This is known as seasonal affective disorder (SAD) – a form of depression linked to seasonal change.

Understanding its causes, recognising the symptoms early and seeking appropriate treatment can make a significant difference.

Symptoms often begin in late autumn, worsen through winter and lift again in spring and summer.

Causes

SAD is largely triggered by reduced exposure to sunlight, which disrupts the body’s internal clock and affects the production of key brain chemicals such as melatonin (which regulates sleep) and serotonin (which affects mood).

These imbalances can lead to low mood, fatigue and difficulty concentrating.

The disruption in circadian rhythm can also alter sleep and appetite patterns, making daily functioning harder.

Who’s at risk

SAD is more common in people living in regions with shorter daylight hours, such as the UK.

Research shows that around one in five people in northern climates experience symptoms of SAD.

The condition is also more prevalent in women and tends to run in families, suggesting a genetic component.

People with a history of depression or bipolar disorder are also at higher risk.

• Diapression
• Diabetes Distress and Burnout

Symptoms

Symptoms of seasonal affective disorder mirror those of depression but are strongly tied to seasonal changes. These include:

• Persistent sadness or low mood

• Loss of interest or pleasure in usual activities

• Fatigue or low energy

• Feelings of worthlessness or guilt

• Difficulty concentrating

• Changes in appetite or weight

• Sleeping too much or too little

• Suicidal thoughts in severe cases

SAD can make socialising, working, or studying feel overwhelming.

Treatments

Seasonal affective disorder is common and treatable.

Light therapy

One of the most effective and widely recommended treatments for SAD is bright light therapy, which uses a special light box to replicate natural sunlight.

Studies show that about half of people using light therapy experience significant improvement in symptoms.

Experts advise using a 10,000-lux light box for 20–30 minutes each morning, ideally within an hour of waking up.

• Red Light Therapy

Medication

Healthcare professionals may prescribe antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors), to help regulate serotonin levels and alleviate depressive symptoms during the darker months.

Exercise

Regular physical activity can be as effective as medication for mild to moderate depression.

Just 20 minutes of exercise three times a week can boost serotonin production and improve mood.

Whenever possible, exercising outdoors in daylight can further enhance the benefits by increasing exposure to natural sunlight.

• Mediterranean-style diet paired with moderate exercise significantly reduces type 2 diabetes risk
• DOMS: Experts explain whether you should exercise when you are still sore

Cognitive Behavioural Therapy (CBT)

CBT helps people identify and challenge negative thought patterns that worsen depression.

It has been shown to be effective in both treating and preventing the recurrence of SAD symptoms. Combining CBT with light therapy often yields the best results.

Staying connected, maintaining routines, and maximising exposure to daylight can also help lift mood and build resilience through the darker months.

What is overeating

Overeating means eating past comfortable fullness, often when hunger is not present. It can happen at social meals or it can become a pattern that drives weight gain and unsettles blood glucose. Overeating is not the same as binge eating disorder, which is a diagnosed condition marked by regular episodes of loss of control and distress^[5].

Definition

A simple definition that works in clinic and in everyday life:

• Repeatedly eating beyond comfortable fullness
• Often eating when not physically hungry
• Eating that leaves regret, sluggishness or a glucose spike afterwards

Those three are enough to start a change plan.

Why it matters in diabetes

Large or rapid meals can push glucose after meals higher and keep it there. High glucose after meals is linked with symptoms such as thirst and tiredness and, when frequent, with higher long term risk^[7].

What the evidence says

1. Ultra processed food leads to excess intake. In a tightly controlled inpatient trial, people ate more calories and gained weight on an ultra processed menu even when meals were matched for sugar, fibre, fat and protein^[1].
2. Portion size pushes intake up. Evidence shows larger portions, packages and tableware increase how much people consume^[2].
3. Sleep loss raises appetite and calories. Meta and trial data link short sleep with higher energy intake. Extending sleep cut intake in a real world study^[3].
4. Hyperpalatable foods and eating rate drive meal calories. Foods that are energy dense, easy to eat quickly and rich in salt, sugar or fat raise intake across diet patterns^[4].
5. Protein and fibre help with fullness. Higher protein supports satiety across meals and soluble fibre slows gastric emptying and supports fullness^{[8], [9]}.

Symptoms and signs

• Eating very quickly then feeling uncomfortably full
• Grazing through the evening and losing track of portions
• Feeling flat, sleepy or heartburn after meals
• Regular high readings after meals
• Eating alone out of embarrassment
• Strong guilt or low mood after eating

If you often eat large amounts with a sense of lost control, at least weekly for three months, that points to binge eating disorder. Guided self help and cognitive behavioural therapy are first line care in the UK^{[5], [6]}.

Common triggers

• Meals built around ultra processed snacks and ready meals
• Portions that are simply too big for your needs
• Short sleep and late nights
• Stress, boredom and using food to blunt feelings
• Medicines that increase appetite, such as some steroids or antipsychotics
• Fear of hypos that leads to defensive eating for people who use insulin

On medicines, speak to your prescriber. Some treatments raise appetite and weight. Insulin linked weight gain is also recognised^[10].

• Ultra processed foods linked with changes in brain regions tied to overeating
• Demonising all ultra-processed food oversimplifies the issue, say experts who found perception of food plays a part in overeating
• Comfort eating

Treatment and self management

Start with what works and measure the result on your meter, your CGM and your plate.

• Make meals slow and structured. Three meals and planned snacks beat all day grazing for most people. Sit to eat, put the phone away, notice first bites, and aim for at least fifteen minutes at the table.
• Shrink portions on autopilot. Serve smaller by default. Use a smaller plate or bowl and pre portion snacks rather than eating from the packet. Portion size change is a reliable lever^[2].
• Build filling plates. Anchor meals with protein, add plants for fibre, add water rich foods such as vegetables, soups, yoghurt and fruit. The British Heart Foundation and Diabetes UK give clear portion guides you can follow today^{[11], [12]}.
• Sleep like it matters. Protect seven to nine hours. Short sleep raises appetite and calories. Extending sleep lowered intake in trials^[3].
• Use simple rules for processed foods. Cook more of your starches, proteins and vegetables at home. Keep ultra processed items for planned moments, not open ended snacking^[1].
• Train attention, not willpower. Mindfulness based programmes reduce binge eating in reviews and trials. At the table, pause, taste, and check hunger halfway through before you carry on^{[13], [14]}.
• If there is loss of control, get formal treatment. NICE supports guided self help and cognitive behavioural therapy. Digital CBT can help while you wait^[6].
• Consider medical options when appropriate. For adults who meet criteria, NHS services may offer weight management medicines within a full plan that includes nutrition and activity. These do not replace the basics. They can help the basics work. Speak to your GP or specialist service about eligibility^[15].

Quick self check

Answer yes or no:

• I often eat past comfortable fullness
• I often eat when not hungry
• I often feel I cannot stop once I start
• I often hide what I eat or feel strong guilt after eating

If you tick only the first two, focus on portion, meal structure and sleep for four weeks and review your glucose trend.

If you also tick the last two, speak with your GP and consider support from Beat, the UK eating disorder charity^[16].

When to seek help now

Speak to your care team or GP if you keep seeing high readings or you are stuck despite trying the steps above. If you have high glucose with vomiting, tummy pain, rapid deep breathing or difficulty staying awake, use urgent NHS guidance^[7].

