the course I stopped and almost gave up then and there butafter dithering for a few minutes decided to carry on for a bit. Round the corner, out of sight, I checked my glucose level, too low and I would have given up. It was 5.6mmol, so why did I feel so b......y awful? New tactics were called for.. I used my emergency hypo gel (15g carbs) and then upped my basal rate back to almost normal.(85%) I had some strange idea in my head that I might not have enough circulating insulin but in retrospect I don’t think that was logical.

Strangely, it worked and the last part of the run, seemed much easier and I felt much happier. I was still slow but I stopped going backwards and caught and overtook several people before the finish.
I’m now determined not to let my training slide again, and I’d hoped that I would be able to work towards the London marathon in April. Sadly that’s not to be as I’ve just received my 5th rejection in a row. That means I’ll get a place for the 2011 event (you get an automatic entry after 5 ballot rejections) so I’ve got 18months to train for it.

Whilst Others Debate Swine Flu vaccine.......

2009-09-10T19:03:00.007+02:00

My local fishmonger has the answer

Apparently a 'nutritionist' at Montpelier hospital says that to strengthen the immune system we need a lot of zinc. Oysters are one of the best sources
The good doctor also suggests eating cheese like Roquefort and the crust on Camembert for their useful bacteria plus fruit and veg for vitamin C, red fruits for beta carotene and kiwis for vitamin E.

Your mileage may vary!

Quackometer

2009-09-08T09:59:00.010+02:00

Most of us use a certain amount of scepticism when looking at medical websites and when reading the views of 'alternative' practitioners. There are a number of 'quackwatch' sites which seek to expose some of the more brazen con artists but not all of the possible suspects have reached enough notoriety to be covered on their pages..
This site http://www.quackometer.net/?page=quackometer
contains a fun gadget (to be taken seriously?... well that's up to you!) It tries to assess whether a website or an individual might be a medical quack. The more canards, the greater the possibility of some sort of quackery.
I had some fun putting in several names that have recently appeared as 'gurus' on diabetes forums. Their scores (out of 10) ranged from 1 (almost respectable) to a certain Austrian doctor who received 7 canards and made it to number 3 on today's high score list. I thought this was probably going to be the highest result. Then, after scanning through some recent postings on a diabetes forum , I put in the name of the author of a book on coconut oil that had been recently mentioned by a poster. I'd never heard of him before but I hit the jackpot... this gentleman now has the honour of topping todays high score list with a whopping 9 canards.
For comparison I put in my own favourite writer /researcher on diabetes nutrition. , Dr G Slama . He has edited a series of conference reports sponsored by Danone, so this might have raised suspicion. This was noted, but still zero canards.
I also put in the whole grains council website and Oldways (advocate of the Med diet) ... both of which I used a lot recently and Diabetes.org.uk. Fortunately none of them had any canards.

Now, you have to use your own judgement and be skeptical of the skeptics but whose advice would you follow, someone with no canards or someone with nine?
Why not try the site for yourself?

All in the Mind?

2009-09-07T09:40:00.006+02:00

Yesterday was supposed to have been decision day, to run the Windsor half marathon or to cry off. We sent off out entry forms with plenty of time to get the training in and it was to be a family affair, myself and OH plus our daughter. What we forgot about was the Summer temperatures , this year a minicanicule. Trying to run when its above 30C and theres no shade is not sensible, after all, even Paula Radcliffe can't cope with heat.
We've upped the training in the last couple of weeks but yesterday was the crux, if I could run or run/walk 2 circuits of our 8km riverside circuit then I'd be OK. The circuit is actually a figure of 8 and includes 3 bridges so its not easy to cut short the run if you're on the 'wrong' side of the river.
We set off, in opposite directions, we run at different speeds so we don't run together.
The first half mile , fine, breathing well, a bit slow but that didn't matter.
Then a thought... you didn't check your blood before you started. I automatically felt for my waist pack ,Oh ***! .
Pack complete with meter, dextrose and car key was still sitting on my seat in the car.
What to do?
No use going back to the car;.....no key.
Go on then I'd at least meet OH who had the other car key.
The problem was I always need a dextrose at 2 miles and I wouldn't meet him until just after that and then still had to get back to the car.
Nothing to do but to carry on.
I ran quite well for a while but towards the 2 mile point my legs began to feel tired. The heat (though far less than a couple of weeks ago) was beginning to bother me, I was sweating, starting to find breathing a bit more difficult. I must be going low, I need a dextrose tablet.
Carry on, where was that husband ?
I REALLY NEED SOME SUGAR NOW.
At last OH came into sight. I told him what had happened and that I needed the car keys. He gave them to me and off he ran with a cheery wave.
Now I felt very sorry for myself, ... didn't he realise I might pass out? . Why didn't he come back with me?
I slowed down, walking rather than running. I realised I was about to go past the hospital. Half of me thought that it might be a good idea to go in and up to the diabetic ward and ask for some sugar. The other half was far too embarassed to do it. I carried on, half running, half walking, and eventually reached the bridge and crossed over, not too far back to the car. My Garmin told me I'd taken over 15min to do the last mile.
I got there, checked level ..... um, 6.1mmol, 6.1mmol !
Not low at all, in fact rather higher than I usually run at.
Sheepishly I locked the car and went back to the riverside. What to do? If I continued in the direction I'd been going I'd not meet OH and I now have both car keys. I decided to run back towards him. A couple of hundred meters along the bank and there he was, that was quick!
Half a mile after giving me the key, he'd begun to worry about having left me .He decided the only thing to do was to carry on, but he had to run as fast as possible.
For both of us that was the end of the run., neither of us felt like going on. He'd done 8k I'd done about 5.5k. No long run, we'll have to try again midweek.

