Keeping my eye on...erm...my eyeballs

When my eye care was transferred from the community clinic to the retinopathy specialist in the Summer of 2009, I didn't really understand what that meant.  Rather, I understood it - the fact that something about the condition of my retinas had deteriorated - but I didn't really understand the implications of that referral. I figured that at 23 years of having had T1 diabetes, this was fairly standard procedure and that changes would, perhaps inevitably, always happen. 

I have never resigned myself to any particular 'fate' with my diabetes.  And since becoming an adult and emerging from my teen years (see also: total disengagement from all forms of clinical care), I have strived to take care of myself. But when you have T1 diabetes you have to learn to face up to the fact that complications may happen.  Although good blood sugar control is widely accepted as the most effective way of reducing the risk of complications, it does just that; reduces risk.  It could, and might, still happen.

As part of that referral my appointments were ramped up from every 12 months to every three, and I no longer saw the friendly nurses at the clinic in a matter of 20 minutes as they photographed my eyeballs and sent me on my way.  Instead I moved to two-hour appointments with an hour-long wait with one of the senior Consultants at Queen Alexandra's Opthamology department, a quiet but personable man known to me only as Mr Booth.  

It wasn't until around a year after I first attended, and 6 months after starting my insulin pump journey, that I started to really ask about what 'all this' meant.  Mr Booth explained to me that a number of years of high blood glucose (BG) levels had left damage to my retina.  He told me to imagine that I had been scratching away at the same spot on the back of my hand, and that eventually that scratch would bleed.  He explained that BG levels over recommended levels (as opposed to the 'non-recommended' ones I had been having fun with) left this kind of damage on the retina.  He explained that my non-proliferative retinopathy (small bleeds) were not too great a risk at first, but that they were beginning to change and I was now considered at the transitional stage to proliferative retinopathy. In human terms, this means that in order to cope with the changes in my eyes, my body would start to grow new, smaller, weaker blood vessels, and that when these break from the incessant scratching I so loved they would leak larger, more damaging amounts of blood onto the retina.

Mr Booth gave me some trusted resources to go to to learn more, and always asked me to continue my hard work.  He was always kind and gave me the truth.  Sometimes that was a hard truth.  But I'm not a 'sugar-coat it' kind of girl (mainly because sugar was not about to help this situation.  Pun-tastic, yah?).  I like to hear it as it is.  It makes me take things more seriously.

So why is retinopathy so serious?  Well, this is why. When the capillaries begin to bleed the vision you are left with until blood disperses (which can take weeks) looks something like this:

As I'm sure you can imagine, life through these eyes is a damn-site tougher.  There would be no driving.  Everything from shopping to working, and cinema to time-telling - everything - would be a challenge.  And it wasn't a challenge I was ready for, or ready to accept, anyway.

I knuckled down, exercised, mastered my pump, bought myself CGM and worked really hard at my diet to find more blood-sugar friendly foods. And I secretly prayed to a God I don't believe in that things wouldn't get any worse.

Dilated pupils.  And approximately four-inch-long lower eyelashes?

January 2014 would mark four years since I first asked Mr Booth what was going on.  January 2014 marked the four-year anniversary of pumping.  And January 2014 also marked the time I was able to rejoin those nurses at the community clinic.  Today marked my annual eye-dilation and photo-shoot and the evidence was there; after four years of constant efforts to keep things on a tighter leash, my eyes have finally shown the progress the Opthamologist needed to see in order to sign me off from their intensive service.

My latest set of eyeball photo-shoots evidenced that not only had I been able to stave off the transition into established proliferative retinopathy, but I had also managed to reverse the damage and put myself fully back into non-proliferative retinopathy (also known as background retinopathy).  And the better news still is that background retinopathy can be reversed even further, returning to a normal, healthy eyeball.

This is, of course, my new aim.

Cateract.  Sparkly.

My cateracts are still in full swing (another complication of diabetes: it speeds everything else up), but they are operable and not something I worry myself about at the moment because I still have
what they call 20/20 vision.  