References

1. Hall KD, Ayuketah A, Brychta R, et al. Ultra Processed Diets Cause Excess Calorie Intake and Weight Gain. Cell Metabolism. 2019.
2. Hollands GJ, Shemilt I, Marteau TM, et al. Portion, package or tableware size for changing selection and consumption of food. Cochrane Database of Systematic Reviews. 2015.
3. Tasali E, Wroblewski K, Kahn E, et al. Effect of sleep extension on energy intake in adults with overweight. JAMA Internal Medicine. 2022.
4. Fazzino TL, Rohde K, Sullivan DK. Hyperpalatable foods, definition and measurement, and links with intake. Obesity. 2019.
5. NHS. Binge eating disorder. Available from the NHS website.
6. NICE. Eating disorders: recognition and treatment. NICE guideline for the UK.
7. NHS. High blood sugar and when to get urgent help. Available from the NHS website.
8. Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. American Journal of Clinical Nutrition. 2015.
9. Clark MJ, Slavin JL. The effect of fibre on satiety and food intake. Nutrition Bulletin. 2013.
10. Royal College of Psychiatrists. Antipsychotics and weight gain. Guidance for patients and carers.
11. British Heart Foundation. Portion sizes and healthy plate building. Patient resource.
12. Diabetes UK. Portion guidance and carb choices. Patient resource.
13. Godfrey KM, Gallo LC, Afari N. Mindfulness based interventions for binge eating. Psychology of Addictive Behaviors. 2015.
14. Kristeller JL, Wolever RQ. Mindfulness based eating awareness training for obesity related eating. Eating Disorders. 2011.
15. NICE. Medicines for weight management in adults who meet criteria within specialist care.
16. Beat. UK eating disorder charity support and helplines.

Separate from diabetes burnout, evidence from studies demonstrates a bidirectional link between diabetes and depression; diabetes seems to increase the risk of developing depression and depression adversely affects the control and outcomes of diabetes.[1]

The term was first used in research in 2011 by Dr Paul Ciechanowski.

It is well documented that some participants experience depression after diagnosis, although this varies from person to person.

Individuals with diapression often typically experience a feeling that goes beyond the physical symptoms of diabetes and the emotional symptoms of depression.

The combination of conditions can lead to decreased quality of life, increased functional impairment, and a heightened sense of despair or helplessness.[2]

The psychological distress from managing a chronic condition like diabetes, coupled with the debilitating effects of depression, creates a vicious cycle that can severely impact an individual’s mental and physical well-being.

How does diapression effect diabetes management?

Depression in people with diabetes (diapression) can prevent effective diabetes management.

Depression can remove the motivation to adhere to necessary diabetes self-care activities such as blood glucose monitoring, injecting insulin, adhering to a diet plan, engaging in physical activity, and taking other medications as prescribed.[3]

The physiological effects of depression include altered cortisol levels and inflammation which can worsen glycemic control making diabetes management more challenging.[4]

Treatment for diapression

Treating diapression requires a comprehensive and multidisciplinary approach.

Antidepressants and psychotherapy, particularly cognitive behavioural therapy (CBT), have been effective in treating depression in individuals with diabetes which can lead to improved mood and better diabetes management.[5]

Mindfulness has also been demonstrated to improve depression symptoms.[6]

Lifestyle interventions which combine diet and exercise can not only improve diabetes control but also have a positive impact on depressive symptoms.

Integrated care models that address both diabetes and depression simultaneously are recommended for managing diapression effectively.

Studies into digital apps have found improvements in depressive symptoms after 12-weeks use.

Challenges

The management of diapression is fraught with challenges.

Firstly, it is a new term that encompasses stigmas associated with mental health issues which may prevent individuals from seeking treatment for depression.

Secondly, healthcare systems often operate in silos with little collaboration between mental health services and diabetes management programmes, leading to suboptimal care for individuals with diapression.

Future research should focus on identifying biomarkers and psychosocial predictors for diapression to facilitate early detection and intervention, and to understand the mechanisms underlying the diabetes-depression link, which could lead to more effective treatments.

Studies exploring the efficacy of novel treatment modalities including digital health interventions and personalised medicine approaches are crucial.

• Walking and doing yoga can help treat depression
• Energy drinks associated with childhood depression and heart problems
• Depression linked to putting on more weight for people with obesity
• Experts highlight link between perinatal depression and autoimmune disease

Known as the andropause or late-onset hypogonadism, the male menopause is a term used to describe low or decreasing testosterone levels in men.

Menopause in women is well documented, but the male menopause is less known.

While low sex drive and difficulty maintaining muscle mass are well known symptoms of low testosterone, there are other, less documented effects of reduced levels of the male sex hormone.

Testosterone, which is mainly produced in the testicles, has a role to play in bone density, sperm production, fat distribution and facial and body hair.

Testosterone levels peak at around age 20 but reduce with age – studies have shown that low testosterone affects around 12% of men in their 50s, 19% of men in their 60s, 28% in their 70s, and 49% of men in their 80s.

What are the symptoms of the male menopause?

The most common signs of low testosterone include:

Low sex drive and erectile dysfunction

As the primary driver of libido, when testosterone levels drop, it can result in a lack of interest in sex.

In addition, it is more difficult to get an erection with low testosterone levels, as the erectile tissue can become less healthy in someone with reduced levels of the hormone. It can cause erectile dysfunction, and can also reduce the effectiveness of drugs like Viagra.

Depression

Although more research is needed to better understand the link between low testosterone and depression, it is known that androgen receptors are located within different parts of the brain, including amygdala, the area of the brain which processes fear.

Memory problems

In a similar way, if there is not enough testosterone to bind certain receptors in the brain, it could cause memory problems.

Fatigue

Energy and motivation levels are driven primarily by testosterone, which is also a type of steroid. As testosterone levels lower, it means men will feel more tired as the day goes on.

Decreased muscle mass 

Testosterone stimulates muscle growth so reduced levels mean that muscle mass starts to decline. However, it can be rebuilt through strength training.

Increased abdomen fat

More belly fat can be a sign of low testosterone. It occurs because fatty adipose tissue replaces muscle mass. Increasing amounts of fat tissue break down testosterone, resulting in low levels of the hormone.

Weak bones

Testosterone is converted into oestrogen in men. Oestrogen has a key role to play in bone health, so men with lower levels of testosterone will have reduced oestrogen. This can lead to osteoporosis, which is when someone has weak bones.

Type 2 diabetes

Insulin is dependent on testosterone, so for insulin to function well, you need testosterone. If insulin function is diminished, it can lead to high blood sugar and type 2 diabetes. One study found that testosterone therapy helped to combat insulin resistance in men with low levels of testosterone.

Heart disease

Some research has indicated that low testosterone could increase the risk of heart disease, cardiac arrest and stroke. One school of thought is that it could be due to testosterone’s role in opening up blood vessels to the heart.

However, experts are divided about the link between low testosterone and heart disease.

Is there a relationship between the male menopause and diabetes?

Low testosterone levels which is the cause of the male menopause is more common in men with type 2 diabetes.

Approximately 25-50% of men with type 2 diabetes have low testosterone levels.

Although the exact reason hasn’t been identified, it is thought that insulin resistance, a key component of type 2 diabetes, may play a role in disrupting hormone production.

Obesity is a significant risk factor for type 2 diabetes and can also lead to lower testosterone levels.

How do I treat the male menopause?

The male menopause is a natural process and just like the female menopause, people experience symptoms differently.

Treatment of the male menopause is made of several different therapies.

Lifestyle changes

A healthy, nutritious diet and regular exercise can help increase testosterone levels, promote hormone balance, and improve your mood. Maintaining a healthy weight is useful as excess fat can convert testosterone into estrogen.

Stress management

Stress can affect your hormone balance.

Activities like yoga, meditation and mindfulness can help reduce stress levels and balance your hormones.

Counselling

Speaking to a therapist about the changes you are going through can prove effective for some people.

Medication

Medication may be prescribed to manage particular symptoms, such as mood changes or erectile dysfunction.

Hormone Replacement Therapy (HRT)

HRT involves testosterone supplementation to help balance hormone levels however has many potential side effects including an increased risk of heart disease.

It is crucial to speak to your doctor or healthcare team before making any changes to your lifestyle and to ensure treatment is individualised for you.

Like any chronic condition, diabetes can have an influence on the family of the person who has the illness.

Help and advice is available to those who think their diabetes is affecting their family. In addition, those who have family members with diabetes can also receive help and support.

Family Guides:

Diabetes and the Elderly

Emotional Impact on Families

Gifts for people with diabetes

Supporting someone with diabetes

Relationship Guides:

Diabetes and Relationships

Diabetes and Dating

Telling People You Have Diabetes

Supporting Your Partner

Bullying and Diabetes

Effect of Hypos on Relationships

Caring for Someone with Diabetes

Why might someone with diabetes need the help and support of their family?