But what about my glucose levels, was I really low at one point and my liver helped out, perhaps the worry had sent them up, or did I just feel low because I thought I should be low? Was it all in my mind?

(It didn't go down afterwards either, it was 7.5mmol before lunch, stayed 'up' all afternoon, then I took off my pump to have a bath and afterwards it had gone down to 4.2mmol.... very strange things blood glucose levels!)

Aligot

2009-09-06T10:30:00.020+02:00

That can’t be good for you!

photo :wikipedia

It's hard to avoid aligot around here.

Restaurants serve it by the bucketful, confit de canard and aligot, saucisse and aligot , rosbeef d’aubrac and aligot. Tourists can’t get enough of it and often take home small tubs from the market at 5€ a throw. The locals like it as well and many of the fetes serve it as part of the traditional menu every year. If you have a deep enough wallet, and book well enough in advance you may partake of a 3* version chez Michel Bras. The tourist office has even produced a jolly song proclaiming its virtues

http://www.aveyronet.com/fr/index.php/2007/08/13/331--mp3-l-aligot-saucisse-en-chanson

So what is it?........... well basically mashed potato and cheese, for some comfort food par excellence, alternatively a dietitians nightmare!
With the aid of a very large wooden spoon boiled potatoes are beaten into submission together with some tomme, crème fraiche and a bit of garlic. Posh versions might have a sprinkle of nutmeg. The tomme is the secret ingredient, it's a very young cheese (3-4days) purists contend it must be Tomme de Laguiole. There is some mystic about the mixing process and to do it correctly your spoon has to follow a figure of eight so many times one way, followed by so many times in the opposite direction. Its hard work on the arms and takes some time. When it’s ready the potato mixture becomes a shiny mass with a gluey consistency that comes away from the side of the pot and sticks to the spoon. The market vendors raise their spoons a metre high to demonstrate elasticity of their product. The cheesy potato strings stretch from vat to spoon without dropping or breaking. Well made aligot is dolloped onto the plate or into a takeaway box, then can be cut away from the rest in the vat with scissors.
The origins of this dish go back many centuries. It comes from the high plateau of the Aubrac and was probably the type of dish eaten by shepherds on cold (and it gets very cold) winter nights. Before M. Parmentier persuaded the French that potatoes were edible, the dish was made with bread. Some people say that it was originally made by monks. These monks ran refuges for pilgrims on the Camino de Santiago. Aligot was probably very welcome on that very high and lonely part of the walk. Almost every ‘pilgrims menu’ now serves it, as we found when we did that part of the Camino last year and most people seem to love it.
Luckily, I’m not one of the majority. I hate the gloopy stuff. It’s just as well, it's high fat, high carb and all that beating will surely have done strange things to the starch structure . Would the broken starch molecules be very easily digested so therfore it's high gi? Or would all that fat in the cheese and creme fraiche slow digestion ? It’s probably like pizza, several hours later the blood sugars would rise with a vengeance to remind you of what you’d eaten earlier. Perhaps it just raises the blood glucose and keeps it raised for a long time. Undoubtably however you tried to give bolus insulin for it, you'd get it wrong.
For someone with diabetes aligot is perhaps not an ideal choice. For other people, given today’s mainly sedentary lifestyles, it’s perhaps better kept for high days and holidays. For many it would prove to be extremely fattening if eaten regularly.

