The best-selling crime writer Peter James has invited Diabetes.co.uk to tea. His Swedish partner Helen has prepared a really sweet cake. But surely people with diabetes can’t eat sweet cakes? Or can they?

And what about exercise? James spends hours every day slaving over his Apple Mac as he dreams up new adventures for the Brighton-based hero of his best-selling series of thrillers – Det. Superintendent Roy Grace. Sedentary lifestyle? Yes and no. In between the long and lonely hours at his keyboard, James goes for a daily jog in the hills near Lewes, and plays tennis at least twice a week in the summer.

“Running is especially energising for me as a writer sitting motionless for much of my work day, and keeping fit is crucial for diabetics”, he says.

Eating sparingly,,,

James eats sparingly for reasons which become apparent when you learn that he has

Type 2 diabetes

He is healthy because he has to be. “If you’re sensible, Type 2 diabetes is actually good for you” he says, with a touch of good-humoured irony. “You’re stuck with it. At the moment there’s no medical research that will enable you to get rid of it. There’s continuing work on it, which includes pancreas transplants, stuff like that, and I think eventually it will be possible to cure it, but probably not in my lifetime? So as far as I’m concerned keeping it under control forces me to have a healthy lifestyle.

“The big advantage of being a diabetic is that the more popular a disease you have, the more money is thrown at it. You don’t want to have a disease that only 50 odd people have because there’s no money in it for the pharmaceutical industry – so no research. There are over two million diabetics in the UK alone.”

“Popular” or not, it was quite a shock for James when he was

diagnosed

soon after his 50th birthday. “I think the big shock was the realisation that you’re not immortal” he says. “But I am of course! As Woody Allen said: ‘I don’t want to live on through my work – I want to live on in my apartment!’ But joking apart, it was a massive shock to discover I had a life-threatening disease.  My first reaction was absolute fear. The second was that my days as a chocoholic (I was addicted to Maltesers) were over! Then when Sir

Steve Redgrave

won his gold medals at the Olympics, as a diabetic, it made me realise being diabetic didn’t really need to affect my life in any way whatsoever.

Peter James, fruitbat.

“OK, I eat a little less fruit than I used to – friends at school used to call me ‘fruitbat’ because I used to mix 10 bits of fruit in a blender. I was a bit of a health fanatic back then and that was enhanced by living for a while in Canada. An uncle of mine emigrated to Canada and became Chief Scientific Adviser to Pierre Trudeau and the Canadian government, and he got into nutrition and fitness. And he’s a pretty good living example: he’s 90 years old, plays tennis twice a week and is still very active mentally.

“The Canadians were into all kinds of healthy stuff long before the Brits, like low cholesterol spreads rather than butter – that kind of thing. I went out there when I was 22 and got quite into that. (I’d been a good athlete at school in spite of discovering poker and smoking!)

But other than skiing I did no regular exercise until I was 35, and embroiled in a tough corporate lawsuit. At night I was kept awake by blinding headaches and frequent pins and needles. After seeing a TV programme on stress, I began jogging every morning. By the third day of running all my symptoms had gone. I started running every day – literally every day. I still do, anything from two to five miles a day. And I play tennis quite a bit to keep fit, too. So I thought ’why have I got diabetes?’

Obesity

“One known reason for the rise in number of people with diabetes is increasing

obesity

and lack of exercising. But I think that stress is another. It is established that stress can be the trigger for a number of diseases – and I don’t think it is coincidence that I was diagnosed with diabetes in the immediate aftermath of my divorce. I was married to Georgina for 19 years. Our breaking up was a nightmare in which I was torn apart by the sheer magnitude of what divorce really entails. I ended up first in therapy, then in London’s Cromwell Clinic with a nervous breakdown. It was absolutely the worst period of my life. I’ve always been in charge of my destiny, so it was terrible to suddenly feel out of control. We finally divorced in September 1998. In January 1999 I was diagnosed with Type 2 diabetes.

“It was discovered by my GP when I went for a check-up. Yet I’d had no symptoms at all – so no thirst or frequently needing to pee, no blurred vision as a result of dry eyes, no tiredness. Many people don’t have any symptoms. This is why it’s called the Silent Killer.

“But diabetes also runs in the family. The gene runs in my family and as a child I had seen the effects on my grandfather who was Type 1. He had it really badly in the days when it was hard to treat. He used to bring this bizarre injecting equipment with him with horrible big needles when he visited. Later he lost his leg and went blind from it. That was a big lesson to me. As well, my mother had Type 2, but she controlled it carefully and lived until she was 83, untouched by it.

“In fact, I now realize I was incredibly lucky that I got diagnosed when I was aged 50. With no symptoms, many people don’t get diagnosed until they’re much older, so I could have been 75 with all the damage that 25 years of untreated diabetes had inflicted.

“Until the discovery of insulin at the University of Toronto in 1922 (you see, once again Canada was at the forefront), if you were diagnosed with Type 1 you had a life expectancy of about two years. Type 2, which I have, is called ‘late onset’, and you tend not to get it until mid-life.

“I like to think that by being open about my diabetes I can help other people. I get really angry when friends of mine – people I care about – ignore their diabetes, and risk their health deteriorating. One good mate, the same age has men, has just had a toe amputated. I’m just astonished to see what some diabetics eat and their lack of exercise.

Uncontrolled diabetes

“If you have uncontrolled diabetes, you’re up to five times more likely to suffer heart disease, stroke, foot infections due to nerve damage, and an eye condition called

retinopathy

which can cause blindness.

I had another very close friend, a smoker, who was exactly the same age is me – even the same birthday – who completely ignored it. He died two years ago.

“Mercifully the

treatment

is much better now than in my grandfather’s day. I nailed it right from the start. I learned everything I could possibly learn about it and tried every alternative. I was probably in denial at first, but only for a couple of days. Then I thought – actually, how do we deal with it. And I realised that if you control it, it’s the same as not having it. I’ve had a couple of medicals when doctors haven’t even noticed I have it. The signs would be

high blood sugar

, and that’s what you have to control.