Living with diabetes is not easy, and unfortunately once it has developed diabetes does not go away. In order to successfully manage diabetes, most diabetics need to make some serious

lifestyle changes

Learning how to

monitor and control blood sugar levels
can take time, and the threat of serious health problems never goes away.

For this reason, a person who has diabetes may need the help and support of their family.

Diabetics may face numerous complications and may also be more prone to depression and stress.

How can one help relatives with diabetes?

Education
is the key to helping people with diabetes, just as it is in preventing type 2 diabetes.

Learn as much as you can, because the more you understand about the disease, the more you can help.

Be sympathetic about the condition, particularly for those people who have been newly diagnosed with diabetes.

Diabetes can be an insidious and frustrating condition, and induces fear in some people.

What healthy changes should I encourage my relative to make?

If you and your relative share meal times, make sure that they eat the same healthy food that you do. Try not to buy any types of food that he or she shouldn’t eat.

Diabetics need to stay aware of their diet, and if you understand a healthy diabetic diet this can be all the easier to communicate to your relative. Exercise is another fundamental part of diabetes management.

Relatives can make exercising easier by agreeing to exercise together, although each diabetic should speak to their healthcare adviser in order to find out what type of exercise will suit their condition.

What else can I do to help the diabetic or diabetics in my family?

Knowledge is power here, and if you can learn how to recognise any signs of problems, you could be a genuine help.

The symptoms of

high and low blood sugar levels
are the place to start. You can also help by understanding the condition.

For instance, if your relative seems more irritable than usual, it could be down to a blood sugar level change.

Any other tips about diabetes and the family?

Just be patient and realise that for some people learning to live with diabetes can be difficult. Recognise that diabetics have good and bad days, and may need your emotional support sometimes.

Remember to set an example by eating healthily and

exercising regularly

Someone in my family has diabetes; do I have a greater risk of developing it?

Those people who have a family member, particularly a close relative, with diabetes do face a higher risk of developing diabetes than someone who does not.

Diabetes is effected by genetics
If it is a distant relative who suffers from the disease, then your risk is somewhat decreased. Blood relatives should all be made aware of their risk.

Do I need to be screened for diabetes if a family member is diagnosed?

All family members should seek screening and understand prevention.

For type 2 diabetes, particular

preventative guidelines
can be followed.

These include:

• Frequent exercise
• Keeping weight constant and appropriate for height
• Testing your glucose levels every three years after the age of 45

What is the best weapon families can employ against diabetes?

Staying aware about diabetes means that you will know when and how to treat it, and also how best to prevent the disease.

You will also be abreast of any new developments and scientific advantages to help prevent diabetes.

There are a few misconceptions of what it means to have diabetes. Diabetes can affect the young and old alike.

Some people don’t need to take any medication whereas others need to take injections each day. The

myths of diabetes
also stretch far and wide.

Each form of diabetes will mean you will need to be aware of dietary carbohydrate intake and how it affects your

blood glucose levels, and will need to ensure you get all the recommended diabetes checks each year.

What does it mean to have diabetes?

What it means to have diabetes will depend on what types of diabetes you have.

Having Diabetes Guides

Diabetes Care

Driving with Diabetes

Diabetes and Employment

Diabetes and Fitness

Diabetes and Travel

Living with Diabetes

Managing Diabetes

Pregnancy and Diabetes

Diabetes and Sex

Treatment for Diabetes

For a real time view of how others live with diabetes, visit the

Diabetes Forum

Will I need to give up treats?

One of the questions people ask is whether they will have to give up on their favourite foods. Having diabetes does mean you will need to be conscious of how different food affects your blood glucose levels.

People with diabetes will usually find that they can enjoy a treat from time to time but perhaps not as regularly, or quite as care free, as they could before their diagnosis.

For some people, a

diabetes diet
may present the opportunity to find enjoyment in new foods.

Will I need to take injections?

This depends on the type of diabetes you are diagnosed with.

People with type 1 diabetes will need to go onto

insulin injections

People diagnosed with type 2 diabetes and most other types of diabetes will usually be treated with diet and exercise or tablets but may be out onto injections if

blood glucose levels remain too high

How do I know what my blood sugar levels are?

People with diabetes can check their blood sugar levels by using a

blood glucose meter
This involves using a device which pricks your finger, drawing a droplet of blood and the meter measures the level of sugar in the blood.

• 
  Video guide
  
  :
  
  Testing your blood glucose

Will I be able to take part in my favourite hobbies or sports?

The answer to this question is largely a yes. There are very few hobbies which diabetes should prevent you from continuing. People with diabetes have been

rock and pop stars, footballers, racing drivers, dancers and politicians.

For more dangerous hobbies, such as car racing or deep sea diving, these may not be as accessible to people on certain medication, such as insulin.

Will I go blind or need to have amputations?

It’s not a pleasant subject but it’s a question that gets asked quite regularly by people newly diagnosed. Statistically, people with diabetes have a higher risk of blindness and

amputations
than the general population, however, these dreadful complications are avoidable.

Maintaining good diabetes control and ensuring you receive all your

annual diabetes health checks
will help you to steer clear of serious

diabetic complications

Will I be able to drive?

In most cases, diabetes should not be a barrier to driving. One of the important issues with driving with diabetes is

hypoglycemia
(low blood glucose levels), which can affect people on insulin and certain diabetic tablets.

Drivers at risk of hypoglycemia
need to be fully capable of spotting the symptoms of low blood sugar levels to avoid accidents at the wheel.

Will I be able to get a job or keep my existing job?

There are very few jobs for which people with diabetes are not able to do.

People with diabetes may not be eligible to be employed in certain military positions.

Being on certain diabetic medication may also prevent you from more dangerous jobs such as becoming an airline pilot or diving instructor.

If driving is a part of your work, you may need to meet certain criteria to continue. Read more on

diabetes and employment

Will I have diabetes forever?

At the current time, most diagnoses of diabetes will mean having the condition for life.

The exception to this is pregnant women who develop

gestational diabetes

Gestational diabetes develops during pregnancy but will often go after the pregnancy is over.

Women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life but this can be delayed or prevented by adopting a

healthy lifestyle

People with

type 2 diabetes
have been in the news for reversing their diabetes, however, it’s important to note that these people have not been cured but have instead been able to come off medication and control their diabetes by lifestyle alone.

What does having diabetes mean to you?

Leave your thoughts in the

Diabetes Forum

In

type 1 diabetes, the body produces very little insulin and so we have to try our best to perform the job of our pancreas.

The task is not an easy one and sometimes control can slip up away from the best of us. This article serves as a guide to help you get your control back on track.

Make things simpler – establish a routine

Many of us who have struggled with our control at one time or another will likely be familiar with the feeling of being always one step behind our diabetes, such as needing to correct a series of highs and lows rather than being able to plan ahead so much.

Making sense of our results is always going to be easier if there are fewer factors to consider, so to help make sense of your blood glucose results, try to keep to a regular routine as best as you can.

Taking injections at the same times of day, where possible, is a good place to start. It is particularly important to take your

long term insulin
at the same time(s) each day.

Test regularly

None of us enjoy

testing our blood
but it is certainly a big help when it comes to getting our blood glucose levels under control.

For example, you might find yourself asking questions about why you went hypo such as:

• Did I take too much insulin for lunch?
• Did I exercise harder than usual?
• Was I already low before the exercise?
• Did I have low sugar levels before lunch?

Testing regularly helps to reduce the number of factors that could have played a part, and so makes understanding

highs and lows
easier to understand, and gives you the chance to better learn and avoid these highs and lows in future.

Weigh out portions and check carbohydrate values

Food portions can often be a source of misjudgement. You may have the same meal on two different days but get different results following from the meal if the size of portion was different on those two days.

It can really help to spend some extra time weighing or measuring out portions of foods, particularly those that have a higher

carbohydrate
value, such as potatoes, rice, pasta and cereal.

This will allow you to make more accurate judgements when making dosing decisions and when analysing your results.