But the food was originally fit for purpose. A hot, cheap dish, made from local ingredients that ‘stuck to the ribs’. It provided the energy necessary for herding animals on a cold draughty hillside or for walking many kilometres over rugged and difficult terrain.
There aren’t really good and bad foods, no food that should be demonised. It just depends on what you are going to do when you've eaten it. Common sense really.

Edit: Other half told me I wasn't being entirely honest. I may hate aligot but I love another dish made with very similar ingredients... tartiflette: sliced potatoes, onions and lardons fried together in a little oil, then baked in a dish with reblochon cheese. Its great after a days skiing and I make it perhaps once or twice during the year. I don't eat a huge portion and it surpringly hasn't been too disastrous on glucose levels but I wouldn't eat it in the days before a cholesterol test. Its not the sort of thing I'd write in a food diary for my diabetologue either ;fortunately she's not likely to read it here .

Eat What You Like! :Just Cover It with Insulin

2009-09-02T12:37:00.009+02:00

How often have you heard that?

Sometimes from other people who take insulin, who perhaps say it without really thinking. Sometimes ,and suprisingly often, from people who don't have to take it in a rather derogatory fashion. Just take more insulin, no problems! The implication is that its a very simple equation and that glucose levels are easily control .

I think some people have a mental image a bit like this

If you eat more carbs then you simply tale more insulin like this

You soon realise that this idea is far too simplistic. Taking insulin is only part of the equation and to get things right everything has to be right. The right amount of insulin for the carbohydrate intake and taken at the right time for the type of carbs, are they low or high GI, the amount of protein might make a difference to some people ,and is there more than the normal amount of fat? If so that might slow down your digestion and the insulin might take effect before the carbs are absorbed.

Have you done some exercise ?, will that make you go hypo later?
Are you about to do some exercise? would it be better to start with higher glucose levels? (and do you really want to have to make that decision now?.... you know it might pour with rain soon!)
What is your blood glucose level before eating? ..... too high? Too low?
Whats the time of the month (if you’re a woman) will you need a bit more insulin?

Have you got an infection or illness? Again a bit more insulin perhaps , but how much?
Are your stress levels high? .... are you about to drive through spaghetti junction in the rush hour?
Is your basal right and able to deal with the glucose from your liver?
I’m sure you can think of others but the picture now looks less like a seesaw and more like this

If you get everything exactly right , glucose levels on target , happy smiley face!

GREAT
But too much insulin, too few carbs, unplanned exercise, plus a hypo from the day before this is what might well happen .

Hypoglycaemia
On the other hand if you plan to go to the gym, so reduce your insulin a bit, eat some extra low gi carbs but get stuck in that traffic jam, causing stress this may be the result.

Hyperglycaemia

JUST COVER THE CARBS?

Simple?
Its no wonder that sometimes levels are a bit like this

(photo wikipedia )

(with thanks to Jopar for reminding me of all the multitude of things we have to get right, every single day and to Tubs for reminding me how I hate that expression!)

Label Reading ( or the difficulty of choosing a savoury snack)

2009-08-29T16:47:00.007+02:00

I don't actually eat many prepackaged foods but when I first developed diabetes, I spent hours studying the labels on those that I did, trying to make the best choice. I still do this when I go to the UK as there are always lots of enticing new products in the supermarket, though often they don't live up to the packet blurb. Like many people I'm a creature of habit so don't have to label read so much now and shoppings a lot faster.
That is until something I buy regularly is out of stock., then it's label reading time again.
Today it happened with the Palmiers, savoury cheeesy biscuts.
Now these are not a healthy food, they are a calculated indiscretion. Quite frequently I go for a run or swim in the late afternoon, then its time to cook dinner . By this time blood glucose is often low In the 20 minutes or so so before serving up its time to pour a glass of wine, and I 'need' a little 'something' to stop my BG going through the floor (well thats my excuse, my diabetologue doesn't agree ) This is where these little biscuits come in.The label tells me they are 46% carbs, (but they are very light), they'e a bit high in lipids and probably too much salt but all they contain is flour, cheese, butter, sunflower oil and some seasoning. They are similar ingredients to the cheese straws I used to make. Not that good, but not horrendous either.

So what to get when there are no Palmiers. It probably took me ten minutes. There were lots of packets to choose from.
The first one had 76%. carbs- a bit high ;
the next contained palm oil-don't want that;
a third hydrogenated and partially hydrogenated fat .(trans fat) -no thanks;
sirop de glucose fructose... I assume thats high glucose fructose syrup, definitely rejected.
Almost all had huge ingredient lists complete with chemical cocktails of flavourings and preservatives. I think I went through almost all the savoury 'snack items' and didn't think I could compromise on any. Just as I was going to walk away, I found a new product: petites tuiles aux 4 cereales: 60% carbs but a whole packet only has 75g, 22% fat but mostly unsaturated and 6% fibre.They contain corn, wheat oat and rice ;sunflower oil : fermented pasturised cream (sour cream?) cracked black pepper and salt. Are they any good, I don't know yet, they'll probably taste like cardboard. If I do like them and they don't cause blood glucose havoc they won't have any next time.