Complications can happen, and I will be ready for them if, or most likely when, they do.  But in the meantime, if you've been diagnosed with retinopathy and think 'well that's it', (because that's what we are often led to believe), that's not it.  There are ways to reduce your complications and give yourself the best chance to stay complication-free as long as you can. 

Wanna get intimate?  Then check out my balls.  

June 2009.  Haemorrhages showing on the left side of the eyeball (red dots)

January 2014.  Haemorrhages vastly reduced and showing signs of reversal.
And a much healthier looking eye all-together.  

Diabesity: one small hashtag for man, one giant leap in the wrong direction for mankind.

Diabesity?  Really?  Giant. Step. Backwards.

#diabeteseducationcirca1954

New year. New pump.

An insulin pump becomes a part of you when you wear it every day.  It becomes your friend; your partner in crime; your invisible ally; and even your enemy at times. But it is a part of you, come what may. 

As this blog turns four years old on January the 24th, having been started the day before my pump journey began, the time has come for a new pump to be chosen. Pump warranty lasts for four years. And as this has proved such an effective self-care tool for me (with a million pointers from my long-suffering (but well paid) team, and lesser-paid members of the DOC) I have earned the right to keep this tool, according to UK standards.

The way I see it I have three viable options. 

My Paradigm Veo has been my lifeline for the last four years and I could not rate Medtronic, the company behind it, more highly. Their customer service is second-to-none, their technology superb and their customer engagement on the up all the time. But pumps have what the world likes to call,  'Unique Selling Points'. Much like a car, phone or long-desired gadget you may still be delighting in after Christmas, there will be something about each pump that best suits your life and your needs. 

When I started the Veo I still didn't fully understand the mechanics of Continous Glucose Monitoring (CGM), but I knew that Medtronic were the only company offering this in the UK, which is why I so wanted one; just to have that option. Patient choice.  The pump teamed with CGM has a low glucose suspend feature which, if you suffer from unexpected hypos - particularly overnight - is a godsend. 

But, travel a few years forward and having tried the Enlite CGM and come to learn about the Dexcom system which people seemed to so rave about, I fell in love with the Dexcom way of doing things. And this was the system I ultimately chose. Given that fact, perhaps the USP of the Veo isn't quite so relevant to me anymore? 

My second option was to go tubing free. You know those people who say the tubing is no big deal? Well, I. Am. Not. One. Tubing is the bain of my life and for me, the one part of pumping which pisses me off. Anyone with cats will understand  the kitty playground you become during set changes. Anyone with doorknobs in their houses beware, should even an inch of tubing escape from your waist area, be prepared to learn what 'involuntary tubing-induced reverse' feels like. 

The Omnipod is the only tubing-free patch pump system available in the UK, and since the upgrade to a newer, smaller pod, is freakin' tiny! It's about a third the size of normal pumps and can be place anywhere on the body you can inject, being controlled with a wireless remote-control. Sex. Ee. 

My experience with Omnipod all those years ago when they first landed on our shores was not good. I won't go into it again but they seem to have turned a corner. This time my demo pod arrived only days after my enquiry with a bright, bubbly letter. Their communication has been good and word on the street is their popularity is growing all the time. 

But I keep a close eye on their Facebook group, because I'm a nosey PWD who likes to know what's going on, and the frequent complaints about pod failures, some people claiming up to 10 month (seriously?!) is something I can't overlook. You see, the next pump I wear will, I hope, bring me through at least one safe pregnancy. I have been using steel cannulas for a year now because Teflon ones kink like a bitch, and switching to steel ones means I've removed that risk factor all together.  Omnipod don't have steel cannulas, a USP I have come to rely on. 

Perhaps that's why, despite its attraction and apparent popularity with Omnipod converts, I haven't even taken it out of the box. It still sits neatly in my (rapidly growing) diabetes drawer under the bed, still resting in its case. (By the way, anyone else's bedroom/kitchen/living room drawers being taken over by diabetes paraphernalia?!).

