Here come the Summer!

...which for a diabetic can mean only one thing: the low blood sugar chronicles are afoot.

There is a myriad of reasons why blood sugars rise and fall. Some days can be a whodunnit of usual suspects in the blood sugar battering game; other days the culprit is glaringly obvious. But it is usually this time of year that I know for definite that summer is on the way. Despite the usual moanings and groanings from the dismayed British people that our summer offers only drizzle and countryside mist, my blood sugars are the tell-tale sign that the country is indeed warming up. 

I love Summer. And I love the sun. But heat has always been a game-changer for me when it comes to low blood sugar levels. Everything from how often they happen, to how to predict them, becomes a battle of (near) epic proportions. 

Someone once told me it's because the body gets hotter and capillaries open wider in order to cool us down. That in return gets insulin pumping through the body much quicker, causing frequent and unpredictable hypos. I'm not sure if that's true or not (any ideas?), but either way, it's time to get the sunscreen out people. Summer is on its way. 

So if we needed any sign that the Summer monsoon is a-comin', my CGM trace suggests a big old yes. 

A mother's response to Matthew Wright

My mother, Christine, is my greatest role model.  Strong, reflective, vulnerable, open and generous beyond words, she too felt the effects of Matthew Wright's recent verbal assault on the diabetes community.  And she was kind enough to put into words how his words - and the bigger problem they represent - affected the mother of someone with diabetes. Here is her beautiful guest post.

Anna has wanted me to write a blog post from a mum’s point of view for some considerable time, but it was Matthew Wright’s outrageous sound-bite about “diabetes-triggering chocolate Easter eggs” that has at last galvanised me into action.

At the tender age of “just-turned 4” my blonde, blue-eyed, slim daughter had not spent the summer sitting around eating chocolate and watching TV but had returned bronzed and happy from a 5-week family holiday in the Austrian Tirol – where at the age of “still only 3” she had walked up mountains (once to glacier-level) every other day and, to the utter astonishment of the local tourist board, had completed enough walks to earn herself a gold “Wanderpass”.

Just 3 months later, on Christmas Eve, I drove my semi-conscious, critically hyperglycaemic daughter to hospital while my devastated husband stayed at home wondering how he would find the heart to “celebrate” Christmas the next day with our 2 sons. 

Within a year of Anna’s diagnosis of Type 1 I had the opportunity to attend a week-long conference in Kaiserslautern, being both cared for (yes, we mothers need looking after as well) and educated about Type 1 along with 30 other mothers and their newly-diagnosed D-children. The age of these children ranged from 18 months to early teenage and not a single one of them was overweight. 

Every one of us mothers, however, felt both guilt-ridden and confused that their beautiful child had developed Type 1. We were all asking why – where on earth had this come from? Of the 30 children only one had a living relative with Type 1 – the 18 month old baby girl - and her desperate father (the Type 1) was so devastated - because he thought it was “his fault” - that he couldn’t yet inject his baby daughter with her life-saving daily insulin.

In amongst all the heartbreak and guilt the various reasons we mothers were putting forward as having been the trigger for the Type 1 were variously stress, shock, the coxsackie virus, a recent immunisation against measles and mumps and bereavement. Guilt, fear and lack of information is a toxic combination. I was soon convincing myself that I had over-stretched my 3-year old and that in fact the 5 week holiday and the gold medal had stressed her little body so much that her insulin-producing cells had failed as a result.

But for all the reasons we were throwing into the ring about possible causes for Type 1 we all knew deep down that our friends and neighbours who heard that our child had developed diabetes were all presuming that the reason for the condition had been “too much sugar in their diet”. They also thought that diabetes management was simply a case of “not eating any more sugar”. 

This was 25 years ago. My daughter was the only child I knew with diabetes, other than the ones I met on that conference. The kindergarten (and, later, the school) had never seen a case before and the day they had to call the helicopter to deal with her hypoglycaemic collapse practically made the newspapers. It also sorted the men from the boys with teachers drawing lots NOT to go with her in the helicopter.

So where have we got to, in Britain, 25 years on? Not very far, if Matthew Wright’s remarks are any indication.

But the D-community appears to be increasingly well-informed, supported and educated, thanks in part to bloggers like my daughter. They take the time to get alongside each other, to share information and experiences, to encourage each other and support each other during the tough times. And believe me, there ARE tough times. They are also embracing a range of new technologies that help them recover some of the spontaneity and confidence that are often the first casualties of this condition.

What neither the D-community nor Joe-Public needs is the kind of ill-informed, casual, misleading remarks that return us to the dark ages of Edwina Curry and her salmonella-triggering eggs.

I suggest that Matthew Wright sits down to a decent-sized portion of humble pie this Easter and takes the time to issue an apology to a whole community that he has deeply offended.