Reviewing your results

If you’re trying to bounce back from a period where your control has let you down, it can help to spend more time than usual to record what you are doing in your day. What you eat, when you exercise and for how long, what you eat, even things you wouldn’t normally inject for.

It may feel like hard work but it’ll really help you to build a sense of the factors at play and, if you stick at it for a few weeks, it’ll really start to pay off and boost your confidence.

Factors which affect blood sugar levels

There are a surprising number of factors that can affect blood sugar levels and knowing the different factors can help you to make sense of those times when a high or low reading has come seemingly out of the blue.

• Read up on the
  
  list of factors that can affect blood glucose levels

Adjusting insulin doses

As you make sense of your blood glucose results, you may need to make adjustments to your insulin doses. If your health team are happy for you to make your own dosing decisions, take a look at our

guide to adjusting basal and bolus doses

Stick at it!

When you’re trying to get your numbers under control, it is common to start with a burst of hope and intent but then hit a wall after 2 or 3 weeks when things either start to get demanding or confusion suddenly sets in and results no longer make so much sense.

This is fairly common and don’t let this put you off. There will always need to be a bit of struggle needed to make progress. Take things in your stride and if you can battle through these times, you’ll find things begin to make more sense again and you may find that you’ve learned even more than you expected during the difficult time.

• Are you looking to regain control of your diabetes at the moment? Share your progress with others in the same position on the
  type 1 diabetes forum

With a bit of knowledge and dedication,

type 2 diabetes
can be controlled.

For those looking to get stuck into type 2 diabetes management, we’ve compiled a guide to help you understand the condition and improve your health.

HbA1c or blood glucose testing?

There are two main methods of monitoring blood glucose levels: regular blood sugar tests and an HbA1c test.

An HbA1c test will usually be taken at intervals of three, six or 12 months. The result gives a good guide to how well controlled your blood glucose levels are over a period of two to three months leading up to the test. This allows you to see whether you’re on the right track or how close to being on the right track you are.

Blood glucose testing tells you what your blood sugar level is at the precise time you test. Regular testing can be very useful for analysing which factors affect your blood sugar levels and by how much.

What can we learn from an HbA1c test?

The

target HbA1c value
for people with type 2 diabetes is 6.5% or 48 mmol/mol.

If you get an HbA1c result at this level or below, you’re on the right track with your diabetes control.

If your HbA1c result is above this target, there is room for some improvement. You may need to incorporate a little more activity into your week, make some changes to your diet or ask your doctor to prescribe a different form of medication.

If there’s one criticism of HbA1c, it’s that it doesn’t always make it easy to work out which individual changes are the most effective for lowering your blood sugar levels or which elements of your lifestyle are having a negative influence.

How can blood glucose testing help?

HbA1c gives a general big picture of how well controlled your sugar levels are, while blood glucose testing can help fill in some of the detail.

Target blood glucose levels
for people with type 2 diabetes are:

• 4 to 7 mmol/l before meals and when fasting
• 4 to 8.5 mmol/l 2 hours following meals

Not everyone with type 2 diabetes is given blood glucose testing supplies on prescription. If your doctor is not willing to prescribe testing supplies, you will need to consider whether to buy testing supplies.

Whilst testing supplies are far from cheap, they can often be very useful for those looking to get to grips with understanding how blood glucose levels vary following different meals.

• Read about
  
  availability of blood glucose testing supplies on the NHS

Diet and controlling blood sugar levels

Making informed diet choices is one of the main ways in which we can help to control diabetes.

• Read more about
  
  diet and type 2 diabetes

Blood glucose testing can be very helpful for reviewing how different foods affect blood sugar levels.

A good way to do this is to take a test before eating, and then another one or two tests after eating, at intervals of around two and four hours after a meal.

This method of blood glucose testing is known as

pre- and post-prandial testing
Testing your blood sugar this way across a variety of meals can help you deduce which meals are better for your sugar levels.

You can also begin to work out what portions of a particular food type your body can tolerate without raising your sugar levels too high.

Low-carbohydrate diets have shown to be effective in people with type 2 diabetes, leading to improved blood glucose levels and reducing dependency on medication. Diabetes.co.uk’s award-winning

Low Carb Program
provides NHS certified nutrition education and tracking tools to help people with type 2 diabetes and prediabetes reduce their HbA1c and weight.

Exercise

Exercise plays a very useful role in type 2 diabetes. As we exercise, our muscles use stored glucose (glycogen), as well as glucose that is available in our blood, as fuel.

Following physical activity, our

muscles
will then look to replenish their stores of glycogen and take in glucose from the blood.

Exercise should have a beneficial effect on blood glucose levels. To see the effect exercise may be having, it can be helpful to test your blood sugar at the same time of day – e.g. first thing in the morning – and see whether more active days are followed by a lower blood glucose reading in the morning.

Note that a number of factors can affect blood glucose levels so don’t be put off if your blood sugar levels do not fall following exercise.

You may also wish to test before, during and after exercise to measure how your blood glucose levels are responding. Some forms of exercise may trigger your body to initially raise blood glucose levels, but you should find your levels come back down after a moderate duration of exercise.

• Read more on
  
  diabetes and exercise

Weight loss and blood glucose control

Research indicates that a larger waistline can have a direct effect on insulin resistance. The larger our waistline, the more

resistant to insulin
our bodies become and therefore our blood glucose levels increase.

Therefore, losing weight and reducing waist size can improve insulin sensitive and thereby improve blood glucose levels.

• Read more about
  
  diabetes and weight loss

Medication

Type 2 diabetes

medication
can help blood glucose levels from rising too high. Some of us may be able to keep our blood glucose levels in the right range without needing medication, but the majority of people with type 2 diabetes take some form of medication.

Whilst most people tend to move onto stronger medication as they live longer with diabetes, it is not hugely uncommon for some people with type 2 diabetes to move onto less strong medication, or even come off medication, if they are able to make significant improvements to their blood glucose levels.

• Read more on
  
  reversing diabetes

Join in on the forum

The Diabetes Forum has helped large numbers of people with type 2 diabetes understand and take control of their condition.

Join in and learn from others in the same position as you on the
Type 2 diabetes forum

Liz Taylor (full name: Dame Elizabeth Rosemond Taylor) is the British-American actress regarded as one of Hollywood’s greatest from the Golden Years as well as a well known celebrity and role model with type 1 diabetes.

Best known for her role as Cleopatra alongside Richard Burton and Rex Harrison, the film is often regarded as ‘the film that changed
Hollywood
’.

Elizabeth Taylor has been rumoured to have been diagnosed with

type 1 diabetes
though this has never restricted her lifestyle which has included numerous marrages, being the mother of four children and trying her hand as an entrepreneur.

In late 2009, Elizabeth Taylor publicly

denied

that she has diabetes.

She was reported in the news at the time as commenting: “I was completely honest with you about my hospitalisation. Now the press, bless their little hearts, had to add something by saying I had diabetes, which is a total lie. But I guess they can’t help themselves.”

There are practical steps you can take today to feel more in control of this relationship with your healthcare team.

Here are the

3 P’s of improving your relationship

with the individuals in your healthcare team.

Plan

Planning may feel like the last thing you want to do before a trip to the doctor, but it needn’t take long and can even be done in the waiting room or on the bus on the way to the appointment.

Think back over the last week or month –

what has been confusing about your diabetes
? Or surprising? Or encouraging? What are the top three things you like to know or say? Jot these down on paper or as a note on your phone to remind you once the appointment begins.

Participate

Step number two starts when you walk into the consultation room. Early on in the appointment, let your doctor know that you’ve planned for the visit.

This enables her or him to see that you are being an active ‘participant’ in your appointment, the second ‘P’ of working with

healthcare professionals
In order to better participate, William Polonsky, a US writer suggests using the ‘ABC’ of effective communication:

• 
  Assertiveness
  
  – express yourself with confidence
• 
  Brevity
  
  – speak as briefly as you can, staying to the point at all times
• 
  Clarity
  
  – express yourself clearly, using short sentences and simple words

Partner

The third step is to understand and keep in mind that you and the healthcare professional are ‘Partners’ – equals.