So I have one last option: the Vibe. The Animas Vibe is a tethered (meh) pump, but it has several features which - for me, for now, for my life -  make this one a major contender. Firstly, the Dexcom I so treasure can now be integrated onto the screen of the pump in exactly the same way that the Veo's could all those years ago. Granted, I have a (very expensive) handheld receiver that I prefer to use (easier during exercise/work meetings/dates/driving) but like those steel cannulas, I have come to rely on my Dex so much, and plan to make it a huge part of my diabetes management during pregnancy, that if anything were to happen to my handheld receiver I would be screwed. We can't afford another one, end of story. So as with the Veo all those years ago, if the worst were to happen and it broke/got stolen/ran away to Rio, I would have the back-up option of my pump which can act as a receiver and display the information to me. 

Secondly, my husband Jamie and I hooked up because of a surfing holiday to Cornwall. It was one of the fondest times of my life and for three years we went back every year to the same place, and beach, where we became a couple whose futures were intertwined. Problem was, with an insulin pump that was barely splash-proof, I had to go without insulin for the 4 or 5 hours we would be at the beach, and sure enough each time I would have angry tell-tale high BG readings for hours afterwards, making it an increasingly miserable experience. The Vibe, you see, is waterproof. Problem solved. We could surf again. I could Kayak without trying to squeeze my pump into waterproof cases that barely work and worry the whole time that splashes of water may render my pump useless. The Vibe, solves that problem. 

It also has steel cannulas. And a customizable food database ready for (*squeezes eyes shut and prays to a god she doesn't believe in*) a pregnancy. 

Have you lost count of the USPs yet? Yeah, me too.

The choice was obvious to me, too. 

I've been hooked up to my cutesy, pink, pumpette now for 48 hours. Unlike my initial learning curve of 'ohmhgodIpressedthewrongbuttonamIgoingtobreakit' when I first plugged in the Veo,  I have learned that the way a pump functions is pretty much the same from one pump to another. A bolus is a bolus; a temp basal is a temp basal. There are, I guess, some features that seem awkward to me because the vibe does them differently to the Veo. Mechanics are louder on the vibe but the screen is easier on the eye. Some menus are more complicated, some things are much easier to find. I know that familiarity will come with time. In a matter of weeks, maybe days, I will forget the 'old' pump and simply remember the new. 

So here she is, the still-nameless-but-rather-beautiful, bath-tubbing, Animas Vibe. 

And so the next leg of the journey begins. 

The mandatory Animas water action shot

2013: Making friends with Sir Steve Redgrave, The World's Smallest Emergency and turning 27

As we say goodbye to the year just passed and welcome in a new year one, I thought I'd run down the fun and frolics I got up to this year as part of my blogging travels.  So here it is, what Insulin Independent published this year:


In January my life was for a very small moment placed in the greatest of danger (see also: not really) when my body went to battle with an evil cannula, taking with it a fair share of my blood supply.  Luckily, I made it.  It was indeed the world's smallest emergency.

By February I'd had enough of the daily grind that diabetes entails and did what any girl in my shoes would have done; I went shopping.  Fortunately my lack of interest in handbags or shoes meant hubs was happy for me to buy myself a Dexcom with our hard-earned wine and beer money.

In March I attempted my first ever VLOG about steel cannulas.  It went well, I think.  See for yourself.

April saw me climb up a Scottish hill and recorded myself trying to master diabetes at the same time. And I rocked some charming head-gear.

May brought with it the delights of the Animas Sports Weekend.  This time I was asked to stand up and tell my story, one of weight-struggles, diabetes and how I used the skills Animas and Dr Gallen, Sir Steven Redgrave's personal physician, brought me to help start shifting my less-than-lovely love-handles.

In June Insulin Independent interviewed the crazy (but lovely) Roddy Riddle, who competed in the world's toughest foot-race with type 1 diabetes.  Although I doubt we'll ever be jogging partners, I'm still in awe of Roddy's inspirational journey.


July saw old faces, ones long moved-on from my diabetes clinic, come back into town.  Faces who reminded me of my years growing up with type 1, and how their support meant I didn't turn into a total basket-case. Not a total one anyway.  Yet.

In August I took on the deeply profound and socially important subject of face-cannulas.  Be prepared. 