“The difference between us is that if you binge on that Swedish cake we’re having this afternoon you’ll be alright, but my blood sugar would go through the roof. Two hours later, if you had a blood test your blood sugar would be somewhere between 4.7 and 7. The blood glucose of a person with diabetes could be anything from 9 or 10 up to 30+.

Looking after yourself

“That’s what has to be controlled. Diabetes

makes

you look after yourself because I don’t have the option of not looking after myself. So you keep your weight down and eat healthily. Exercise is the best as it stimulates the pancreas. When it comes to blood glucose meters I use a OneTouch UltraEasy and test every morning, first thing, two hours after breakfast, before lunch, two hours after lunch, before evening meal, before bed and during the night, if I wake up.

“I always carry glucose tablets. Eating regularly is vital for keeping a balanced sugar level so I need to plan ahead. For my research, I regularly go out on patrol with the Police, and there are times when they are following a villain and I can hardly say, ‘Hey, let’s stop because I need my lunch!’

“Five years ago I switched from control by tablets to injecting as well and life has become much easier. I take one 24 hour injection in the morning and a smaller dose with each meal. If I want to have a sinful treat I can, and just up the dosage. It’s brilliant! In fact, I’ve got really good at it. I can surreptitiously jab myself under a napkin while out at a restaurant. Just like with some of the criminal characters in my novels, nobody would suspect a thing.

My life expectancy is normal – I should get to at least 1000. Which I am planning to do!” Just think how many Roy Grace novels Peter will have time to write in the next 940 years!

Peter James’s novella, “The Perfect Murder” has recently been published by Pan MacMillan on March 4, and his new Roy Grace novel, “Dead Like You” will be out on June 2nd.

Neuropathy is one of the most common diabetes complications, affecting between 60% and 70% of people with diabetes at some stage. Neuropathy simply means nerve damage, and can occur in every organ system but most commonly in the feet, arms, hands and legs.

Neuropathy is most common amongst people who have had diabetes for at least 25 years, and also more common amongst those who have trouble controlling their

blood glucose

Furthermore, those who are overweight and have

high blood pressure

face a greater risk.

What causes Neuropathy?

Neuropathy can be caused by high blood glucose, abnormal blood fat, damage in the blood vessels, autoimmune factors, injury to nerves, inherited traits and lifestyle factors such as alcohol or

smoking

Neuropathy symptoms

Symptoms depend on the type of neuropathy but can include:

• numbness
• muscle wasting
• indigestion
• dizziness
• urination problem
• 
  erectile dysfunction
  
• weakness and others.

How is Neuropathy treated?

Diabetic neuropathies are treated by bringing glucose levels under control,

medication

, treatments such as creams.

• 
  Read about Diabetes Neuropathy
  
  
  
  

Community perspectives

• Dobbs
  : I also had neuropathy for a time (which is what led me to discover I was diabetic) but after about a year of controlling my levels it subsided considerably and now I’m rarely aware of it and it almost never bothers me. I do believe tight control of your levels is the only way towards longer-term improvement, but these other suggestions are great if they bring a bit of relief while you’re waiting for things to improve.
• Lillibet
  : Tight control of blood glucose can in some cases reverse neuropathy – though to what degree I don’t suppose anyone can say. I’ve also read of supplements which can help:
  Alpha Lipoic, Acid,
  Evening Primrose Oil,
  Benfotiamine,
  Vit C
• Roy948
  : I have similar burning sensations in my ankles and feet, ask you doctor to try a capsule called LYRICA, for me it has worked wonders.
• Donal Bredin
  : I have suffered for a few years with this. It seems to get worse in cold weather. This winter after getting it bad I did a number of things:
  
  – I went online and got some very thick warm socks
  
  – I went on the vitamin B complex.
  
  – I gave up the statin pills I was on for cholesterol.
  
  – I made sure the electric blanket was on for at least one hour before I went to bed.

There is no doubt that computers have a role to play in healthcare, and using computers to help manage diabetes is becoming increasingly common.

One way in which computers and connectivity can help people with diabetes is using data management systems.

Usually, data management systems are simple programs that automatically or manually let you log data such as

blood glucose levels

This data can then be displayed as a graph to identify trends, or even showed/sent to a healthcare professional to help manage diabetes.

What diabetes data management systems are available?

Many blood glucose meters now come with diabetes management software pre-loaded. For instance, with the

Bayer Contour USB

it is simply a matter of plugging your meter directly into your computer. Other data management systems such as MyLifestyle allow patients with any meter to manually upload a variety of health information, including blood glucose levels.

Almost all blood glucose companies now provide diabetes management software, much of which is available to download for free. Diabetes management software includes the SLdiary by Sinovo, Compass by Accu-Chek, OneTouch

diabetes management software

from Lifescan, Smartpix.

Recently, a number of bespoke products and phone applications have emerged, including Glucose Buddy, Diabetes Diary and Diamedic.

So, should I use a data management system to help manage my diabetes?

Using a data management system is down to the individual. Some people with diabetes find that they are particularly effective for managing diabetes, particularly for looking at long-term

blood glucose averages

and comparing these with diet and exercise patterns.

• If you can find a diabetes management system that you feel comfortable using, and helps you to control your blood glucose system, please share your finding with the
  diabetes community

What does the community have to say?

• JamesHallam
  : I use Glucose Buddy on my ipod touch to track my blood glucose, insulin, food and exercise. It has a website which you can upload you data to, and this produces a number of graphs and averages and even calculates an estimate of you HbAC1. I email myself the logs from Glucose Buddy every month and also track them in my own spreadsheet. It started of quite simple but has grown and now does a number of things.
• Fergus
  : So far I found most management software promises a lot, but fails to deliver…
• Fergus
  : I now I tend to use it much less often than before. I grew more confident and also more lazy, the data input became a chore and if left more than a day or too, it obviously became less accurate and less useful. Now I use it every now and then, if changing basals or if blood glucose levels become less predictable, or when I’m raising my levels of exercise. I’m also more selective about what data only putting in what I actually need.
• Dragongirl
  : I looked at what was available for the Aviva Nano and then set my husband to write a simple Excel spreadsheet on which to list food, amount eaten and carbs consumed, plus all the totals and graph outputs – only for the things I needed. I filled this in for 12 weeks including showing the GP and then ditched it for a simple list in a simple notebook, which addresses day-to-day stuff.
• Fergus
  : Another negative point is that it seems every meter has its own software specifically for that meter and I feel a unified software package instantly usable by healthcare professionals  would be more use as my diabetes nurse’s eyes seem to glaze over when I show her my print outs so she obviously doesn’t really know what she is looking at. Surely it wouldn’t be too hard to write a program that would upload data from a variety of meters and display the information in a uniform fashion so patients and HCP would instantly know what they were looking at?