The horrifying thing was what was in most of the products. It's a tiny market here compared with the UK but a growing one.

French Paradox?

2009-08-27T17:42:00.018+02:00

Fruit and vegetables, locally grown and sold in large quantities

A variety of well made cheeses, from cows, sheep and goats

Meat, locally reared and killed. The notice shows the names of the farms from which the animals came.

Some fish, always lots to choose from.

Pain de campagne, low gi and eaten in large amounts

Something to finish the meal, not everyday and not too large or too sweet

But don't forget the wine!

So what do the people who according to the statistics are a part of the French paradox seem to buy and eat? Butchers sell all kinds of meat, beef, pork, veal, lamb, lots of duck and other poultry ,rabbit and occasionally goat and horse. Nothing is wasted, almost everything is eaten including parts of the animal usually relegated to pet food in the UK.

Though a long way from the sea, fishis extremely popular and far more plentiful and varied than in the UK. (even our local 'fast food ' restaurant Flunch always has at least 4 fish dishes every day). Dried, salted cod is used in traditional local dishes.

People struggle home with whole trays of fruit, it was melons and peaches this week. Seasonal fruit and vegetables are relatively cheap and people eat lots. Cheese selected carefully but eaten in fairly small portions. Bread, often pain de campagne (made with coarse flour and soudough raised ) rather than baguette is eaten at every meal.

French patisserie , often very rich, tends to be just for Sundays and special occasions, for everyday eating fruit is more common. And the wine, well people drink it,but I often get the impression that they drink less at any one time than the local British inhabitants.

My part of France has the highest life expectancy in France. Most of my neighbours are very elderly. One of the reasons I think they have such long lives is they have been active and remain active. Sadly, when I read the the local paper it often seems that the most common causes of death of the older farmers areagricultural accidents... often turning over the tractor on a steep hill. These men and women have lived hard lives,their youth was during ww2, a time rarely mentioned but I gather that times were hard. Market in the past was as much as anything a social occasion, much of the food was (and is) grown or reared at home. The market was a place to sell the surplus produce and to meet friends and relatives from other villages. Even today much of the chat between locals is in 'patois', here a mix of Occitan and French. Now they drive or are driven to market, but in their youth everyone walked; every week 15km there, followed by 15KM back again.

Whilst they still can, my neigbours continue to walk, perhaps only a few kilometres a day. I see them walking the quiet roads, stick in hand. Apparently the GPs say that they should walk a minimum of 3km a day but I don't think they need to be told, it's what they've always done. The terrain round here isn't easy, it's hard to to farm and you need to be fit to walk any distance. In the photo below I tried to show the hill outside our house . It goes down 250m and then straight up again. One tourist book calls it the land of the 1000 valleys. I'm sure that working and walking in such an area must develop good cardiovascular fitness.

I don't really think there is a paradox. The local diet includes a huge variety of foods, mostly local, fresh and homecooked. People don't count calories, carbs, types of fat or check their vitamin intake. Whats missing, at least in the diet of the older generation are biscuits, crisps, ready meals , sweets and fizzy drinks and snacking between meals. They've also had a lifetime of hard work and whilst they are still able, continue to keep themselves fit.

OF MICE, CVD and Forums

2009-08-27T17:33:00.002+02:00

Actually its far too hot!
The various forum debates on this piece of research were fairly predictable, ranging from the thoughtful and valid questions about the use of animal models to potentially libellous statements about the scientists integrity. On reflection the most useful thing about this study maybe future reseach into whether there are better bio markers for artherosclerosis.
One poster did mention the French paradox. As it was market day I decided to take some photos to show my views on some of the reasons for this.