Open Letter to Matthew Wright

Dear Matthew,

As I fired up my Twitter account this evening because of the conversation flitting around social media about the comments you had made about 'diabetes', I was intrigued about what you could possibly have said to rile a whole community so.

I navigated your Twitter feed and could see that many had not seen the item on today's 'The Wright Stuff, show which had sparked such controversy.  You invited the diabetes 'trolls' (as you referred to them) to go and watch it, so I did.

Which part was it, exactly, that you wanted me to watch before making any ill-informed remarks?  I don't intend to put forward any fallacious points so please, let me be sure we are on the same page. Was it the part where you asked, "Does every little child deserve a tooth-rotting, diabetes-triggering chocolate egg at Easter?".  Or was it the phone-in during which regular insinuations were made that chocolate Easter eggs could, according to your opening link, 'trigger diabetes'. Which ever part it was, I watched it. 

It doesn't surprise me when people ask me if I got diabetes from eating too many sweets as a child, because most of the world is poorly educated on the subject of type 1 diabetes.  It saddens me.  It saddens me immeasurably - but it doesn't surprise me.  Truth be known, I am not someone who usually alights my soap box and gets all together vocal about this issue because I understand completely why they don't: their lives have not been touched - or devastated - by type 1 diabetes.  What do I know about sickle cell anaemia?  Nothing.  What do I know about Leukaemia?  Nothing.  What do I know about multiple sclerosis?  A little, because my life has been touched by it. But then Matthew, I am not the host of a current affairs television programme which invites the viewer to join in and broaden their minds.  Neither are the people who make their badly thought-out and even more poorly delivered comments to me in their attempt to sound interested in something they can see affects my life so greatly.

Perhaps I am not giving you enough credit, Matthew.  Because it seems highly unlikely to me that you find yourself scrolling through hours of peer-supported reviews and up-to-the-minute publications of an afternoon, in order to prepare the auto-cue wording for your daily show.  I find it much more likely that someone on your production team does this.  Sadly, that person has failed to do their job to even the most basic of standards.  Had they searched the Internet for even 10 minutes they would have been able - very clearly, very easily, and with great accuracy - to understand that chocolate does not cause type 1 diabetes.  In fact Matthew, according to the Guardian article you posted on Twitter in an attempt to back up your 'argument', it does not cause type 2 diabetes either: sugar may be linked to Type 2 diabetes, chocolate is not.  And neither is linked to type 1.  

It is a sad indictment of our society that a current affairs show with you at the helm, can make such a foolish, careless and stigma-laden comment. But perhaps the saddest thing of all is that when you were challenged on Twitter and asked to recognise the seriousness of type 1 diabetes, and in doing so think about the way you might feel if it was your own child carrying the wildly-inaccurate but oft-used label, your response was "I can think of worse".  Yes Matthew, I imagine there are worse things than type 1 diabetes.  I imagine holding your dying child in your arms is worse.  I imagine Gerry and Kate McCann would give anything to have Madeleine back, even with diabetes.  But does that in any way diminish the devastation that type one diabetes can have on whole families?  Do you know what that diagnosis really means?  Do you understand the dangers complications and minute-by-minute attempts to manage it?  Do you understand the way a parent feels when their child is labelled as having 'deserved' their type 1 diabetes, because mainstream media continues with such vigour to report this utterly erroneous nonsense?  I doubt it.

And let me tell you this, perhaps the greatest irony of all in your item today; chocolate is good for people with type 1 diabetes. In fact, it is an extremely useful tool in the diabetes arsenal. You see, the fat in chocolate causes a slow, steady and reliable release of the energy within the snack; something diabetes specialists know, and now recommend as a snack for anyone whose blood sugars have a tendency to drop at a certain time of day.

In fact Matthew, having watched the show, seen the tweets and really thought about my response, it is this which I have asked myself the most: why even mention diabetes?  Neither type 1, nor 2, was a discussion point of the item.  Neither one is linked to eating Easter egg chocolate (which has about as much 'sugar' in it as a bowl of fruit and yogurt).  And neither one would have made the piece about Easter eggs and whether or not they should be given to children, any more relevant. 

What it did achieve was to demonstrate that The Wright Stuff is willing to use a medical condition - one fraught with stigma, misrepresentation and which (quite clearly) not enough is known about - as a way of making somewhat mundane links sound sexier.

Sadly, my only experience of your show will be both my first, and last.

Yours faithfully,

Anna Presswell

Say HOW many carbs?

It's easy to get complacent with type 1 diabetes.  On a daily basis the disease demands frequent blood testing, carbohydrate calculations, preemptive dosing, correction boluses and walking the tightrope of 'too high' and 'too low'.  It's a fine line, oft stepped over.  But as it has featured as part of my life for the last 27 years I have learned to guestimate much of my foo - usually with a fair amount of prevision - making much of  daily my life easier.  On average a bowl of pasta is 7.5 units; an omelette, 1.5 units.  For the most part I successfully navigate my way through the day with only the occasional mistake.  But guessing because you need to, and because you are being lazy with your approach to diabetes, are different things.