Recent diabetes news indicates that

online communities could genuinely help people with diabetes

to support each other and learn more about their condition.

Whatever the type of community, researchers believe that patients are likely to trust their peers.

Developing communities

In the last few years, communities have evolved to include Facebook, Twitter and more advanced forums where hundreds of thousands of people with diabetes meet daily to discuss and learn.

The

Diabetes.co.uk Forum

, which is the largest online diabetes community in the UK, has been online for several years.

The Diabetes Forum doesn’t have any doctrine or agenda; it is simply a neutral discussion space for people with diabetes to communicate with each other.

By observing our forum and our

Facebook

and

Twitter

pages, it is obvious that an online community has a strong role to play when it comes to sharing information and personal experiences, getting reinforcement and support, and meeting people in a similar situation.

Consulting a professional

However, although user-generated health content such as blogs, social media and forums is a big part of the future of healthcare – it is worth bearing some guidelines. Never take anything written online as necessarily true – always check with your healthcare professional. Debate can develop into full-blown online arguments and although moderation teams should help to prevent this, forums are not always harmonious.

Safety first

Always use forums safely – never give out contact details or agree to meet offline. It is worth remembering that not everyone is what they seem. That said, through using forums in a safe and responsible manner a great community can be reached.

What does the community have to say?

• Fergus
  : The help and support on this forum is excellent between members and many have benefited from the experiences, good or bad, of other members and have become confident enough in their own diabetic management to then advise others. In this way we help self empower many members to cope and manage their own diabetes and to be able to ask their HCP’s relevant questions about their diabetes.
• Doczoc
  : Here’s to the biggest and best diabetes forum! I wonder how many lives have been changed for the better by being a member on here? I know mine has. It’s literally saved my life. Nice work everyone.
• Fergus
  
  :
  
  The best part? Reading that someone has got the diabetes help they need off the back of advice from this forum. Can’t ask for much more than that.
• Carolynjw
  : This forum has definitely saved my life in just a few months. I was just about suicidal back in November, and have turned around my diet, decreased my insulin, dropped my Hba1c by 1.6 – all in a few months. Thanks everyone on here…
• Fergus
  : Following on from what has been said previously I think that this Forum in particular has to be the best, most open, honest and balanced place you are ever likely to find on the net. A fabulous diabetes resource. There are all manner of opinions given on here, some factual, some anecdotal. All are worthy of inclusion and of consideration. You can ignore things, take things on board, or just ask questions to clarify what has been said.

Join us!

• 
  Join the Diabetes.co.uk Forum
  
  
• 
  Find us on Facebook
  
  
• 
  Follow us on Twitter
  
  

Patient perspectives on pre and post meal testing are mostly positive. Read the thoughts of several community members on the topic of pre and post meal testing below.

• Page 1:
  
  Pre and Post Meal Testing
  
• Page 2: Patient perspectives & forum threads [You are here]

Perspective from: ronjo94

I was diagnosed type 2 about 4 years ago. I tested before and 2 hours after initially whilst testing the water to find a suitable

diet

(my clinic is not much help) and made a log so to be able to analyse the results. I found that my annual HBa1c results differed in that they were lower than my own readings.

My average was 8.2 against the HBa1c of 6.9 the 1st year. I am aware that self monitoring is only a guide and cannot mimic the HBa1c reading however, after much experimenting I found that if I took my readings 3 hours after a meal rather than 2 hours after, my results came close to the HBa1c results. This method for me therefore provides a better indication of my sugar levels throughout the year (between annual checks), and I only need to occasionally check my levels to maintain an average. Having said that, I am unable to control peaks which occasionally can be as high as 14. If I had an inexhaustible supply of strips I could maybe iron out the peaks and therefore improve my

HBa1c

figures. Alas, 100 strips last year and I have just had to beg for a meagre 50 more does not enable me to provide consistent control.

I would point out that these peaks are NOT due to a diet change but, if I was able to be able to note every one, I might be able to effect some change. I realise that this is a long post but it may gel with someone who has similar problems as I know that we all differ in our needs. Incidentally, just to give an example. I can have a reading of say 7.5 before my evening meal which could consist of 2 slices of homemade (and therefore no un-necessary additives) granary bread, with a low salt and fat spread plus a little tinned tuna followed by a cup of cocoa or barley drink with no sugar, just a little Splenda and, 3-4 hours later go to bed with a reading of 12. The following morning before can be 8-9 and 3 hours later 6.5, It’s a problem.

• Community profile:
  ronjo94’s forum profile

Perspective from: Meisonlyme

I test before every meal and before going to bed. I find this useful as I am a carb counter and knowing what my blood glucose level is before eating tells me a number of things:

• Whether I need to include a “correction” dose of insulin with the meal I am about to eat to bring my level back down to within an acceptable range.
• Whether I accurately worked out my previous meals dose of insulin correctly based on the amount of
  
  carbs
  
  I believed I was eating.

I test before bed as I have a sliding scale of long-acting insulin doses depending on where my blood glucose level is, if I give myself the wrong dose because I didn’t test then this can result in my

blood glucose

being elevated in the morning, therefore being a bad day of feeling lethargic and tired or having a hypo in the night which is also not pleasant, or waking up with sugars lower than would be preferred which means I have a headache.

The testing at night therefore means I can have a good day the next day, which is true about 95% of the time (the other 5% is when I am ill and there is no rhyme or reason to what my blood glucose levels do despite all the testing I do because of infection levels).