Rather than feeling like a passive recipient of their medical expertise, remember that you are two adults with an immense wealth of experience. The healthcare professional has expertise of diabetes and how your biology operates, and you have immense expertise developed through your daily life with diabetes. Together,

you and your doctor
can share that expertise with one another to work towards the benefit of your health.

While some readers will be able to read these 3 Ps, implement the steps and begin to make changes right away, for others, it can feel harder to make a shift. This is when it’s worth thinking about what’s going on with your emotions that’s causing this difficulty. To help you with this, you might like to try this exercise:

• Bring to mind a particular diabetes healthcare professional that you are finding it a bit of a struggle to relate to.
• Take notice of the emotions that you are experiencing. Are they positive or negative?
• Put a label on these feelings you are experiencing. Hopelessness? Contentment? Anger? Joy? Embarrassment? Tension? Support? Sadness? Uncertainty? Fear? Security? Shame?
• Notice this feeling. Think about who else in your life (especially from your early life) you also have those kinds of feelings about.
• What figure comes to mind – Your strict headteacher at school? A kindly babysitter? A family member who makes you feel guilty that
  
  you’re not a ‘good’ diabetic
  ? A supportive uncle?

Psychodynamic models of therapy

Associate the feelings you have about the healthcare professional with the feelings you have about someone else in your life may seem like an odd exercise, and in some ways it really is!

But psychodynamic models of therapy offer the idea that the way we relate to people in our life today, particularly ‘authority’ figures such as healthcare professionals – are modelled on these relationships with early caregivers.

So perhaps you relate to your diabetes doctor as if they are your controlling headteacher from school, who you always wanted to secretly rebel against.

Or your supportive uncle, who if you smiled sweetly for long enough would always ‘let you off the hook’ if you did something wrong. You might think this is complete nonsense and if it’s not a helpful idea for you, then don’t make use of it. But if this way of thinking does resonate with you then do make use of these reflections.

Knowing that some of the feelings that you have towards your doctor or nurse actually belong in the past and are no longer serving you in your adult relationships, can, over time, help you to relate in a more helpful way, with the ultimate goal of improving your health.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Name:

Lee Calladine

Diabetes type:

Type 1

Occupation:

Events co-ordinator

See more:

DRWF

Talking about his diagnosis, Lee Calladine’s first description of diabetes is that “it was disorienting – I was very much feeling like a rabbit in the headlights.”

Diabetes diagnosis

It was eight years ago that Lee went to stay with his cousin and they had a Chinese takeaway and watched a DVD. But that night Lee could not stop drinking – complaining of a really horrible thirst, and his cousin asked – jokingly – “What’s wrong with you?”

Lee thought he had a virus and that it would pass. But at work that week he was losing his temper and continued to feel bad and he noticed that weight was dropping off him. “I had this intense thirst, I was bad tempered and didn’t feel like myself at all. I was drinking anything I could – orange juice, coke. You name it, not knowing that I was in fact making everything worse,” he remembers.

Do I have diabetes?

Later that week he bumped into a friend who was a nurse who, after exchanging just a few words with him, told him he had

diabetes

and had to go to the GPs immediately. He went the next morning and was told to go direct to the hospital.

“I was there a few hours, spent a little time with the diabetes specialist nurse and was put in insulin there and then and sent home a few hours later,” Lee says, “It felt a little surreal at the time, it all passed in a bit of a blur. I listened to so much information, talked to a dieticia, then went homen, sat down and just felt lost.”

But Lee wasn’t about to take the diagnosis lying down. In retrospect, he says, “They were great at the hospital but it was not enough. I did not jump in and read everything, but I did decide to learn as much as I could I went about it quite methodically. I do feel lucky that due to training to be a chef I did have some knowledge about food. Knew how carbs worked what they were and how they would work in my body. I had knowledge about nutrition.

Diabetes for Dummies

I read

Diabetes for Dummies

and my mindset was, ‘get on with it’. I learned what I could and I still do. I think you do have to become your own doctor to an extent. I let it become a part of my life and did not fight it, or deny it. In a way getting the diagnosis was a relief – I really thought I was dying and I never want to experience that thirst again.”

Today, Lee not only looks after his own health – he is a part of a charity that funds diabetes research. Not everyone who has a chronic condition wants to spend all day working on the same thing, but Lee sees his work with the

Diabetes Research & Wellness Foundation

(DRWF) as a ‘double edged sword’, explaining, “It’s true that I live and breath diabetes, both professionally and personally,but I’m in an enviable position of having access to a wealth of healthcare professionals and I have information at the tips of my fingers.”

Education events

Lee plans and attends diabetes education events for DRWF. “I get little refreshers all the time about how to stay healthy from people who are leaders in their field,” he says. “Also I know we’re doing good work, which helps me feel better about having all aspects of diabetes around me all the time – some of it is a little bit scary sometimes. But then I get to be excited about a new

blood test meter

, or know to get organized enough before I go on

holiday

so that I can feel like it’s a holiday and not be worrying about what I’ve forgotten to bring with me. I get to see new products as soon as they come out and news and updates on research and treatments… things are good in the main!”

Name:

Rebecca Weddell

Age:

35

Diabetes type:

Type 1

For her day job, Rebecca Weddell makes unique lampwork glass beads for ‘discerning designers’. That sounds simple enough, but when you realise it involves A blow-torch, you think twice.

She says, “I’ve been hard at work today teaching two students at once how to play with fire to melt glass and make beads, but WE took regular breaks to cool down from the torch flame!”.

Diagnosed: 24 years ago

One hot lady, as they say. Rebecca is in fact 35 and was diagnosed in 1986 when she was 11. She’s now a 5-a-day injector and does a lot of blood tests – she admits she’s “a little obsessive” as she does up to ten a day but she also has very good control as a result. But it’s not just the blood testing that does it.

“I had amazing care when I was diagnosed, I was taught to carb count and have always done it,” she says. She’s also a recent graduate of the SADIE course at Eastbourne hospital, a local equivalent of DAFNE. She explains, “Having done the course I find that I want to have more of a clue about what I’ve eaten in terms of its carb content and seeing how it’s affected my blood sugar.”

DAFNE

DAFNE stands for Dose Adjustment for Normal Eating and the courses aimed at people with type 1 diabetes. Most PCTs now offer some sort of DAFNE course, like this one at Eastbourne.

Even people who’ve had diabetes a long time can benefit from the courses.

Partly, it makes you go back to basics, with a refresher course on how insulin works, why counting carbs helps, but it’s also good to talk to other people with diabetes and share your experiences.

Using a diary

Rebecca’s started to use a diary again – a simple practice that most of us stop doing, but it’s an old stand-by that can really help if you go through a bad spell when good control is proving elusive. She explains,  “I’m enjoying plotting dots on the graph in my new blood test diary, partly as it reminds me of the 1980s. Back then, I remember getting through reams and reams of photocopied A4 charts.

Those were the days of very expensive glucose meters, just two blood tests a day, and often urine tests as well. Everything was plotted on those sheets.

Now the diary I use has space to record what food you’ve had with a space for the insulin too, and more than one line for each part of the day, which is very helpful. After just two days of using my new book I’ve identified where the problem might be (at the moment I’m going far too low far too often) so I’m already taking steps to be slightly less trigger-happy on the insulin.

It’s a bit ‘back to basics’ but it’s just what I’ve needed, to see it down in black and white. It’s easier to make sense of it now I’ve got somewhere sensible to write it all down in.”

Bead making

As for Rebecca’s chosen field of glass bead making, which she happily describes as “playing with fire”, it was a stroke of luck on a cold day that had her visit the annual Art In Action event near Oxford where she popped in to a tent to warm up and watched someone make a glass bead using a torch. It started as a hobby, but on being made redundant in 2008, Rebecca has made it into a business and now makes and sells beads as well as teaching others the craft. “It’s literally a cottage industry,” she says, “it’s not a production line – every bead is different.”