Diets and CVD

2009-08-25T12:16:00.018+02:00

When I was first diagnosed I had an echograph on my arteries. My doctor was a bit concerned about the amount of plaque but the blood flow was fine. I more or less followed the French dietary suggestions, from various leaflets but took account of GI of carbs. My dietitians advice was directed this way and at the start I was far too afraid to vary my insulin by much so ate fairly prescribed amounts of carbs. At the end of the first year my HbA1c was down in the low fives and another echograph showed much less plaque. I now get scans every 2 years and my diabetologue is far less worried. What I do works for me.
On the other hand,there are lots of people on various diabetes forums who advocate a low carb , sometimes very low carb approach. They frequently decry mainstream science and like to claim that it is carbohydrates alone that are responsible for CVD and the current world obesity problems.
Their gurus are people like Drs Atkins and Bernstein, their hero is the science writer G Taubes .They love to cite certain high profile blogs.I'm sure most people reading have come across them.I have dutifully read much of the required reading, but I haven't been convinced. I feel that extremely low carb diets have not been shown to be either effective or safe in the longterm . ( I certainly don’t buy a high in anything diet either).
At times I have been really worried about the way they promote the diet., their woe (way of eating) as the only way, a diet to be embraced no matter what a person's lifestyle, activity level or medical history .
Recently these people have been able to quote limited studies, which suggest low carb diets as being effective in the short term for losing weight, and for lowering glucose levels in type 2 diabetes . These studies have suggested that LDL cholesterol and triglycerides fall whilst HDL rises.
(funnily enough quite frequently low carbers argue that cholesterol levels don’t matter, but thats another subject)
Its not surprising that this headline caught my attention this morning.
Low-carb diets linked to atherosclerosis and impaired blood vessel growth
It related to a study on arterial plaque and diet using mice model
The press release contained some background anecdote to the study.

"The study’s first author Shi Yin Foo, an HMS instructor in medicine and a clinical cardiologist in the Rosenzweig laboratory at BIDMC, first embarked on this investigation after seeing heart-attack patients who were on these diets – and after observing Rosenzweig himself following a low-carbohydrate regimen.
“Over lunch, I’d ask Tony how he could eat that food and would tell him about the last low-carb patient I’d admitted to the hospital,” said Foo. “Tony would counter by noting that there were no controls for my observations.”
“Finally,” said Rosenzweig, “I asked Shi Yin to do the mouse experiment – so that we could know what happens in the blood vessels and so that I could eat in peace.”
So the researchers from the Beth Israel Deaconess Medical Center devised a study. They used ApoE mice...... apparently normal mice don’t spontaneously develop artherosclerosis but this particular strain has been created in laboratories. When fed a western type diet the mice quickly develop very high levels of VLDL (very low density lipoproteins) and develop arterial plaque resembling human plaque . These mice have been used as a human model in a variety of studies on dietary interventions, pharmaceuticals and investigations into lipid metabolism. They are useful, but as with all animal studies the results may not be directly applicable to humans. (Meir and Leitersdorf 2004)
They fed the mice one of three diets: a normal mouse “chow” diet (65 percent carbohydrate; 15 percent fat; 20 percent protein), ; a “Western diet” (43 percent carbohydrate; 42 percent fat; 15 percent protein; and 0.15 percent cholesterol); or a low-carb/high-protein diet (12 percent carbohydrate; 43 percent fat; 45 percent protein; and 0.15 percent cholesterol). They observedthe mice at 6 and 12 weeks (growth is a lot faster in mice than humans!) Just as in recent human trials the ‘low carb mice’ gained less weight than the ‘Western diet mice’ but greater amount of artherosclerosis. The control group of ‘normal chow mice’ had ‘minimal
evidence of artherosclerosis’. When the markers for CVD such as cholesterol levels were investigated, mice on the low carb diet had similar or lower markers to those on the Western diet. So this didn’t explain things. However one finding was that these low carb diet mice had a 40% reduction in EPC ( endothelial or vascular progenitor cell ). What they don’t yet know is what the roles of these cells actually is.

So what was Professor Rosenzweigs reaction to the study?

“ these results succeeded in getting me off the low-carb diet......... This issue is particularly important given the growing epidemic of obesity and its adverse consequences. For now, it appears that a moderate and balanced diet, coupled with regular exercise, is probably best for most people.” (Prescott 2009(Augus24))

Meir, Karen S., and Eran Leitersdorf. “Atherosclerosis in the Apolipoprotein E–Deficient Mouse.” Arteriosclerosis, Thrombosis, and Vascular Biology, 2004: 1006-1014.
Shi Yin Foo, et al
Vascular effects of a low-carbohydrate high-protein dietPNAS published online before print August 24, 2009
Prescott, Bonnie. “Low-carb diets linked to atherosclerosis and impaired blood vessel growth.” online press release , Beth Israel Deaconess Medical Center, 2009 (August 24). http://www.harvardscience.harvard.edu/medicine-health/articles/low-carb-diets-linked-atherosclerosis-and-impaired-blood-vessel-growth

It will be interesting to read the various responses on diabetes' forums to this research

After the Fete:

2009-08-25T12:14:00.018+02:00

A fantastic evening, 510 people fed and a packed dance floor from the start.