• Community profile:
  Meisonlyme’s forum profile

Perspective from: Synonym

When I was first diagnosed and had seen the Diabetic Nurse who advised me to eat my normal diet as it was very good I was feeling very unwell and so I found the advice confusing and inadequate. In the beginning I needed to know what was making me feel so ill and when I started testing before meals and 2 hours afterwards I was able to actually see what levels I was starting from on my normal diet.

The testing enabled me to cut down portion sizes first of all to see what difference that made. I was then able to isolate which food was causing the spikes and by gradually cutting down on some and eliminating others from my diet I was able to control my BG levels effectively. I have discovered how combining some foods can ameliorate or lessen the effect that some of them have on my BG levels.

I was very interested to note that T2 friends did not always react to foods in the same way as I do. Different things make them spike and they need to use different ways to help them avoid spikes and control their BG levels. When I am unwell I have noted that my BG levels are again very different and if I test I am able to select my

foods

to afford a measure of control on these occasions when my levels would otherwise be sky high.

When I am anxious or under stress I have also noted the rise in BG levels and testing before and 2 hours after meals has been very helpful on keeping a greater measure of control. I noted that when I went to bed, if my BG level was too low, the morning reading would be much higher than usual and it would be hard to get the numbers down throughout the day. Through testing and eating a small snack to prevent BG levels becoming too low before bed time I have been able to ensure that this does not happen.

Clearly the standard advice to eat plenty of starchy

carbohydrate

was not appropriate for my body and following it made me very unwell so testing has been the only way to work out the way to a better quality of life.

• Community profile:
  Fergus

Perspective from: Jenrose

When I was first diagnosed 4 years ago I was prescribed test strips and I used them to test before meals and 2 hours afterwards in order to determine what effect the food I had eaten, or what drinks, affected blood glucose levels.

I also used the meter when I felt

hypo

At first I would feel like I was hypo when the bg level was 5.0 mmol/mol.

Now if I had eaten what is recommended for a hypo I would have then gone too high. After a couple of years I found that after walking twice as far as usual with the dog that I would regularly go below 4.0 mmol/l and once went as low as 2.9 mmo/l.

About 2 years ago I was not given any prescriptions for test strips so I purchased them myself. Recently I had lunch at 12 noon and had 1 digestive biscuit in the afternoon as I knew I would not be eating until late that evening (6.30) and when I tested I was surprised that it was 8.0 mmol/l.

Now I have heard people say that there is no need for a type 2 on

Metformin

to test because there is nothing that can be done about the result. In my opinion the result gives a person knowledge and with that knowledge they then have a choice – if blood glucose is on the high side before eating then a choice can be made of what to eat and what to avoid. Testing first thing in the morning now and then will also give an idea of whether they are keeping on track especially if not seeing the nurse for 10 months for an hb1ac result.

• Community profile:
  Jenrose’s forum profile

In the past, aspirin was often prescribed to people with diabetes, with the aim of reducing the risk of cardiovascular disease as a diabetes complication.

However, concerns over an increased risk of bleeding associated with aspirin have led to recent new guidelines for aspirin for diabetics in the UK.

Aspirin: revised recommendations

In late 2009, Diabetes UK revised their recommendations regarding aspirin. They stated that people without known cardiovascular disease need to discuss their individual cases with their healthcare team, rather than taking aspirin as a preventative. Those people that are already taking aspirin were advised to continue until they have talked with their healthcare team.

Diabetes UK recommends that people with diabetes who have a history of cardiovascular disease should take aspirin – including those with

heart disease

, stroke, transient ischemic attack and peripheral vascular disease.

Effectively, the consensus is that aspirin should not be used routinely to prevent heart attacks amongst people with diabetes. Previous guidelines that suggested aspirin should be used by diabetics to counter the risk of heart attack and stroke are now invalid.

That said, some high-risk groups should still use aspirin to lower their risk.

Patients with diabetes should discuss their aspirin use with their healthcare professional. The fact remains that amongst people who have had a heart attack or stroke, aspirin has been shown to reduce the risk of future cardiovascular events by a significant amount. The risk of stomach bleeding needs to be carefully considered and discussed with your healthcare team.

What the community are saying about hypos?

• Foreman
  : I have stopped taking low dose aspirin following advice from a consultant. Now my GP wants to restart me on them. I’m confused; I understand the reasons for taking them but I want to know if the risks outweigh the benefits?
• Hobs
  : There are risks and possible side effects with most meds, but you would need to know why the meds were prescribed in the first place to evaluate if the benefits outweigh any risk by taking it. I was prescribed 150mg of dispersable aspirin daily for cardiovascular reasons and to counteract any digestive tract problems I also take the proton pump inhibitor lansaprazole. To get technical, aspirin slows the production of sticky platelets in the blood and therefore reduces the clotting factor, and for men, after several TIA’s some years ago, aspirin is a risk worth taking.
• Vanessabc
  : I always refused to take aspiri, under considerable pressure from my consultant, and am glad I stood my ground. I have also been under pressure to take a drug to reduce my cholesterol (which has always been superbly low), I am refusing to do this, they never suggest a change in diet to reduce cholesterol, which is much safer and natural).
• IanS
  : Most acidic substances are imbibed as aqueous solutions, such as the various examples that you gave. Unless aspirin is taken in solution, it is usually taken as a tablet, which then sits next to the stomach wall. Now the stomach already contains a very strong acid solution. So strong in fact that it continuously dissolves the stomach wall. Fortunately, it continuously renews itself.

  It would seem that the problem with aspirin is not actually its acidic qualities that result in holes in the stomach wall, but the fact that it causes ulcers in the wall or even local bleeding. These ulcerated spots are less able to renew themselves, hence in some people the wall can be breached.

• 
  Witan
  
  : Aspirin is to thin your blood and reduce possibilities of clotting, the jury is out and divided on the need and effectiveness of this. For me Aspirin had some strange effects on my stomach (Dr would not believe) It made me very constipated and I proved this by stopping and starting it several times.

Managing blood glucose levels is the key to avoiding diabetes complications. Fluctuations in blood glucose can damage nerves, organs and blood vessels.

Furthermore, a raised glucose level may cause very few

symptoms

, but still be damaging in the long term.