I have a smartphone - one equipped with just about every diabetes app going which makes eating out almost impossible not to carb count, if I wanted to.  Yet this week, when I met up with everyone's favourite Ninja and sat enjoying my Costa Chai Latte in the sunny harbour of Gunwharf Quays while putting the world to rights,  I wasn't quite giving the 'due care and attention' to my diabetes that it demands.  Having not been bothered to spend time on any of the resources I have to hand, more interested in catching up with friends, I threw a somewhat reserved 2 units at my super-sized lactose-swamped treat, because I wouldn't want a hypo to ruin the lovely glucose trend I'd been sporting that morning.

Around 40 minutes into our coffee and conversation, I started to feel the tell-tale muggy head, heavy muscles and strange sense of smell of a high blood sugar creeping in.  I glance down at my CGM receiver in my hand and...wait...what the?  14.1 mmol and rising very fast? I was 5 mmol when I got here!

I dove into my bra for my pump (present company of course being one of the few I can do this with!) and bolused another 3 units.  But I reeeeeally wanted another coffee because it tasted so good (that should have been my firest major clue that this would be more than a 2-unit treat...) so I gave in and racked up another.  This time I took 4 units - because I wasn't going to be making that mistake again!

As Ninja and I bid each other farewell and went our separate ways I started to wonder... what if the sweet tasting delights of the Chai Latte were less about spices and more about sugar?  It was very sweet, after all.

I finally instructed the brains I was born with and used the technology in my hands to tweet Costa in the hope they may pick up my question but, without response, I made my way onto their website.

It's times like these - when realising I have unwittingly devoured 175g of carbs (which should have been around 17 units of insulin and for which I had given a pointless 2) that I remember that I cant't get complacent with diabetes on board.  Even my 3 unit correction barely touched the sides of the first coffee, let alone the second. And no wonder I eventually danced with 20 mmol before finally the food wore off and the right correction was given.

I have to remind myself of the hidden carbs that most processed foods have in them, and that while it's OK to have these treats, it's not OK not to bolus for them.  Lesson learned Costa, lesson learned.

Do you get complacent and pay the price?

LivLife: suitable for diabetics?

When I heard about a seeded batch of bread sporting the catchy name 'LivLife' and purporting to be suitable for diabetics, I was just a little cynical, truth be told. I've eaten foods claiming to be 'suitable for diabetics' over my 27 years with T1 and have either learned the hard lesson of just what too much aspartame sweetener does to 'diabetic' chocolate, or learned the even harder way just how many carbs there are in 'diabetic' jam (around 60% of it is still pure sugar, in case you were about to make the mistake of slathering it on a piece of bread as a 'diabetic' snack.  See also: enough glucose to power a rocket).  But I do take genuine delight in a slice of bread - particularly anything anything close to a farmhouse seeded or granary kind. And there are many times when a sandwich, slice of toast or crumbly croutons would go down a treat.

Sadly most breads, even the seemingly 'safe' varieties like wholegrain pittas which have a GI score of around 57 (55 and under is considered low GI), seem to have an aggressive effect on my BG levels and turn even a saintly salad-filled lunch into a must-be-managed afternoon crisis.  So much so that in recent years I have all but given up on any kind of carb-wielding slice of bread.  

The problem is, there are only so many salads you can eat before you've tried them all.

My first impressions of LivLife were good.  There were seeds bursting from the loaf and the smell of fresh, high-quality bread overwhelmed my senses as I opened the bag and peered inside.  The slices were small, but not too much so.  In fact, two slices together make a perfect-sized sandwich to take to work.  Actually I take two; because it tastes that good.

But the real test, beyond any pretty packaging or delectable aromas, is the impact on glucose levels. A blood-sugar bashing treat is one thing, but a daily lunch choice needs to be something which won't cause repeated post-prandial spikes that cause HbA1cs to jump around and complications to come a-knocking.

LivLife claims to be suitable for diabetics because it has half the carbs of other breads - in fact, it claims to have as little as 3.8g carbs per slice!  So a sandwich of two slices with a low-carb veggie or protein filling, should be less than 10g carbs per sandwich!

This week, I put my LivLife to the test and experimented my way through lunch breaks to see just what happened with the so-called 'suitable for diabetics' bread.

The CGM trace below was a trace I had after eating two small wholemeal pittas with bacon and avocado salad stuffed inside and a smattering of mayo to give it some 'yum'.  I had bolused 20 minutes before I ate, ensuring I'd allowed time for the insulin to hit my system and become active before I devoured my well-earned lunch.

