Tuesday, 6 September 2016
Monday, 11 July 2016
Saturday, 4 June 2016
"Let's get back on track". That was the sombre advice from my Garmin app this morning after yet another appalling attempt at running. "Let's get back on track"...
The truth is, I feel pretty broken at the moment. For once in my life, the only thing that seems to be taking relatively little effort on my part is having diabetes. That's a strange thing to write really - the thing that's a 24/7 fixture in my life is the easy bit.
As usual, there's a lot going on (which is of my own doing), but it all seems to have fallen at once so I'm stumbling from one thing to the next without much time to think. That's not always a bad thing I guess - the pressure of working on a few, quite different things is interesting and definitely keeps me on my toes.
But it does mean a few things are getting squeezed out (I've not found a way to add a few extra hours in the day yet). Worryingly, it seems to be any kind of exercise which I'm sacrificing at the moment. Given my pathetic metabolism, that means I've invariably put on weight, and I seem to be obsessing about it rather a lot.
I look back at where I was 12 months ago, and I was running 100 miles a month, at my lowest weight for about a decade and feeling invincible. Now I'm struggling to run 4 miles (partly due to a stubborn knee injury I sustained mid-April), I'm about 12lbs heavier than I have been in ages and quite frankly it's making me miserable.
I seem to have developed some kind of weight obsessed insomnia as well and I'm finding it tricky to switch off, which is a little frustrating given how tired I actually feel at the moment. There's a lot running through my mind every night but I seem to go back to how frustrated I am that I can't run, and the effect it's having on me.
I've been travelling a lot lately for various reasons (social and otherwise) - London and back three times in six weeks (with another three in three weeks at the start of July)...
To be honest, I don't think there's much of a point to this blog, other than to write all this stuff down so it's one less thing in my head.
I should be able to shift some of this unwelcome weight which will make me feel a lot happier. Body image problems can't be over-stated in my opinion and it's something I wrestle with a lot more than I let on. I know my knee will come back to being somewhere partly sensible so I should be able to get out and find the enjoyment I got from running last year. And hopefully I'll get some sleep too.
At least diabetes isn't causing me too many problems. For once.
Until next time.
Monday, 4 April 2016
Mondays pretty much start the same way for me every week… The alarm goes off around 5:45am, and, silently cursing, I take stock of how I’m feeling… light-headed (hypo), a bit stiff (hyper) or just tired (‘in range’)? I drag myself to the bathroom and stand on the bathroom scales. And I sigh.
Diabetes is an enormous daily battle that I won’t rehash for the millionth time here and now. I’ve lived with diabetes for long enough now to be able make most days ‘better’ days, though I’m not impervious to the bad days by any means.
I’ve started writing this blog post a few times and I’ve held back – I’m scared of straying into unchartered waters and accidentally throwing opinions around on things I (and many other people) don’t really understand. But here we go.
I can tolerate Type 1 diabetes most of the time, but where I struggle every day is with my weight.
About 18 months ago I devoted a huge amount of energy and effort to tackling my weight and lost 3 (and a bit) stone to get to a position I was vaguely happy with. I cut my diet back to about 1200 (net) calories a day, ran 20-30 miles a week as well as doing four or five mornings a week on my exercise bike. It was exhausting and took over my life, but I did it. But that’s when it started to get difficult…
I’ve always found it (kind of) manageable to lose weight, but I’ve equally found it far too easy to put it back on again within a few months. This time I feel like something is a little different. I’ve had fluctuations obviously, but I’ve pretty much avoided piling the pounds back on. But it’s much harder work than it was to get to this position in the first place.
What I’ve discovered is that actually, my body only really needs around 120-1300 (net) calories a day anyway and regularly eating above that means I’ll put weight on. My diabetes consultant refers to it as being a ‘thrifty phenotype’ – basically if there’s an apocalypse, you’ll probably starve before me (sorry), but basically I don’t need a lot of food to keep ticking over.
This creates a number of problems for me. The first, and most obvious one is that I LOVE food so I feel like I’m constantly faced with the choice of skipping one meal in favour of another. Or I have the chance to go out and run 6 miles to be able have something. Whilst I both love and loathe running (it feels like life support to some degree), my life doesn’t allow the same number of opportunities a week to pound the pavement, so more and more I feel like I’m choosing breakfast plus one other meal.