By September Sir Steven Redgrave, arguably Britain's greatest Olympian, and Insulin Independent were on first name terms.  Weeeeelll, in fact he kindly took the time to share some thoughts on his journey with diabetes, and share wisdom on what Dr Gallen helped him achieved.  

In October the bright lights of Barcelona beckoned as myself and some of my favourite diabetes bloggers from around the world met as a group to talk about all things diabetes. My highlight of the weekend (other than the many delicious Spanish wines I tried) was talking about what we

hoped to achieve in the next year. 

In November I bared my soul about my issues with food, overeating, and struggling to battle my diabetes demons. The love you showed me in your emails, in person, and in your comments, overwhelmed me.  

And to round the year off on Christmas Eve, I turned 27.  And looked back at the journey.

Thank you for joining me.  Happy New Year and here's to 2014!

27

Dear Anna,

I found some photos of you today.  Your mother showed them to me after she rediscovered the scrapbooks she lovingly created of family life as you and your brothers were growing up.  As I flicked through the cataloged memories I came across a few of you. You don't know me, but one day - in say, 27 years or so - our paths will cross. Our journeys are intertwined my friend, and I have some things I wanted to say to you.  

You are three-and-a-half in this photo and what you lack in arms you more than make up for in undeniable sweetness. You are cute as a button and starting to learn it.  You are knee-high to a grass-hopper and so very 'new' in comparison to the world you live in. Your wisps of golden brown hair are still delicate enough to be highlighted under the glow of the Summer sun.  You are learning to pose for the camera and are sporting your own version of the Baywatch bikini.  You are working it, kiddo.  

You are healthy, happy and care-free - as every little girl should be.

It is Christmas Eve 1986 in Germany now, and you are four years old.  You have inexplicable taste in clothing colour-schemes and your parents have clearly favoured the beginnings of a mullet as your hairstyle of the moment.  I'm sorry, I'm not here to help you with this but to deliver the message that it will make a fantastic conversation piece in a place called 'the Pub', a few years down the line.  You're friends will love it. 

It is a special night because tomorrow is Christmas morning; the morning every child lives for.  But you are also tired.  It is an alien tiredness - one that doesn't come from playing too long or running too far.  It consumes you. 

For you, this night will change the course of your life forever. Because tonight, in just a few hours time, you will be taken to hospital, somewhat aptly named 'the ill house' in German, where you will be diagnosed with type 1 diabetes.  

I am sorry.  A million times, I am sorry.  Your parents had already been told this was a possibility at the start of the week but were sent home to play the waiting game. They don't yet know what this truly means but they won't have to wait any longer. Tonight, on Wednedsay, December 24th, 1986, diabetes arrived.

I wish I could make you understand that it's not your fault - you didn't do anything wrong.  And I am not here to take it away - I wish I could.  But that too would change the course of your life.  It would take you away from what you will become, which -  red bikini, mullet and all - is something you can be proud of.  What I can do is give you a 'heads up' from somewhere down the line.  I can make a you a promise; that everything will be OK. 

The man helping you light that candle is your father.  He and your mother will do battle with diabetes, armed only with insulin, syringes and urine testing strips to keep you safe, with a conviction only they and other parents can possibly understand.  They rule your diabetes with an iron fist and walk the perilously narrow tightrope between 'too low' and 'freaking high!' on an hourly basis, because have been warned of what can happen to you if they don't.  The threats they have been given are too much for you to bear so for now, they carry that burden alone. They will make it a big enough part of your life that you take it seriously, and a small enough part that it doesn't become something that defines you.  Quite rightly, you have no idea how hard they work to keep you care-free. Your mother will continue to embrace you, console you, encourage you and challenge you to do the best that you can in your diabetes care, forever.  Even when you have moved away and turned your back on the home she once made for you, she will offer you her warmth to help cradle you from the hurt diabetes can cause.  Never stop saying 'Thank you', even though she doesn't ask.