I love the way everyone joins in from toddlers to great grandparents with every age group in between cluding the hard to please teens. We did a fair amount of dancing though OH’ s legs were a bit stiff after the run in the morning.

As for blood glucose levels, I ate the melon , missed out on the charcuterie, bloused before the green salad , chicken and a bit of bread, ate the cheese but declined the flan. Because it was a relatively low carb , meal my bolus worked out at 3.2u. Even so, I probably over estimated a bit as was down at 3.8mmol (68.4mg/dl) when I got home. The red wine probably played a part. A cup of coffee and a biscuit called a fouree framboise. (a bit like a jaffa cake with raspberry jam and dark choc) This did the trick and my fasting level next morning was 4.4mmol (79.8mg/dl).

Clearing up

Next morning was the clearing up. About 35 volunteers did all the cleaning down, humping and dumping of chairs and tables necessary. By midi everything was ready for a meal of ‘restes’.. leftovers. There was a great debate as to the quality of the pate and the jambon this year.... pate excellent, jambon ‘moyen’. I decided to be on a regime to avoid the extra dish of a ragout made with the chicken livers and gesiers (gizzards) . Other half said they were very good...... but why did he bring home a carefully wrapped package for the cats?

Our Village, En Fete (a bit about life in this part of France ... not much about Diabetes!)

2009-08-23T11:05:00.001+02:00

Back home In England, you think of the school fete, the church fete , or the Red Cross fete. You know the sort of thing, cake stalls, tombolas and Mrs Jones’s class dancing round the maypole. Here the word applies to all sorts of feasts, festivals and partied but in this part of the world, this is the season of the village fete, much bigger events to their English counterparts. Originally, they were big parties held in the summer to welcome back the children on their holidays from work in Paris and other big towns. This still happens, relatives try to come back for the fete last year I met an elderly lady who had left the village 65 years ago as a GI bride. Every ten years or so she returns for the fete.
So what goes on? Each village has its own way of doing things, they don’t change much from year to year as it makes it easier to organise. Last night we travelled about 30km to a village for a Celtic night. This village (population 417) hosted an event with 3 music groups from Ireland and France, pipers from Scotland and Galicia, a barbeque and bar for well over 1000 people in a giant tent. (That was the first of several events including a large vide grenier and a huge meal to round it off)
Our village is a bit smaller; there are no more than 60 people, about 35 in the village, the rest in neighbouring farms. This includes several octo and nonagenarians and a handful of children. This morning we organise a 10km and 15km run. This is not for the faint hearted, it includes lots of climb and some quite rough terrain. This year the competitors won’t have to worry about the mud like last year, we’re in the middle of a heat wave and the temperature will be very high. My husband is running, but I’ve chickened out this year, though I have run in previous years.
The afternoon is gentler, though just as fiercely contested; a pentanque competition.
In the evening is the main event, a bal for up to 800 people. On the menu, melon with a slug of Muscat, charcuterie , pain de champagne, green salad, our famous poules a la broche, (chicken on a spit), cheese, fruit tarte, lots of vin rouge, oh and coffee with eau de vie to round it off. The whole lot accompanied by dancing to a top class accordeoniste, Sylvie Pulles with her band.
This is completely organised by the local people. The chickens are local. They arrive from neighbouring farms on Saturday morning.... still squawking. (Stop reading now, if you’re squeamish)
Everybody helps. The chickens are efficiently dispatched by a middle aged couple. An elderly man plunges them into a bath of hot water. Then they’re plucked , feathers flying everywhere, and then draw. All the edible innards are then washed and set aside for making into charcuterie. The chickens are trussed, with strips of lard tied to their breasts, seasoned with salt and garlic and are ready for cooking over a wood fire next day. About 250 chickens are prepared like this! The charcuterie comes from a local firm; this has to be cut up, as do the melons, the bread and the flan. The lettuce has to be washed. Tables collected from the main village in the commune and set up. ... I could go on. There’s a lot of work and for most of my neighbours the day job doesn’t stop for the fete. The cows still have to be milked.
My problem as a diabetic is just how to bolus for this very large meal strung out over 2-3hours. I’ll let you know tomorrow how I got on!

Why not Type 2, Whats 1.5?