• Rebecca has been using the
  
  Desang blood test diary
  

Name:

Scot Lester

Age:

37

Diabetes type:

Type 2

Diabetes Forum member Biohazard tells us his story about his diabetes.

I was diagnosed in May 2012, after feeling very tired in the afternoons, even falling asleep which was not great as I am a stay at home dad to my 4 year old boy.

I also developed

thrush

on my tounge. I did not have any other classic

symptoms of diabetes

like thirst or going to the toilet – I was just tired. My wife ordered me to the doctors and I was given some mouth drops and sent on my way.

This did not clear up so I went back, this time a full

HbA1C blood test

was arranged which came back as 11.1%. I was type 2 diabetic and given metformin to take daily.

I loved bread!

This was not a shock to me as my mum was also type 2 (on insulin) and my dad was

type 2 on medication

– both of who are no longer with us. I also had the most amazing sweet tooth and loved bread!

Without delay I found my way to Diabetes.co.uk after a quick Google search and joined up to the Diabetes Forum and was reading for hours. My decision was made to very low carb/high fat diet and I went to the shops and got a

blood glucose meter

, which very quickly became my best friend.

Cutting down on carbs

I decided on no more than 35g carbs per day and wrote everything I ate on my phone app for counting nutritional info. I don’t note what I eat now unless its new food. I also check my levels before and after every meal.

Within 1 week my levels were great and with my GPs acceptance I did not take the additional

metformin

he advised and stayed on just 1 a day.

I went to see the DN and she said no testing was needed – once a week will do and to eat starchy carbs with every meal. With what I read on the

Diabetes Forum

this seemed very bad advice so I ignored this and followed the information given to me by other diabetics for whom their diet was working for. And, for whom have been getting great results!

HbA1c of 5.5%

Just over 3 months later I visited the DN after another set of blood tests of which the results were an HbA1c of 5.5%. The nurse was amazed as she had never had a patient at her surgery with as good results in such a short time – if indeed under 6% (which was a little shocking and understandable as they keep saying eat carbs with every meal)!

My

cholesterol

also went from 4.5 to 3.5 which was great.

We agreed that I’d come back in another 3 months and discuss coming off meds altogether. I did, however, 2 days after seeing her, stop taking my meds and this has had no affect on my levels. I do take multivitamins,

cinnamon

and

bitter melon

tablets daily as these are found to stabilise blood glucose levels.

My levels are now pretty much in the region between 4.8 and 5.5 most of the time.

Scot’s findings

I’ve got a couple of rules I’d advise for other people with diabetes:

• Get a great blood glucose meter, I have a
  
  FreeStyle Lite meter
  
  which is small and reliable.
• Do exercise, I go to the gym at least twice a week and do low impact for at least an hour.
• Eat only whole foods and cook yourself, I also bake my own cakes using almond flour and sweeteners, it makes me feel like I am eating forbidden food with little or no impact on my blood glucose levels.

If you’ve found inspiration from Scot’s story – or would just like to speak to Scot – get in touch with him on the

Diabetes Forum!

Name:

Marcus Grip

Age:

–

Marcus’s story is not a typical story of diabetes. The particular way Marcus developed diabetes has allowed him to come off insulin, whilst keeping

blood sugar levels

stable.

When I was 9 years old, I was diagnosed with diabetes. In the beginning it was very strange, for almost two years. I barely needed any insulin, I could eat almost whatever and the doctors looked very surprised!

It was like my

pancreas

still produced insulin, like it wanted to fight and keep itself alive. But eventually that decreased and went away after around two years.

I went to different kinds of healers like a Qi Gong master from China, Kinesolog, Acupuncturist, Massage therapist.

I ate or drank a lot of different stuff (like bitter cucumber) that really helped me the first years.

They all told me I had “

fake diabetes

” and that it could be cured and that it had something to do with the stomach and the kidneys.

But since I was a teenager I did not take the responsibility and rarely listened to what they said and what my body said.

I drank alcohol and ate a lot of bad food contributing to a

high HbA1c

for around two or three years.

Vegetarian lifestyle

Then one day, I got a call from my mother telling me that my father had asked for help after

almost 20 years of alcoholism

I was shocked and right away I determined to stop too and become a more healthy being.

A lot of help and wisdom from my mother made this easier than expected. I had just 2 months earlier become a vegetarian and step by step I experimented and explored a healthier lifestyle.

I tried Raw Food and in 2010 I started with a

LCHF diet (low carb high fat)

and it went pretty well but still those shots everyday.

In April 2011, I went to a frequency healer, recommended by my mum and I wanted to give it a shot. This is a machine invented by a person from NASA which calculates the frequencies that your body is sending out into the computer. You can then see what instabilites you have.

Pancreas infection

The conclusion from the visit was that I had an infection in my pancreas, rather than the conventional types of diabetes! Well this was very shocking after 11 years of having

diabetes symptoms

The healer instructed me to eat alkaline food since the stomach was the issue as to why I did not heal from the infection. I did so and 6 weeks later I came back and my results were great according to the computer as well as with my blood sugar.

She said that with the number of years you’ve had diabetes, it will take many months to fully recover so I am still in the recovering process.

Volunteering in Costa Rica

I was volunteering in Costa Rica for 3 months, Aug-Nov 2011, and had a hard time with the different food and carbohydrates which made my blood sugar rise again but now I have really put effort into this and since I am now choosing my own food again, I have great results.

Sometimes I no longer need my

long acting insulin

Free from diabetes

I also discovered that when I am doing training and exercise, that I truly enjoy, (like skateboarding, parkour, snowboarding and surfing) that my blood sugar level gets lower and stabilizes my control. I discovered that you need the joy in the exercise to get great results.

At least that goes for me and that is my story of how I became

free from diabetes

• Marcus runs his
  
  own website devoted to diabetes
  

Name:

Gillian Peace

Diabetes type:

Type 1

See more:

LeicsDiabetic Mums

I was diagnosed with

type 1 diabetes

four years ago. I had just returned from a holiday in Thailand where I thought it was the heat making me drink and wee so much.

I lost a stone in four weeks, which was a bit unusual, as I usually pile it on

when on holiday

I mentioned my problem to my practice nurse and luckily she was on the ball.

Phobia of hospitals

After a urine sample and a prick on the finger she ran off to get the

duty doctor

My blood sugar was 33. I was admitted to hospital where I spent the next three days. I already had a needle and hospital phobia so I was pretty petrified!

Everyone couldn’t believe how well I looked but how poorly I actually was – I suppose the sun tan helped with that.

The thought of

injecting four times a day

was scary enough without the thought of having to prick my fingers too. I met the diabetes team. It took ages to learn everything and hypos really scared me.

Hyperglycemic with ketones

I had to take time off work as I went from being

hyperglycemic

with ketones down to

hypoglycemic

and back again over the first month or so. Initially I had no understanding of carb-counting, but I eventually stabilized. I managed to get my hba1c to around 7 and last year I decided to have a baby.

That was even harder! At first

I had hypo’s galore

and by the time I was 7/8 months pregnant I was injecting about 7 times a day and taking 4 times the amount of insulin than pre-pregnancy. I changed hospitals, going to the Leicester Royal Infirmary, where I learnt not to ‘feed the insulin’ but to carb-count.

Blood sugar control through pregnancy

The point was that I had good, tight blood sugar control

throughout my pregnancy

Charlie was delivered by cesarean section at 36 weeks. Luckily I had a fantastic consultant who prepared me for theatre and talked everything through with me in advance. I’d been going every two weeks to a diabetic anti-natal clinic and was lucky enough to have this team with me on the day, which made a huge difference.

Dawn phenomenon

About three months after the birth I started suffering with what is called the ‘dawn phenomenon’, which is where your

blood sugars naturally start to rise

in the morning. I needed to do an injection between 3am-5am every morning to bring my sugars down.

Of course that left me feeling rubbish the next day with no energy at all. My consultant put me on the waiting list for an

insulin pump

to help solve this problem. I’ve been on the pump for about three months and feel so much better than I did before.