Within just one short hour of my (supposedly healthy) lunch the beautiful straight line I had been admiring all morning was gone after my 2pm lunch break and was replaced with a vertical sky-climber.  I tried this lunch three times with tweaks (once with more insulin; once a little earlier - which resulted in a nasty hypo pre-food).  This is not the way to enjoy food.

After too many frustrated days in a row I gave LivLife a whirl, and was presented with this:

Now this is a CGM trace to enjoy! 

This time I put the same accompaniments (bacon, avocado salad with mayo for yums) into two LivLife sandwiches, and the result was fantastic!  In case you can't tell, I bolused at 12.45pm and ate at 1pm. Both days I started at a respectable (but slightly high pre-meal) 8 mmol, but the outcome of removing most of the carbs but still enjoying something more substantial than just a salad, was a CGM trace that meant I wasn't going to be chasing corrections all afternoon.

So there you have it: LivLife really is suitable for diabetics, and even comes recommended by one.  If you are someone who likes to put away Joey from Friends kind of sandwiches you may need to make yours a triple-decker because the slices are about three quarters the size of a 'standard' loaf, slice.  But considering the carbs in a  modern standard slice are often nearing the 20g mark, and LivLife have managed the same taste and satisfying hunger-buster with just 3.8g carbs (with 2g fibre!), I think I can live with that!

You can get LivLife in Morrisons (only selected stores so find your most local one) and Ocado, where it should be in with all the other breads.

Let me know what you think in the comments or on email, and enjoy!

Letting go of control. Sort of.

When I was told, after years of what felt like a distinctly twisted relationship with food, that I had what's called 'Binge Eating Disorder' there was an immediate sense of relief that washed over me.  How I would ever pick apart what went wrong all those years ago when I was diagnosed with diabetes, and had to immediately impose strict rules around food and exercise as a young child I couldn't - and still don't - know.  But the knowledge that someone was willing to help me address it felt like a huge step in the right direction.

This week as I sat in the initial session and learned about the guided self-help approach that we would adopt and the time-frames we would aim for, the inevitable question of losing weight came up.

"Am I still able to try and lose weight on the programme, if I am doing it healthily?, I enquired.   "Only my husband and I are travelling soon and I have a beach holiday in August." 

"Well, we will monitor your weight, but to follow any kind of programme or impose the kinds of strict rules that you inevitably break and end up bingeing over, works in the opposite way to the way we would like you to start moving, so it doesn't work alongside this programme.  If you wanted to focus on dieting, we could always pick up the programme after you lose any weight you want to."

I was suddenly aware that this huge step in the right direction I'd been offered could be completely pulled from under me if I tried to lose weight during the treatment.  And I knew that wouldn't do.

"OK sure, so losing weight isn't a problem per se, but I can't be doing any structured weight loss.  That's OK."  I said out loud.  

"Anyway, I'll probably lose weight if I stop bingeing anyway.  Especially if I focus on eating only healthy food." I told myself in secret where the psychologists wouldn't know.  "Wait, they just told me I can't try to lose weight, so I need to stop thinking about it!".  

As I got home, thinking about the session today and about the thought of letting go of trying to lose weight I found myself forever going back to the thought of being out of control of weight loss.  

"Maybe I can just try and follow diet principles and then the sessions will help too?" I told myself.

"No!  Stop it!." 

I argued with myself throughout the day.

"I don't need to focus on losing weight!" the angel on my right shoulder told me, "It's OK because it will happen because you will be following THEIR programme!", told the devil on my left.

As I found myself changing the settings on the MyFitnessPal ap so that no-one would know that I was still counting calories I realised, I am a control freak.  Perhaps only about food because this is the beast we are trying to slay, but I was going to have to let go of this desperate need to control my food if I was ever going to get over the binges that inevitably follow periods of restriction and rules.  That's why I'm here, after all.

For 20 years I have used weight, diet and scales as sticks to beat myself with and as a means of making myself feel inadequate. Now, for the first time, someone is taking that control away from me.  Of course I am panicking.  The dream is that in three or four years I will be a healthy weight because I no longer obsess over food.  Granted, as a person with a medical condition that requires constant assessment of food, both before eating and when looking at the after effects, I will never be able to be 'thoughtless' over food.  But the only way I will be able to let go of my need to limit - and lose control of - my behaviour around food, is to view it in a different light.

So gone is the BMI calculator on my iPhone.  Gone is the MyFitnessPal app that I was so keen to hide from friends who may know that I shouldn't be trying to diet. And gone are the diet apps that would dictate how 'good' or 'bad' my day had gone. Gone is the weight tracker that places me in the 'red' category each time I weigh myself. Gone are the sticks.  Gone are the beatings.

And the beads of sweat will subside, I'm sure.