Increasing likelihood

Having diabetes does increase the likelihood of major health issues such as heart disease and stroke. Furthermore, poor blood sugar control increases the risk of a blood vessel becoming blocked.

Types of complications

Major diabetes complications include nerve damage, retinopathy,

kidney disease

,

sexual dysfunction

, miscarriage and stillbirth.

Nerve damage, also known as diabetes neuropathy, is caused by high blood glucose levels.

Neuropathy

can lead to tingling or burning, and also affect the digestive system and cause nausea, vomiting or diarrhoea.

Retinopathy

damages the retinas, blocking blood vessels or causing them to leak and preventing light entering the retina. The blockage of small blood vessels in the kidney can ruin kidney function and lead to kidney failure. Diabetes complications also include sexual dysfunction, causing

erectile problems

Smoking

has also been highlighted as a cause of diabetes complications. Regular blood glucose testing, learning what your blood glucose means, and setting goals to manage blood glucose can all lower the risk of diabetes complications.

To learn more about managing diabetic complications please read the following guides:

• 
  Diabetes complications
  
  

What the community are saying about diabetes complications?

• 
  Noblehead
  
  : Try to tighten up your control and hopefully these early changes in your eyes will not progress to more serious complications. Stable bg control, keeping blood pressure/cholesterol below normal, and of course eating a healthy well balanced diet can all prevent further damage.
• Fergus
  : Now, I am all for everybody keeping tight control but there are limits to what is good for you. Most know that high levels are bad for you and will eventually cause complications, however there are many who seem to think that ultra low will make it better. Not so ! There are consequences to everything.
• Badmedisin
  : Anyway, I had ‘early diabetic changes’ for about 15 years before it developed into background retinopathy, so there’s a good chance you still have time to prevent your changes getting worse, as long as you stay in control.
• Fergus
  : Complications will set in if you ignore it but I like to think that control will delay or even eradicate the inevitable as it is always described as a progressive disease. I don’t think it is a question that anyone can truly answer but it is always best to give it your best shot. Never give up and always take control is my motto.
• Castigers
  : In my early days I had pictures of what happens when Diabetes truly takes control…was more than enough for me to stick to the straight and narrow.

The community feature this week focuses even further on diabetes and hypoglycemia, a topic we feel is essential for people with diabetes to understand.

Blood sugar levels mean the amount of glucose in the blood, and when this falls below a certain point a number of symptoms occur – this is hypoglycemia, or a hypo.

These should go away about 15 minutes after eating sugar if mild, but should be taken seriously.

• 
  What is a hypo?
  

What causes hypo?

Hypo is a short name for a low

blood sugar

event caused by over-treatment, too few calories for energy requirement, or

alcohol

What happens during a hypo?

Hypos can be mild or serious, depending on whether you can manage yourself or you need assistance.

Symptoms include:

• paleness
• shaking
• perspiration
• feeling weak
• rapid heartbeat
• hunger
• agitation
• difficulty concentrating
• irritability
• fatigue
• blurred vision
• temporary loss of consciousness
• confusion
• convulsions
• coma

Hypoglycemia

is treated by drinking or eating 10-20g sugar in any form. For serious hypos, glucagon should be administered or an ambulance should be called if this is not possible.

Healthcare professionals advise treating serious hypo as an emergency.

In cases of serious hypos, an ambulance may need to be called. Healthcare professionals advise treating serious hypo as an emergency.

If you experience regular hypos it is well worth testing your blood glucose more often. You may need to review your treatment and management routine. Make sure you always carry enough glucose with you. Read more on

hypo awareness

What if I am regularly experiencing hypo?

Regular hypos mean that you should test blood glucose four times per day. You should carry sugar, adjust your treatment and management routine and make sure you have a glucagon injection kit. Be aware of hypo symptoms and follow advice from healthcare professionals.

Remember, regular hypo can be dangerous and damage long-term health.

What the community are saying about hypos?

• Fergus
  : When I see anything below 4 on my meter I tut and feel annoyed and sad. Then I spend a few minutes at least stressing about how it happened, how it can be avoided and with firm assurances to myself to not make that mistake again.
• Fergus
  : 2.9 mmol/l is definitely hypo ground, it sounds like you may be running your BG levels too low if you get no hypo symptoms until that very low point. When I hit 2.4 mmol/l once I knew it was coming and I felt dreadful
• DannyB
  : My BS levels have been pretty predictable now for some months. I do not take tablets or insulin – I control with diet (relatively low carb) and exercise. (I am type 2). Normally my late afternoon levels (before my evening meal) are around 5.2/ 5.8. However for the last week or so I have noticed that my BS level (just before my evening meal) has been much lower: 4.1 / 4.5. Then just now I felt a little ‘wishy -washy’ so thought I would just check my level and it was 3.6. I have only ever seen a figure as low as that once before after I had been on the treadmill for too long.
• Lucozade
  : There’s a documented phenomenon whereby established diabetics “lose” the threshold for hypos and start to experience hypo symptoms at higher thresholds than the “routine” 3.9 for example, so even at say 5, they can have hypo symptoms, even though it shouldn’t happen at 5.
• Fergus
  : I don’t think there is anything to worry about with the odd lower reading. Maybe it means his blood sugar levels are becoming more normal, maybe he ate a fewer carbs or did a bit more exercise the day before. Maybe he is becoming a little less insulin resistant. 3.9 is on the low side of normal but 4mmol isn’t a figure below which it’s immediately dangerous. (in places that use mg/dl the level of 70 or even 65 is given for hypos. Like 4mmol, round figures 70mg/dl converts to 3.88mmol/l).

Most people with diabetes have heard the word cholesterol, and know that a high level is best avoided. This feature looks at lowering cholesterol and what cholesterol does to the body.

What is cholesterol and why lower it?

Cholesterol is a fatty deposit that can increase the risk of heart attack or stroke, particularly for people with diabetes. A buildup of cholesterol can make blood vessels narrower and more easily blocked.

• Read about
  
  Diabetes and Cholesterol
  

Is cholesterol just bad for people with diabetes?

There are two forms of cholesterol. One is ‘bad’ cholesterol – Low Density Lipoprotein. The other helps to clear blood vessels and is ‘good’ cholesterol – High Density Lipoprotein.