The second problem is food guilt. I’m sadly not immune to the temptations of an occasional takeaway. Having skimped on calories for the rest of the day (and/or been for a run), I’ve been known to dabble in a chicken chow mein from time to time. The thing is that pretty much as soon as I’ve eaten it, I have an overwhelming feeling of guilt about what it’ll do for my weight and I’ll compensate for days afterwards too. I have genuine regret about something I’ve treated myself to, and I’m pretty sure it’s not healthy (the guilt that is, the takeaway definitely isn’t…). If I’m eating out at restaurants, I’ll pick a salad more often than not because it’s not a guilt-inducing. Having a hypo is a nightmare when I feel like this – I’m eating calories that I don’t want to correct it and I resent them for it.
The last problem is how it makes me feel. I’m writing this after stepping on the scales to find out I’ve put an improbable 4lbs on this week, and it’s pretty much all I’ve thought about all day. I knew last week I would have put a few on (about 3lbs) as I’d been away for Easter and it’s a lot harder to stick to a calorie goal while you’re away. But being back home hasn’t improved things. I know I used to be a lot heavier, but I look in the mirror and I’m fundamentally unhappy with how I feel. I hate the nagging from my inner voice before I eat anything…
I’m used to seeing food as numbers – it’s impossible not to when you’re doing mental arithmetic before you eat anything. But I see calories everywhere too, and calories scare me a lot. Having diabetes puts me at a greater risk of stroke, heart disease and cardio vascular disease, than people who aren’t ‘in the club’. I’m about twice as likely to suffer from one or more of those as a result of my diabetes, and being overweight doesn’t help my chances much either.
I’ve noticed that gradually, I’ve stopped cooking new things almost entirely because I know I can rely on the knowledge that what I eat most days, falls into safe zone and I don’t want to stray from that safety. I know when I do stray, I’ll have put weight on. And when I put weight on I’ll be miserable until I’ve lost it all. I feel like I’m resigned to logging everything I eat for the rest of my life to be able to stay at a healthy(ish) weight, and the though of that exhausts me.
I wrote recently about how a day off from having diabetes would be nice. Having a day off from this food guilt and unassailable obsession with my weight would be nice too.
Thursday, 31 March 2016
When Neil and Athinyaa spoke at DPC16 at the start of the month, everyone listened - it was a heartfelt, emotive talk about providing care to people, not patients. This blog they've written continues that theme, and it's incredible. Enjoy.
Monday, 28 March 2016
* I'm going to keep linking to that video because a) it's funny and b) it's a reminder to keep grounded about our opinions on stuff generally
I've already written twice about the Libre:
- This is about how I felt before I started
- This is about my experiences of my first sensor
But I'll try and give some of my more general thoughts on it in case it proves helpful to anyone thinking of parting with the money for the first time.
- It gives you more information, and (here's the caveat), with the right understanding, more information is very powerful. It's not about the number of results - with the right tolerance for pain, you can get the same amount of data but the information (about what direction your BG is heading) is a very important addition
- It can be a very motivating tool. Diabetes isn't a game, but approaching it like one can be beneficial. I get a big psychological boost from seeing the trace line staying within the bounds that I set spurs me on. It also gives me confirmation that I know what I'm doing (at least some of the time), but...
- When things aren't going my way (particularly when I'm high), I find the Libre very demoralising to the degree that I think it almost has an adverse effect on me. Recently my BG was rising and rising and rising and I'd ruled out illness, bad carb counting, bad insulin/cannula... everything. And still it rose. As it's so easy to swipe and test, that's what I do. And it makes me unhappy and frustrated which doesn't help. With a fingerprick, I feel like I make much more of a choice to test, and so I can switch off from it if I want. I don't approach it in the same way with a Libre.
- It makes me feel more confident that I can correct from a relatively good reading (say 7.5mmol) to something 'better' like 6mmol and not go too low. It's like it gives me the opportunity to nudge my BG either up or down to stay within my own target range.
- I feel like I've ended up eating fewer 'proper' meals and started snacking more as it gives me the chance to feel more in control of how my BG is behaving. I'm not sure that this sort behavioural modification is a good thing or not, but it seems to be an unintentional side effect.