Before I’d had Charlie I was scared to have a pump permanently attached to me. It has still taken a while to get used to, but I can now honestly say that I wouldn’t give it back. It gives me more freedom and I can usually hide it so people don’t know I’m wearing one.

Coffee group for diabetic mothers

While I was attending the hospital for my pregnancy I met a couple of ladies with diabetes. We now meet up as a group for coffee every now and then, sometimes even at the clinic if we all have appointments.

We have Type 1,

Type 2

mums and a

gestational diabetic

mum too. We also have a Facebook page. It’s great support and a couple of the ladies really helped me with my pump and convinced me to give it a go – I owe them a big thank you, so THANK YOU!

Name:

Jill Wright

Occupation:

Retired

Jill was diagnosed with diabetes in 1951 – when she was just 22 months old. So she’s lived with

Type 1 diabetes

virtually all her life.

She has seen some changes, some of which were so long ago that she can only vaguely remember them.

Open about diabetes

Jill’s very open about her diabetes, as maybe you would be if you’ve essentially always had it. “I’ve never been secretive about it,” she says, “I think the more open you are with people, the better.  After all, at some time you might need their help. It’s not the first thing I say when I meet someone new, but I don’t worry about telling people if I need to explain things.”

Diabetes diagnosis

She can’t

remember being diagnosed

, but she’s been told that she became a very thirsty baby and started to waste away. “The local GP were a bit slow picking up on it, but they’d never seen a baby so young with it. I was put in hospital and it was back in the days when parents were only allowed to come in during visiting hours. My mother said I used to scream when she had to leave me. It hasn’t marked me for life though, I’m lucky not to remember it.”

Not in the family

As far as she is aware, Jill did not have diabetes in the family, though she muses, “it wasn’t a long time before then that people with diabetes just died, so maybe there had been someone in the family who had it but died of it before I was born and I did not know about them.”

Jill’s right that only a generation before diabetes would have been a killer. At the time of her diagnosis, he mother was told that Jill ‘would not make old bones.’ There were no

tips for people with diabetes

at the time.

60 years later

Sixty years later and Jill is doing just fine, thank you very much! She’s on two injections a day (she uses animal insulin) and does four or five blood tests daily too. “I like to know what’s going o,” she says, but she also remembers the many years she was diabetic and did not have a blood test meter. “The technology was not there’” she says, “it just wasn’t possible when I was growing up.”

She also says that in the early days there were not a lot of rules or regulations about diet, “I ate what I felt I needed. All we had back then was the ‘wee’ test – five drops of urine plus 10 drops of water in a test tube then pop a tablet in and it would fizz then change colour. If you were blue or green you were all right. If it went orange then you were in trouble!”

Blood testing and carb counting

Blood testing

and

carb-counting

came in later.

As a child Jill was treated by a local GP whom she recalls was “a nice, kind man.”  In her teens she went to a different clinic and she recalls there were “very fierce, if anything went wrong you felt it was your fault.

We counted

carbohydrate ‘exchanges’

and had to calculate our insulin. It felt like leaping over hurdles all the time, with loads of maths involved. I hated it, and didn’t stick to the rules!”

Despite what sounds like rebellion, Jill kept her head and had a sensible approach to her diabetes and she knows she’s doing fine, although she also feels that her regime is now a little old-fashioned by modern NHS standards.

Good care from the NHS

“I get good care, but most people are on the human insulins and on four injections a day, so the younger nurses aren’t used to someone on bovine insulin taking just two a day.  I do seem to be a part of a small and dwindling group of people on animal insulin, but it works for me. I’ve learned what my body needs and what makes it work, and why change?”

One thing Jill thinks has also changed, unlike her

insulin

but like the technological advances in blood testing, is that “Medical people are much easier to talk to now, it feels like more of a partnership, where you’re in control of your health and they are assisting you, not telling you off all the time!”

Name:

Peter Shaw

Diabetes type:

Type 1

Occupation:

Vice Chairman of the British Kitesurfing Association

Peter Shaw’s father was an aircraft engineer and his family was stationed overseas in Brunei when Peter was

diagnosed with diabetes

He recalls, “The only injections I’d had before then had been immunization jabs which I’d really hated having. I was 10 when I was diagnosed and my main memory is being told I was going to have injections for the rest of my life. I was truly terrified of the thought.”

“I also remember that

Type 1 diabetes

was so rarely seen that the doctors at the hospital were calling back to colleagues in the UK for tips on stabilizing a newly diagnosed T1, as most hadn’t studied this since training.”

Diabetes in the 1980s

This was in the mid-1980s and as there were issues starting to affect the regio, combined with Peter’s age,

educational needs

and diagnosis of diabetes, the family decided to return to the UK.

Better care in the UK

“The care was miles better in the UK,” says Peter, the care received in Brunei was excellent, it just took them a while to get up to speed “I was seen by a paediatrics team at Horsham Hospital. But back then, blood test meters were almost the size of laptops and lancing devices were like something from the French Revolution! I had a very early Ames Autlolet but my mum had to do the lancing. The

blood test meter

was a Glucometer, also by Ames, that my dad had to get imported via his company from the USA as they simply weren’t available. It was hard work for those around me.”

OmniPod insulin pump

Today Peter is on an

OmniPod insulin pump

that has an on-board blood test meter. He chose the OmniPod because of his involvement in kite surfing. He is vice-chairman of the British Kite Surfing Association and regularly spends extended periods of time in a wet suit. “As I do a lot of watersports, I needed a pump that did not have tubing,” explains Peter.

“I can get a wet suit on over the pod without pulling it out and tell it what to do with the handheld device. I have no worries about tangling or snagging. It’s waterproof, although in all honesty nothing is really sea-water proof so in this respect, the pods 3-day life span is a boon as they don’t have to survive past that time.

I put the PDM in a watertight case when I’m not using it. I use a Multiclix finger-pricker as I don’t have to handle any sharps and it’s reliable, solid and painless but could do with being smaller. It’s a great bit of kit. It’s all so much better than in the old days!”

Peter has learned from experience that testing after the first 30-40 minutes on the water is key, as this is the window when adrenaline (and being cold) can mask

hypo symptoms

“I force myself to come in and test after the first half hour and then I know I’m okay for another hour or so.  After that, I just have to be careful when I start to tire as that can also cover symptoms.

And I never go on the water without a couple of

sachets of glucose gel

stashed in my harness!”

Active and healthy!

Despite an active (and relatively healthy) lifestyle and constant

carb counting

, Peter says that there has been a slow decline in his control over the last few years which was the main reason for the switch to pump-therapy.

He had an

HbA1c

of 5.2 in 2007 and it’s now 7.2 – still a very respectable level although it is higher.

“My care team at the hospital have been great, especially my diabetes specialist nurse. They’re behind me all the way. I’m hoping to go on a CGM (

continuous glucose monitoring

) trial too. I’ll give anything a go if it helps me live the lifestyle I want.”

Name:

Richard Lane

Occupation:

Chairman of Diabetes UK

Richard Lane is someone who lived with diabetes for a long time before being one of the first people in Britain to have pioneering surgery in 2004-05 to have

pancreatic islet (stem) cells

from three organ donors put into his body where they began to secrete insulin, ‘curing’ him of diabetes.

A cure is coming

He is an impassioned speaker, eager to share his experience to give other people with diabetes hope that a

cure

is coming, even it if is still on the horizon for most at the moment.

He says, “I have been extremely fortunate to have had break-though treatment, which makes me incredibly happy, as it does my wife, children and all those who care about me. My thanks go to all of them. My diabetes story started when I was 32. I had odd

symptoms

and it proved hard to diagnose. I was really quite ill and thought I had cancer because of an extraordinary loss of weight and other relevant symptoms. I actually said, ‘hooray’, when I was

diagnosed with diabetes

It was a relief, but little did I know what was in store for me!”

Considering islet cell transplantation

In 2004, after retiring through ill health, Richard was asked to consider islet cell transplantation.

At this point there had only been seven people in

Canada

and two people in England who had undergone the operation. After two months of extensive tests, risk assessment and

education

, which involved his wife as well as himself, he was put on the waiting list for his first transplant.