How much LDL cholesterol should I aim for?

Healthcare professionals

in the UK recommend that people with diabetes keep levels of bad (LDL) cholesterol under 2 millimoles per litre (mmol/L).

Furthermore, total recommended cholesterol levels should be under 4 mmol/L for people with type 2 diabetes.

How is high cholesterol treated?

Controversial medication Statins lower the amount of cholesterol in the blood, although not all people with diabetes agree with their use. Statins are available on prescription. Statins include:

• Atorvastatin (Lipitor)
• Pravastatin (Lipostat)
• Rosuvastatin (Crestor)
• Simvastatin (Simzal, Zocorn, Zocor Heart-Pro)

Some research indicates that taking a statin if you have diabetes lowers the chance of heart or circulation problems whether you have high LDL cholesterol or

heart problems

However, many people with diabetes disagree with statin use – a whole topic in its own right.

What other treatments for cholesterol are available?

Further treatment for cholesterol includes fibrates, but they are less commonly prescribed and may only be given if a statin cannot be taken. Fish oils are also thought to lower levels of unhealthy fats called triglyceride.

Fish oil could include oily fish such as mackerel, sardines, salmon and trout. Fish oil is also available in capsules.

However, one study showed has shown that fish oil could raise levels of bad cholesterol. Niacin is another older treatment for high cholesterol, which has been largely discontinued due to side effects.

Another cholesterol treatment under investigation is Ezetimibe, which stops cholesterol getting from food into the body.

Eating a

healthy, balanced diet

and avoiding high-cholesterol food may help many people with diabetes to achieve and maintain a healthy cholesterol level.

What the community are saying about Lowering Cholesterol

• Fergus
  : My cholesterol has never been raised and has not been affected by the additional cream, cheese, nuts and seeds and I am not on any medication for cholesterol even though I had strokes 4 years ago. It is all very difficult to work out what is best for us individually as we are just that – individuals!
• Fergus
  : About two in three adults have a cholesterol level that is higher than recommended. Having high cholesterol affects your heart and blood vessels and increases your risk of developing cardiovascular disease (CVD). High cholesterol causes fatty deposits (known as plaques) to build up inside your blood vessels. In time, the blood vessels supplying your heart may become so narrow that they can’t deliver enough oxygen to the heart muscle, particularly when you’re exerting yourself. This can cause you to feel chest pain (angina). If a fatty plaque breaks off, it may cause a blood clot which can block blood flow to your heart (heart attack) or brain (stroke).
• Fergus
  : I don’t think though you can avoid the large body of evidence that shows a clear association between high cholesterol levels and CVD and also the benfits of lowering these levels if they are too high and you have diabetes
• M4z
  : My cholesterol level when I was first diagnosed was 3.4 – and is now at 3.5. I’ve been Type 2 since 2003 on 2000mg Metformin, 80mg [reduced to 40mg since starting Byetta] Gliclazide and recently started taking 5 mg Byetta . He was still insistent that I should start “cholesterol reducing medication”. I refused, saying that as 5 is an average, I have a well below average level, and I’m quite happy with this.
• 
  Noblehead
  
  : I am a great believer in lowering cholesterol levels by natural means, although I know this isn’t always possible in some people. The general advice is to eat a well balanced diet with ample fruit and vegetables, whilst cutting back on your saturated fat intake.

We’ve been amazed how helpful sharing experiences can be, so the features and interviews section of Diabetes.co.uk is all about sharing.

We want to know who is being affected by diabetes, what are the key issues and how the

diabetes community

feels about them.

This section also features guides and information that don’t quite ‘fit’ anywhere else in the site.

The Diabetes Community Features area regularly publishes features and interviews of interest to the diabetes community as well as giving you the option to comment about how you feel.

You can browse existing features using the menu on the right hand side.

Calories are units of energy contained within the food you eat. People with diabetes can make a positive difference to their health by learning to count calories, whether or not the goal of the individual is to lose weight.

This feature runs through crucial steps in learning to count calories as a diabetic.

How many daily calories do you need to eat to lose or maintain a healthy weight?

If you are diabetic, this information should be available from your doctor or dietician. Another method is to calculate 16 calories per pound of body weight, but this is approximate and should only be used as a guide.

• 
  Visit the
  
  Weight Loss forum
  
  

If you need to lose weight, cut down on calories. For many people with type 2 diabetes, weight loss is the goal. Eating fewer calories can help diabetics to lose weight in stable way.

• 
  Portion distortion
  
• 
  Diabetes and weight loss
  

Diet Plate

Use a diet plate, or the information from a diet plate, to help count calories. Knowing and understanding the different food groups and how each individual food and drink affects your blood glucose level is the key to successful diabetes management and weight loss.

Carbohydrate calories

Calories from

carbohydrates

are particularly important. Carbs have an instant effect on blood sugar, and this can have serious consequences for diabetes management.

Be aware of what you eat, particularly portion sizes. Food labels are now detailed guides of how the contents will affect you. However, be aware that often calories listed on labels are for a serving only.

Portion size makes a radical difference to how your body processes food and the influence on blood sugar.

Remember, eating healthily should be combined with regular exercise and (if necessary) appropriate medication to manage diabetes successfully.

• 
  Test what carbohydrates do to your blood glucose levels
  

What the community is saying about counting calories

• Fergus
  : Personally I’ve never counted carbs – just eaten “sensible” portion sizes and tried to stick to “compliant” foodstuffs wherever possible.
• Fergus
  : I know this has been said over and over on here but I’m going to say it again anyway – we are all different and what is ok for one may not be for someone else – test test test and eat to your meter is the key
• Fergus
  : Another thing: never assume that things will be the same forever, retest occasionally; this month this site had encouraged me to retest alcohol. When I was first diagnosed as having impaired glucose tolerance, I tested some alcohol and it raised my BG for days so I thought I couldn’t drink alcohol at all. I have now been testing different drinks and found that where previously I had lumped all wine together and thought I couldn’t drink any. I have now realised that though I can’t drink white wine or fortified wines, I can (like many people) have a glass or two of red wine with no damage to my BG – Hallelujah several years of abstinence is now over.
• Fergus
  : For a diabetic the carbs are more important than the calories. If you eat a lowish carb diet then you will lose weight as well. You have made a good start by cutting out the ’empty’ carbs, i.e. the starchy carbs in bread, potatoes, pasta and rice and can get your ‘good’ carbs from vegetables and fruit. The key is to test before and two hours after meals to see how the meal has affected your blood sugars and also to reduce the portion sizes of food on your plate gradually.
• Fergus
  : In addition I wouldn’t bother with counting anything, just portion control and completely cutting out the starchy carbs and just getting your carbs from your fruit and veg. Eat to your meter and you can’t go far wrong.