You are eight, and you have now lived as many years with diabetes as you did without it.  You no longer live in Germany, having moved 'home' to England at age 7.  You have started school and now holiday with your father in Germany in the Summers, choosing to spend most of your time with your friend, Davina.  You have known her since you were both six months old, your birthdays only a matter of days apart. You have also developed a nasty habit of faking hypos in front of Davina, because the attention she gives you makes you feel special.  Davina is courageous, bright and ever-devoted to you. When she sees you go hypo she wraps her arms around you, flags down strangers for help and runs to get your brothers.  You can still recall her being at the end of the table in Kindergarten when the medic had to treat you.  That hypo was very real, very frightening and she was there - I can remember her hand on your foot. Be warned that your hypos  - the real ones - also frighten her. You will grow to be ashamed of this and the first time you have the courage to admit it to anyone, will be in a blog post on the anniversary of your diagnosis.  But I forgive you, Anna.  I know that you are confused, immature and in many ways, still hurting.  I also know that this friendship will endure.  To this day she remains your friend.  You still write her letters (although they are called 'emails' these days) and every time you see her she welcomes you with her kind, warm arms. Be grateful for her.

You are 11 now and making your way up to secondary school.  Over the next few years you will begin to take control of your diabetes yourself; administering insulin, doing blood tests and taking hypo treatments.  You have stopped faking hypos.  But in this part of your journey you will begin your troubled relationship with food - one which will stay with you until a time I have not yet seen.  The tight ship that your parents sailed when you were a child means that you have escaped all complications and appear to be carrying that on.  But you now have a focus on food that secretly hides compulsion and anger.  You will feel the darkness of depression. You will hate yourself at times because you use others as your yardstick.  

This. Will.  Not. Do.

Your weight will swing, as will your focus on health.  You will lose weight in your teens by over-exercising and under-eating, and you will dabble briefly with slimming pills.  But in your late 20s you will turn a corner.  You will learn how to exercise safely with diabetes and you will begin to understand just how and why your battle with weight is so much more complex than someone without your condition. Eventually, you will stand in front of 70 people and tell them about your journey.  In this moment, you will feel only pride.

You will also meet a girl at school.  A girl named Lauren.  Your friendship with Lauren, as with Davina, will be one that endures.  You will see highs and lows, share heartache and joy and eventually when you are 31, she will ask you to be in the room as she welcomes her son, your Godson and nephew, into this world.  This will be the most emotional and beautiful moment of your life.  Your journey with diabetes will be softened immeasurably by the patience, understanding and empathy that this girl will show you.  She makes it seem as though she knows exactly how you feel even though that can't be true.  Remember to reciprocate.  

Only real men wear tutus

You are now in your 20s.  More than two decades with diabetes have passed and you have met someone - someone who will become your husband.  Playful and kind, he will learn the mechanics of diabetes faster than you ever did. Within weeks he will understand hypos, carb counting and daily must-do routines that most young couples don't need to concern themselves with.  You will praise him for this, but not enough.  No praise for the burden he also now bears will be enough.  He will see you in hypos that both frighten and enrage him.  "Why does this have to happen to her?"

When you tell him that you are going to start wearing a piece of medical equipment on the body he so loves, piercing it with cannulas and monitors, he takes it in his stride.  He has plans for when you're 80 and he needs you around for them, so he embraces this change with open arms.  He will joke with you that it's his 'girlfriend remote'. This makes you laugh. To this day, he makes you laugh.  

You will have to talk to him about pregnancy and how hard that journey might be.  He goes with you to your pre-pregnancy appointment and holds your hand, because he understands how scared you are.  You will watch the pregnancies of others play out, wondering if you too will share the same wonderful journey of becoming a parent.  That, I can't answer for you yet, but there is no man in the world you would rather try with.  Just so you know, the man in the tutu is not your husband.  It just felt like a good time to tell you that only real men wear tutus; remember that.

You also start a blog.  The day before you start using that bizarre medical device that you probably can't even comprehend yet.  This project becomes your greatest achievement yet (other than actually getting to adulthood.  Well done, by the way). You start it for God-knows-what reason, but it becomes something that connects you with a million voices around the world.  It will become the saving of you.  

As for me?  Well, you and I will never meet, yet already we know one another.  We have shared a journey, yet the person in the photo has yet to walk my path.  We move in the same direction, but will never be in the same place at the same time. Just know this:

It will be OK.  