“The support that I received from the team of surgeons,

doctors

and specialist nurses, including a psychiatrist, was fantastic,” he remembers.

15,000 beta cells

As many as 15,000 beta cells are required per huma, per kilo of weight, and at the time Richard was the oldest, tallest and heaviest of the patients operated on to date, needing 1.25 million islet cells.

Each operation involved the insertion of a probe with a canula on one end, which is pushed in between the ribs, through the liver and into the portal vein.

Beta cells in plasma are dripped in and are distributed into the liver. It can take up to three transplants as many of the islet cells die during the process.

It was a good result though. Richard says, “I was the first person in the UK to completely come off insulin. This situation continued for about a year, but I have now had to go back on to insulin. I’d contracted a viral infection from which some antibodies developed which are damaging my lovely new beta cells, and now I have to supplement my natural insulin via the pump and

count carbs

again.”

“The fact is that my first two aims have been achieved – to eliminate

hypos

and to stabilise the diabetes-related complications I was experiencing, so to not have fully continued to achieve the third aim (to come off insulin) is a small price to pay. I’ve not had a major hypo since the day before my first operation. If necessary, and if a suitable drug can be found to resolve the immuno-suppression problem I might have another transplant, which may correct this.”

Chariman of Diabetes UK

In November 2008,

Diabetes UK

announced that Richard Lane OBE had been elected as the charity’s new President. In the UK, Diabetes UK had set up the Islet Cell Consortium, which brought together nine islet research centres from around the country to ensure the technique was available here for the benefit of people with diabetes.

With the help of its members and supporters, Diabetes UK raised the money needed to pay for the first ten islet transplantations to be done in the UK according to the “Edmonton Protocol”.  Since then, Diabetes UK has secured funding from the

NHS

to transplant other patients.

Islet cell transplantation has now been accepted by the NHS as proven and recommended

treatment

, but only for those who have lost their warnings of hypos, and who have other serious problems with their diabetes.

This restriction is mainly because of the shortage of organ donors, although research to produce stem cells in the laboratory is proceeding very satisfactorily, and if successful, will resolve the problem of the shortage of organ donors.

However, the therapy is not yet sufficiently well advanced to guarantee
insulin independence and therefore freedom from diabetes, but the signs are really encouraging.

Name:

Dean Salisbury

Diabetes type:

Type 1

Dean was diagnosed with Type 1 diabetes when he was eleven years old.  This summer, he went on an

insulin pump

He says, “It’s like science fiction! In the old days we boiled our glass syringes to make them sterile, and either had to wee on a stock or – going back even further in time – pop a tablet in a test tube with a mix of water and wee and waited for it to stop fizzing and change colour.”

Blood test strips gripe

While he’s been fairly happy with his healthcare to date, he admits that recent attempts to restrict the number of

blood test strips

he’s allowed has left him pretty disgruntled.

“The big cost to the NHS is people who, for one reason or another, can’t control their diabetes and it leads to all the horror stories –

kidney failure

and so on.  I must be a relatively cheap date by comparison. Why restrict my strips when all I’m doing is what my consultant has recommended me to do? The point being that if I take care of myself now then I won’t cost the NHS a fortune in the future.”

One pot a week

Instead of being prescribed enough test strips for a month I have been told that I am only allowed one pot per week because of the cost but across the month I still get the same amount and in a time when we are all trying to save the planet I am forced to drive to my doctors at least four times per month, before the pump it was just once.  It just does not make sense considering I have very little impact on the resources available at my surgery and I have to rely on others to collect my prescription as I just cant keep getting time off work.

DAFNE

“I’m sure I’ll work out who’s the right person to talk to get this addressed, but I shouldn’t have to,” says Dean. As part of his interest in his own healthcare Dean’s done a Bertie – a variation of the better-known

DAFNE course

– which was held at the hospital where he goes to diabetes clinic. “I think it did me good to go – you do get a bit rusty on carb-counting and slip into bad habits.

Plus, it was up-to-date. The last time I had to learn all about food and insulin was decades ago – although it’s one long learning curve when you have diabetes as you learn about food and insulin ‘on the job’ as it were. But it did give me a boost to do some more learning at this stage.

Now a pumper

“Since becoming a ‘pumper’ my life has changed dramatically and I feel so much better for it and the support I get from Broomefield Hospital is first class, I upload information from my pump on a weekly basis and adjustments are made to my régime as seen fit, I don’t even have to go to the hospital I can sit at my desk and discuss with

Specialist Nurse

, Margaret Bardle, as she will have all of the data from my pump on her desktop and will advise me accordingly.

“I do not miss the old black-and-white days having to wait in a hospital waiting room for 5 hours to be told your wee is the wrong colour, and told to go away and don’t even look at things that may have sugar in them.

“Now I have no fear of

hypos

, the pump has rectified that situation for me and I will be for ever grateful to Dr. Fletcher and his team at Broomefield Hospital as now I look forward to my hospital appointments.  They are not getting my pump back… ever!”

The following is a guide to what you can do if you, a family member or friend is stranded abroad and in particular, are facing medication shortages.

Should you need medication

• Should you be a British national stranded abroad and you are running out of medication, you can check if any is available at your local pharmacy, or go to a local hospital or doctor.

Should you need a hospital or a doctor

• You can visit the website of the British Embassy to enable you to find a hospital or doctor www.fco.gov.uk/en/travel-and-living-abroad/find-an-embassy/
• Should you have a number, phone your local embassy for further advice. You ought to call the British Embassy if you have been admitted to hospital. British nationals stranded overseas can contact the Foreign and Commonwealth Office (FCO) advice line on +44 20 7008 0000 for more information.
• www.iamat.org The International Association for Medical Assistance to Travellers is able to provide names of English-speaking healthcare professionals in the country you in and is able to advice travellers.
• You can also contact the closest British Embassy or local medical schools for lists of English-speaking doctors.

Retain receipts

Should you have to pay for prescription medicines or other medical treatment, retain any receipts for possible reimbursement in case your travel insurance provider is able to reimburse you when you return home.

Latest travel news

• If you are concerned about the safety of a British national stranded abroad, you can phone a Foreign Office helpline on 020 7008 0000, or go to its website at fco.gov.uk
• All flights bar a few are grounded today due to the Icelandic volcanic ash cloud. It has been confirmed that British flight restrictions are to continue until 1pm on Tuesday.
• You can go to nats.co.uk the British air traffic control service for up to date information.
• Some flights are operating into Scotland.
• London is considering using Spanish airports, which are now open, as a ‘hub’, for flights coming from African, Asia and America.

Upon getting to Europen, passengers can then use other transport services like coach, train and ferry to get home.

Eurostar, ferry and coach services have also all been increased to help passengers unable to fly. Forecasters are predicting that the disruption is most likely to continue into next week.

People with diabetes stranded abroad

Should you have diabetes (or are on medication that is depleting) and are stranded abroad, you need to get in touch with your GP and your travel insurance company.

• It is also imperative to contact your airline or your tour operator. You may be given priority booking due to your health condition.

Rights if your flight is cancelled

Under European regulations, airlines are under no obligation to pay compensation should they be able to prove that the cancellation was due to ‘extraordinary circumstances’ which were unavoidable, even if all reasonable measures had been taken.

According to EU legislation, should you have been at the airport when your flight was cancelled, you may be entitled to refreshments, meals, appropriate telephone calls, hotel accommodation and transport to and from the hotel.

Should you have booked two single tickets, as opposed to a return ticket, the same EU rules may still apply. So you should be entitled to meals and accommodation until alternative transport home can be arranged.

Can I claim on my travel insurance?

You can claim on your travel insurance depending on what kind of insurance policy you have. Certain policies offer cancellation cover for natural disasters.

However, others exclude what they refer to as ‘acts of god’. Hence, you need to carefully check your contract terms and conditions. Your airline is likely to refund you for any cancelled flights Yet you may also need your insurance company to pay out for additional non-refundable bookings like accommodation and car hire.

Defaqto, the financial research company, is urging that you urgently contact your insurer and find out what cover you are entitled to.