Testing your blood sugar with a blood glucose meter is one of the key skills of successful diabetes management. Each individual requires a different blood glucose testing approach for their diabetes, and some will need to test blood glucose more regularly than others.

Self-monitoring

of blood glucose can be very important. An accurate testing regime can help to find the right diet and exercise, and avoid diabetes complications.

Furthermore, each blood glucose meter has different attributes, and some meters will suit different individuals better than others.

Choosing the right blood glucose meter

There are a wide variety of blood glucose meters on the market. Some meters are designed for ease of use; others for ease of transport or connectivity, still more incorporate advanced technology such as USB software or
Fergus
testing.

Learning to use Your glucose meter

Blood glucose meters work in different ways, and you may need training from a diabetes healthcare professional to help you understand how to use your blood glucose meter.

Furthermore, the

Diabetes.co.uk community

will have a range of help and advice to offer about using your blood glucose meter.

Which meter for you?

Getting the right blood glucose meter is a matter of looking at what is available and what you will need the meter for.

For instance, you should ask yourself questions such as will you be travelling a lot with the meter, will you need to test in public and therefore prefer a discreet meter, do you like to travel light and require a very portable blood glucose meter?

Many people prefer a

small, compact meter

All of these questions and more should be answered by the diabetes blood glucose monitor information below, now including video guides.

• 
  Blood glucose monitor guide
  

Top diabetes meters with video reviews

Our very own Sue Marshall has reviewed some of the most popular blood sugar meters available in the UK and provides an informative walkthrough about how to use the following meters.

• 
  Bayer Contour USB
  
• 
  Accu-Chek Mobile
  
• 
  Bayer Contour
  
• 
  Accu-Chek Aviva Nano
  
• 
  LifeScan OneTouch Ultra2
  
• 
  Smallest blood glucose meters available
  

What the community are saying about their blood meters?

• Fergus
  : No one seems to have a view on why these test strips cost as much as they do. Personally I feel there is absolutely now no justification for the price that they are. I don’t deny any company from recouping its research and development costs and making a reasonable profit, after all we live in a capitalist society whether we like it or not and undoubtedly the meters and test strips must have cost several millions to develop. However these things have now been available long enough for all these initial costs to have been recouped when you consider the number prescribed by the NHS and private sales.

Podiatry (foot care) for people with diabetes is one of the most overlooked aspects of diabetes management.

Reviewing the community discussion regarding podiatry and particularly for visiting podiatrists reveals that many people with diabetes are entirely unaware that they need to take special care of their feet and visit a podiatrist at once if problems arise.

Higher levels of blood glucose can damage the nerve endings in many areas of the body and organs, which is why tight blood glucose control is an essential aspect of diabetes care.

Why podiatry is so essential to people with diabetes

• Diabetes causes nerve damage known as peripheral neuropathy
• Diabetes affects the circulation, and poor circulation can affect how the body heals
• People with diabetes are more prone to infection
• Diabetes complications can also affect the feet
• Diabetes can affect the joints and make them stiffer

What happens with poor podiatry?

A variety of foot problems can arise when poor foot care fails to catch issues at an early stage. These may include:

• Damage to the foot
• Foot ulcers
• Foot infections
• Charcot’s joints
• 
  Amputation
  

Don’t forget your podiatrist!

Podiatrists are one of the essential

professionals

within diabetes care, and have a much underrated role to play in preventing and managing foot complications amongst people with diabetes.

Podiatrists are on hand at every stage, be it prevention, concern about a foot problem, and dealing with genuine problems once they occur.

Visit your podiatrist at least annually for a risk assessment.

What the community is saying about podiatry

• Fergus
  : Diabetics can self refer to a podiatry department. I would say NEVER ignore a foot injury, so SEE A PODIATRIST. Find their number from your district hospital website and phone them. They don’t take foot injuries lightly.
• Fergus
  : I was limping for well over a week. When I finally tried cutting the toenail, I pulled a bit at the side and an infection got in. My toe swelled up and started releasing horrible smelling pus. I thought it would heal itself, but it didn’t.
• Fergus
  : I see a podiatrist free at the local clinic. (Hounslow). At one visit I was referred to the hospital for some shoe inserts which fixed a problem.
• Fergus
  : Firstly, your doctor should know that neuropathy (nerve damage) is often caused by diabetes and there are drugs out there which will ease the pain, specifically formulated for neuropathy caused by diabetes. I don’t drive either and walk a lot therefore. It took me a week to get used to Crocs (they weren’t painful, just felt strange) and now I love them. I can walk and walk and never get sore aching feet or blisters.

• HLW

  : I’ve got a problem with one of my big toes; it’s infected at the side of the nail. I’ve got some antibiotics left over from the last time this happened a few months ago (doc prescribed me 2 courses last time, told me to take the 2nd course if it happened again). The doctor said I should go back if it happened again / kept happening. My question is, how urgent is this?

Eating well and maintaining a stable weight is particularly important for people with diabetes, so we figured that learning more about weight management was long overdue. Lowering waist measurement will help to improve your blood sugar control and reduce the risk of diabetes complications.

The diabetes community recently called for the creation of a weight loss forum, but how do you manage your weight as a diabetic?

Reaching a healthy weight may seem like a serious challenge, but it can seriously improve your long-term health. As well as self-esteem and a greater quality of life, losing weight helps you to feel fit and healthy.

There are a variety of different approaches to losing weight, with each individual experiencing weight loss in a different way.