2009-08-22T13:07:00.001+02:00

Since diagnosis I’ve learned a lot about the various forms of diabetes but at the time I was a bit perplexed. My French wasn’t good enough to ask questions and none of the hospital staff spoke much English.
Luckily, in anticipation of type 2 I had ordered a book by Gretchen Becker. This came to the rescue ( I still use it for reference). It contains a short passage on LADA: Latent autoimmune diabetes of adults. This is a form of type 1 which develops more slowly and occurs at an older age. She wrote that there were two tests, a test for insulin production (C peptide) and one for antibodies, anti GAD. I bookmarked the pages and asked the doctor next day.
I understood her to say (and I’m not entirely sure I understood her at the time) that the test was negative for C peptide ie: no insulin production (though I must have had a little) and positive for anti GAD ie evidence of an autoimmune attack.I also think they took into account that I had high ketones and was relatively sensitive to insulin.

If I had been type 2 I could have lost my insulin production during the long period in which I ignored my symptoms. Most people with type 2 produce too much insulin however, eventually, in some people ,the beta cells become exhausted. These people need to inject insulin but usually in relatively large quantities because high insulin resistance. Though I had little or no insulin of my own I wasn’t insulin resistant and needed slightly less than .5u of insulin per kg of weight.

In retrospect, my theory is that I’d spent the previous three years losing beta cell function. I suspect that when I lost the first lot of weight I became more insulin sensitive. My body was able to manage for a while on the reduced insulin production. Exercise, hard physical work in the garden and diet helped keep things relatively stable for a while. Over time I gradually or perhaps suddenly I lost most of the remaining insulin production. The result was very high blood glucose levels and ketones producing the second bout of weight loss. When I tried to exercise I think I must have had quite high ketones and the rapid breathing on my bike ride was a symptom of them. I was told that if I had left it much longer I would have probably ended up in a coma

Type 2 Diabetes: The First Year-An Essential Guide for the Newly Diagnosedby Gretchen Becker

Lets Start at the Beginning

2009-08-22T12:31:00.000+02:00

First things first. Let me introduce myself. I’m a British woman living in the depths of the French countryside. I share my life with a husband, three feral cats, and a large garden. I’m a mother of two, a grandmother to three and the only daughter of elderly parents.
........ and I have diabetes, the main theme of this blog. I developed it in my mid fifties but though I developed it in middle age, it isn’t type two. The ‘official’ diagnosis is type one, but as my doctor said
‘maybe it’s more like one point five’