- It takes the stress out of some aspects of diabetes, particularly overnight basal testing. Being able to get a full picture by swiping once every eight hours means I can test right before bed and first thing in the morning and start to identify any problem areas - I think that's a real positive.
- The graphs and data the software gives you are very helpful. I've never seen my own "ambulatory glucose profile" before, but I feel a lot better being able to see it. The HbA1c estimator is also pretty helpful, and (in my limited experience), not far off being accurate either.
- You have to decide for yourself how you define its accuracy. I know what I kind of expect my BG meter to tell me when I start feeling low, and equally when I get that sticky feeling behind my eyes when I'm going high. The Libre isn't always going to give me that same figure, but as long as I have that internal calibration, I feel pretty confident being able to dose or even correct from it's reading. But again...
- Knowing its limitations is important too. Don't use if before driving (always finger prick), don't use it if you've got an arrow showing rapidly falling (or rising) glucose - you need blood to really understand what's going on.
Saturday, 19 March 2016
Sugar Tax. I don't remember anything that has so divided that diabetes online community. Sure we all have different views, that's what makes us a community. Of course we don't all agree - where would the fun be in that? But the announcement of the Sugar Tax has everyone scrambling for an opinion.
I'll admit a few things from the start.... firstly, I'm pro Sugar Tax (for reasons which I'll explain), and secondly, I'm not sure writing this blog is the best idea I've ever had - experience tells me it could end up with me taking a week off the internet.... It's important to realise that my opinion is no more valid than anyone else's. I'm not right, but neither am I wrong. It's just what I 'reckon'. And who doesn't love a good reckon?
So I'm pro Sugar Tax... light your torches and grab your pitch forks. Why am I in favour of it? Incentivisation. My academic background is in economics (so I'm also generally pro Free Markets too), and I like the theory of how individuals react to incentives. That theory generally being that when faced with a choice over two 'identical' products, the rational choice is to choose the cheapest one.
Now Coke and Diet Coke aren't quite identical, but they're pretty close. If one is cheaper than the other - the rational choice is to choose the cheapest one right? Why pay over the odds for a Coke when Diet Coke is (almost) identical? Add to that, the differences are that Coke has more sugar (and more calories) then you're almost winning twice. Changing behaviour is difficult, but people acting rationally, understand the dis-incentive in choosing more expensive Coke, over cheaper Diet Coke - so it should work.
But this is where it gets tricky. In theory, theory and practice are the same. In practice, they aren't.
Sugar Tax comes with a whole host of other things to consider. Is the level of tax going to be big enough to make everyone behave rationally? Probably not (price elasticity of demand is what you're thinking of there). Are there socio-economic implications of increasing tax on soft drinks? Yes of course. There are loads - too many to even begin to discuss here.
Is Jamie Oliver a bit annoying, and prone to the odd diabetes-related gaffe? Yes of course. Isn't it a half measure if it doesn't include sugary milkshakes? Yeah. What about my hypo treatment? Agreed. There are alternatives, but you need something that works for you. Thankfully Diabetes UK have our back on that one. Why not make fruit and veg a load cheaper instead? Yeah why not? Completely agree. Ask a farmer how much he makes off a 20p cucumber...
In my humble opinion (which, remember, counts for no more and no less than yours), I think people hear the announcement of a Sugar Tax and assume it's the only solution being proposed. I don't think it is, and don't see how it can be. Affecting the behaviour of a huge number of consumers isn't going to happen overnight, and isn't going to be done by a 7p levy on a can of coke.
I think the majority of people know that being overweight and inactive is bad for you, but they don't change their lifestyle. Many people also know that smoking is bad for you but people continue to do it. Though that number continues to fall as tax rises and the number of places you can smoke decreases. Multiple measures gradually affect behaviour.
We already have a limit on advertising junk food to kids. Placing sweets near supermarket tills is on its way out. Evidence shows that indeed in some parts of the world, sugar tax has some effect on changing behaviour. It won't change the world overnight (not least because you won't see it for two years anyway).
It's easy to be cynical and say it's patronising, pointless, punishing those who are already worse off. But it's also easy to think that we have a responsibility to ourselves to be healthy, to reduce our risk of cardiovascular disease, strokes and Type 2 diabetes. And if we don't want to, that's fine, but you'll have to pay a small premium for it.
Anyway - it's just what I reckon...