Type 2 taboo

I've had type 1 diabetes for almost 27 years and by the measure of time alone, I am an expert in it. I have lived each second, minute, hour and day since I was four years old with it. I will proudly posit that I know more than the world's greatest medical experts because when their day in the office is done and they put down their textbooks, journals and award-winning research and head on home, I don't.  I continue to live with it and feel it, each moment.  

That said, I am in the somewhat unique position that as a person who is obese and has struggled immensely with my weight ever since the diabetes diagnosis darkened our door, I have the opportunity to see a glimpse of the world through the eyes of a person with lifestyle-induced type 2.  I know what it's like to be obese;  I have eaten in secret because I worry what people will think of the 'fat girl' in the corner eating a burger; I have hidden myself from my husband's eyes - and touch - because I'm been ashamed of what I've become;  I've opened myself up and confided in you the psychological warfare I go into each day with disordered eating.  

'Stigma' is a word on many a tongue these days.  It is used in a way to suggest those fighting it are spear-heading a new and forward-thinking world.  We are crime-fighters out for a better world. We talk of changing futures, improving lives, turning pages; of poor media reporting and misconceptions; of re-education and using the global community as the step forward.  And yet, all you have to do is tiptoe into many diabetes forums - forums filled with wonderful, open-minded people - to begin to see that stigma is rife in our very own community.  

The language oft-used to talk about type 2s makes me hugely uncomfortable.  Because if I didn't already have type 1, I would most certainly be at risk of type 2.  It is this blame that I find so raw.  As if the guilt society places upon the overweight for not fitting into an acceptable dress size isn't enough, they are forced too to live with the guilt of having 'brought diabetes upon themselves'.  

"I won't have people thinking I brought it on myself".

"I have no sympathy with people who ate themselves into diabetes"

"I didn't deserve this, I didn't do anything to get this."

Of course you didn't.  None of us did.  But can we really sit there and say that someone with T2 as a result of disordered eating 'brought it upon themselves'?  Is it ever that simple?

In exactly the same way that someone without diabetes cannot possibly imagine how it feels to live with it without making wild assumptions, nor can someone without first-hand experience of disordered eating possibly try to imagine how it feels to have deep-seated issues with food.  It is never just a case of fat, lazy slobs eating too much and giving themselves diabetes. To think so, is to be blind to the truth.  People don't sit there and 'give' themselves diabetes; no-one would make that decision.  And if they got it from abusing food, we should be asking the right questions to understand why!

What do they go through every day?  

Why do they eat this way?  

What happened to them?  

Do they have anyone they can talk to?  

Could I help them? 

Only 70% of people with type 2 are overweight.  There are 30% of people 'tarred' with the unhealthy lifestyle brush too, just as people with type 1 are. But the answer is not to distinguish between those who got it from eating too much and those who didn't - the answer is to reach out and ask WHY they live and eat the way they do.

Perhaps I am so focussed on this issue because this week I sat with my dietician and cried as I begged her for help to address my disordered eating.  Perhaps it is because I am tired of seeing people coldly blame people with type 2 for the poor media reporting of diabetes.  Perhaps it is because I understand what it feels like to feel powerless around food.

Either way my feeling is this; people with type 2 diabetes brought on my over-eating or unhealthy lifestyle did not 'bring diabetes on themselves'.  Diabetes is a by-product of a lifestyle they live and no-one has the right to judge, mock, discriminate or wag their finger at anyone with lifestyle-induced type 2, without first walking a mile in their shoes. No-one.

And until we can rule out stigma within our own communities, we can never truly do so to the rest of the world. That journey starts at home. 

What do you think?  How do you feel about the stigma surrounding diabetes?

World Diabetes Congress 2013: standing up to stigma and starting projects anew.

When I heard that my friend Carrie Hetherington, from Tauranga, New Zealand, was heading to the World Diabetes Congress in Melbourne, I acted sharpish to make sure that she would be the first guest-poster to grace the pages of Insulin Independent.  