How I came to be living here is part of the story of the stages that lead up to my diagnosis Its a long story, so settle down with a cuppa. I hope I don’t bore you too much .you can always skip it !
Christmas 2000, the end of term. I had been the Middle school co-ordinator for a large first and middle school in an outer London borough for a year. It wasn’t an easy school, when i first started there it was called an educational priority area school. We had children from many countries, with many languages, and many children from families with huge social problems. You had to be on top of things. I was tired, my class were known to be particularly difficult, that’s why I had been given them. There didn’t seem to be enough hours in the day. I knew I wasn’t performing my management duties very well. The head called me in and without saying it explicitly, more or less gave me an ultimatum, improve or give up the management position. I spent that holiday skiing in Andorra, it was a fantastic holiday, my job now gave us a bit of extra money and we were able to take our family with us. I kept my problems to myself, I didn’t even confide in my husband.
Back at school the problems hadn’t gone away, my classroom control deteriorated, I just couldn’t cope. I can’t remember what precipitated it but I broke down in school and saw sent home . I visited the doctor dissolved into tears in his office and he signed me off work for 2 weeks and gave me a prescription for some pills. He phoned me a couple of times to check on how I was feeling ,I told him I was OK to go back, he renewed the prescription and I returned to school.
Of course I wasn’t ready, school was no different, the class seemed if anything worse. I thought I was heading for a breakdown, just another burnt out teacher. I’d seen it before and was scared of the future. I did not want my career to end in ignominy. I made a plan.
Like others, I’d spent many happy holidays in France and dreamt of buying a holiday home there, an old tumbledown cottage, somewhere in Brittany which we could lovingly restore. It had always been a pipe dream. Why not live the dream? We could buy a house, one with some outbuildings to turn into gites. Lots of TV programmes were telling us how easy it was to do. Other half would have to leave the RAF but that was possible and he was just old enough to retire early and get a pension, we would have enough to live on, the gites would give us the extras. We didn’t have any capital and we would have to sell our house. There would be no turning back.
My Husband was so worried about me, he agreed very quickly. He knew he was unlikely to promoted again in his last few years and the terms of early retirement were very good. He applied to retire and was stunned to get a reply within a few weeks. He could leave in August. I didn’t wait until then, by half term I had given in my notice. I was leaving teaching for good.
The first day of the Easter term I sat by the sea in a bar in Collieure. We’d decided to go further south than Brittany. It was a beautiful day we were house hunting. I thought how envious my colleagues would be. What was strange was how thirsty I always seemed (it must be the heat), I’d taken to ordering sirop de cassis with water. It normally came with a small carafe of water. I drank the lot. I also had a small water bottle by me in the car from which I continually sipped. Not surprisingly we had to stop frequently for the loo.
We spent three weeks looking and eventually decided on an old school building/house in the Aveyron. In reality we didn’t find the house we had imagined, neither in looks nor in position. Our money wouldn’t stretch as far as we thought. Quite frankly it didn’t really fit many of the criteria we had set, though it was a nice house with room for a pool. This was a mistake, we really shouldn’t have rushed into decisions so quickly.
We went back to the UK and set in process the selling of our house and moving. The details don’t matter here. It took time and eventually we moved to our new house in the middle of December. I had got used to drinking a lot by now, and it didn’t seem odd even though the temperatures were sub zero, -10 on the day the furniture arrived. What I hadn’t noticed was that I was losing weight. Like many women I had gained weight after children and then more had crept on. I was probably obese in BMI terms but I hated weighing myself so I didn’t actually know, I avoided looking at myself properly in the mirror. We started work on the house and very large overgrown garden. As my trousers got looser and looser, I couldn’t help noticing that i was getting thinner (it must be all the hard work). I still didn’t realise how much I had lost until my daughter took me clothes shopping. I wanted to try 14s on, perhaps 12s. She said 10, she was right.
By now I was beginning to suspect I had a problem, but I liked my new figure so I wasn’t too concerned..It wasn’t difficult to find out that my symptoms (and by now I also had recurrent thrush ) were of diabetes. I checked my urine with a strip filched from my pregnant daughter, it was positive. ‘ OK ‘, I thought, type 2, that’s not serious, it’s a mild form of diabetes. (Before anyone comments, I now know better!)
(all the websites said that type 2 was a disease of middle age, it was children and adolescents that got type 1, type 1 had a fast onset, type 2 a slow one, and given my previous weight, as far as I could see I had all the criteria of type 2)
Now a sensible person would have gone to the doctor. I wasn’t sensible and I was in a new country, didn’t want to explain in my poor French. In any case the treatment for type 2 was diet and exercise. I could do that without consulting a doctor. I cut out croissants and cakes...well most of the time. I changed to brown rice and pasta. I started running again even when overweight I’d run the High Wycombe half marathon a few years earlier. I stopped losing weight, which was just as well because I was thin enough. The thrush came and went. I probably still drank more fluids than before and for some reason became very sensitive to alcohol. I carried on for 2 years like this. We continued to work hard in the garden, though we didn’t have enough money to develop the gite project.I ran a bit, and cycled a bit and swam in our new pool. I didn’t feel ill. Sometimes I forgot all about the fact I might have diabetes.
Then winter came, I became less active and started doing a lot of sedentary craftwork. I even started knitting, something I’d always hated before. I went back to the UK, my daughter was shocked at my appearance. I was very, very thin. She tried to make me promise to see the doctor on my return to France. I still prevaricated, not wanting to have to go for lots of tests before my second grandchild was born and I had left it so long I was embarrassed and a bit scared. Our grandson arrived but I still put going.
Spring came and I decided to get off my backside amd start exercising again. We would go for a mountain bike ride. We hadn’t gone more than 1km along a stony track when I ran out of energy. I started breathing rapidly trying to get some oxygen. My husband thought I was having a heart attack. Somehow, after a rest I managed to summon up enough energy to get back to the car. We went and found a doctor.
Dr G. was a bit surprised, there was this strange, very skinny English woman telling him in very broken French that she thought she had type 2 diabetes. He didn’t seem convinced but gave me a form for a fasting blood test. If it was above 1.26g/l (126mg/l, 7mmol/) I was to go back and see him. That night I ordered Gretchen Bekkers First year of Type 2 Diabetes from Amazon.
The results were faxed to my new GP, 3.65g/l(365mg/dl, 20.2mmol/l). I went to see him the following morning. He phoned the hospital telling me to go straight there. I misunderstood; there must be an outpatient clinic they had fitted me into. He put me straight. I was to go to the emergency department, the doctor would meet me there. I would probably have to stay in for a few days. Within the hour I was on an insulin pump to bring my levels down. After 3 days the doctor told me, I would have to take insulin for life, ‘but’ I said ‘I have type 2, can’t I take tablets?’ ‘No,’ he replied you have type 1, or maybe 1.5.’ They then tested me for everything under the sun and taught me a lot about my newly diagnosed condition. I stayed in hospital for 10 days.