Carrie was the first ever person from New Zealand to become a young leader and is known not only for her dedicated campaign to change New Zealand policy of providing only one brand of glucose meter for all, she also recently won the World Diabetes Day essay competition about the future of diabetes in Nigeria. 

Making waves?  You bet.

Carrie kindly put into words what this event, and the sometimes heart-wrenching information she learnt there, mean to her.  Enjoy...

It's very hard to put the experience of a life time into words. How do you express what it feels like to spend 10 days with over 140 people from 73 countries who have diabetes? People your own age, people just like you. Testing, injecting, carb counting, listening, supporting one another, being understood in a way that only other people with diabetes can. Before I left I worried about being the first ever young leader from New Zealand, little did I know I was about to walk away with precious friends, unforgettable memories and a lifelong global family.

I was lucky enough to represent New Zealand at the November 2013 International Diabetes Federation Young Leaders Programme and the World Diabetes Congress in Melbourne, Australia. The first 5 days involved sitting through intense seminars from morning till night, working during lunches and dinners and taking short coffee breaks. We immersed ourselves in diabetes. We should have been exhausted, but we were running on adrenaline and enthusiasm, we absolutely loved every second of our sessions.

In the remaining 5 days we attended our own selected seminars at the World Diabetes Congress. People of all statuses attended lectures together and I found myself chatting to CEOs, the heads of major pharmaceutical companies, even global leading diabetes specialists. These situations would never happen for young leaders outside of the conference, we were all blown away that people of such high regards wanted to learn about our upcoming projects and had seen us walk on the stage during the opening ceremony. Being at the World Congress taught us how to advocate diabetes, how to put our condition on the map, effectively support our own countries and then extend that internationally. We were taught to change the world.

We spent days learning about the incredible research happening at a global level - the artificial pancreas, genetic testing and the latest diabetes management technology. We even had the privilege of hearing from Dr Fran Kaufman, who truly believes there will be a cure in our own lifetime because their trials are getting so close to that final step. However, it was the personal anecdotes that really moved us. Friends we had made during the first few days stood in front of the audience and bravely shared their own experiences. The situations they had faced due to their diabetes left us speechless and emotional. In China you have to fight to be able to get an education because some schools and universities will reject your application if you have diabetes; your partner's parents will likely end a relationship or engagement due to a diagnosis; and some leaders had even been fired from their jobs. In India the same stigma is rife, diabetes will seriously hinder your marriage prospects, education and survival. In other countries it is seen as a spiritual curse and medication is ignored or withheld because removal of the 'curse' is the only solution they see as being necessary. The implications seem endless, and are of course shocking to hear when you live in such a liberal country with support, technology and funding from your government.

Diabetes has the potential to destroy your future in some parts of the world. People live in fear and they hide their diabetes because of the serious impact it will have on their life. How can you create support groups and help people with diabetes when they are unable to reveal their condition in public? How can you save lives in developing countries when there is no money to buy insulin? These are the questions that remained in our minds, the things that need to change.

It is confronting to hear about these global issues when you have the same condition. But it made all the young leaders stronger, more focused and more excited about creating projects to make a positive change. You can imagine that most of the young leaders arrived with the intention of learning how to improve the situation in their own country, and most of us left bursting with extra ideas about changing the rest of the world. Our enthusiasm seemed to excitedly snowball during each day of the conference.

The primary goal behind the Young Leaders Programme is for each attendee to return to their country and successfully implement a project in the next two years, before the Vancouver 2015 conference. This project could be anything from a small support group to a camp, or a large global initiative. So keep your eyes and ears open, because 140 young leaders are about to try and confront world issues, remove stigmas and make the world a better place to live in for people with diabetes. The quote we were left with was by Mahatma Gandi, 'be the change you wish to see in the world'. What can you do to change the world? How can you help people with diabetes in your country?

If you are ambitious, excited and between the ages of 18-30. You could be chosen to represent your country at the Vancouver conference in 2015, and I'll be there talking about my projects too. Please have a look at the IDF website when applications open in 2014 http://youngleaders.idf.org/join and talk to your national member association. Before you apply, see what you can do to help in your region. How can you use your positivity to make a difference?

Young Leaders, literally flying the flag