Do I need to lose weight?

Waist circumference can tell you if you need to lose weight, using the following guidelines:

Waist circumference measurements

• 
  White and black men
  
  should be below 94cm (37 inches)
• 
  Asian men
  
  should be below 90cm (35 inches)
• 
  White, black and Asian women
  
  should be below 80cm

Body Mass Index determines weight in relation to height. To learn more about your BMI please check our

BMI calculator.
If you are confused about your BMI, discuss it with your healthcare team.

• Discuss weight management in the
  
  Weight Loss forum

How do I lose weight?

Motivation is the key in losing weight. Write down why you want to lose weight.

Stare at the challenges to time and budget head o, face them down and work around them.

If you need help in losing weight, your diabetes nurse, GP or dietician should be on hand to talk to you and help you.

• Work out a healthy diet plan based around portion control, and
  
  control the calories

Set yourself clear long and short-term goals to achieve as you lose weight. Write it down, and stick to it. Hopefully by reading the forum perspectives and threads below, those who feel they need to lose weight can find encouragement and support.

Never has a topic galvanised the Diabetes Forum as much as the carbohydrate, specifically, how carbohydrates affect and causes diabetes. We thought that a feature about carbohydrates and how they affect diabetes care was long overdue.

However, opinions about how many carbs to eat and how they affect each individual are numerous, and it is worth remembering that diabetes type, general health,

medication

and carbohydrate type all play a role. It is a complex topic, so where better to look than our forum.

Low-carb can be beneficial

Many forum members have found a low-carb diabetes diet beneficial to manage their blood glucose levels.

Elevated

blood sugar

is the primary symptom of diabetes, and reducing food in the diet that raises glucose levels should be one of the primary goals of diabetes care. By lowering glucose levels in the diet, medication can be reduced or even (in type 2 cases) stopped.

Carbohydrates are in a lot of foods

Carbohydrates are found in a variety of foods such as white bread, pasta, potatoes and flour. These foods metabolise into sugar and raise blood glucose levels amongst diabetes patients. The goal of a

low-carb diet

is to restrict/cut down/remove these foods.

• 
  Test what carbohydrates do to your blood glucose levels
  

Disrupting sugar levels

Not all carbohydrate foods disrupt

blood sugar levels

, and some healthy natural/raw/unprocessed foods are considered a normal part of a low-carb diet – even if they contain carbohydrates.

As with all aspects of diabetes management, carbohydrates in food can have different influences on different people. By counting carbs and testing regularly after meals, people can find out which foods they can safely include and which should be restricted.

• 
  The Low-Carb forum
  
• 
  Low-carb diabetes diet guide
  

Carbohydrates, due to the huge impact they have on blood glucose levels, should be restricted up to the point that the dieter maintains a healthy blood glucose level.

Gradually, the amount of information in the public domain regarding

low-carbing

has soared, just check out the forum perspectives below.

What the community is saying about carbohydrates

• Fergus
  : Sugar is the simple form of carbohydrate. The danger is in consuming too many carbs at a time and therefore your pancreas cannot cope with this and your blood sugars rise . Continual high blood sugar levels lead to diabetic complications over time. Controlling the amount of carbs we eat helps to control our blood sugar levels and thus stave off the complications.
• Fergus
  : Sugar is a carbohydrate… It is imperative as a Diabetic to count them, that way leads to better control of your own Diabetes.

• Dillinger

  : However, for every percentage point drop in HbA1c blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these microvascular complications in both Type 1 and Type 2 diabetes.

• Fergus
  : An effective low carb diet is one which maintains, most of the time, a healthy blood glucose level. The amount of carbs it contains will vary between individuals. The consensus on the forum is that the following applies:
  
  – Low carb (ketogenic) 0-50g carbohydrate per day
  
  – Typical low carb 50-90g
  
  – Liberal low carb 90-130g
  
  – Moderate carbs 130-170g
  
  – High carb 170g plus a day
• Fergus
  : It is always an individual issue. But for me personally, being diagnosed with Type 2 in May, the diabetes clinic I attended showed me that a low carb diet was necessary – and I’ve lost 15 lbs (can you hear how happy I am!) in 3 months. Most importantly, I’ve lost the “cravings” for high carb foods that I once adored, home-made white crusty bread, BIG bowls of pasta, nachos with creamy dips…

One of the key ways to manage diabetes is to establish a blood glucose monitoring regime at home. This means having your own meter and using it regularly to determine how diet, exercise and lifestyle affect your blood glucose levels.

This gives rise to a phrase often used by experienced diabetics on the forum: ‘Eat to Your Meter.’

Thankfully, there is a range of blood glucose monitoring devices available in the UK, not to mention a wealth of online knowledge regarding their use.

Day to day decisions

The day to day decisions that make up a life all have an influence on blood glucose levels. By monitoring blood glucose, people with diabetes can keep their levels stable.

This is an essential goal to achieve as a diabetic, as it significantly lowers the risk of developing serious diabetes complication such as neuropathy and stroke.

Stable blood glucose levels achieved by a combination of diet, exercise and medication or insulin if necessary should be considered a major goal of diabetes management.

• 
  Top 5 smallest blood glucose monitors
  
• 
  Guide to blood glucose monitors
  

The latest technical innovations mean that blood glucose monitoring is fast, effective and relatively pain-free. Advancements in lancing technology mean finger-pricking is nothing like it used to be. Furthermore, meters are now small and discreet, functional and brilliantly linked to other technology like computers.

This allows long-term plotting of blood glucose averages and the ability to share this with healthcare professionals.

What the community is saying about blood glucose monitoring

• Fergus
  : Analysis is a doddle as you can check everything you need and see it all on screen. Backlight. Fast response time, a matter of a few seconds. Free software and cable to link to PC. Fantastic on-screen graphing capability for glucose levels etc, etc. My Endo couldn’t put it down and was fascinated by it’s features! 7 to 90 day averages easily read
• Caspararemi
  : Anyway, it just arrived today and wow I’m impressed! It’s so small and compact, I think it may be the best meter I’ve used in the last 14 years. I love the screen being so bright and easy to see and the software giving you a graph (though given I’ve only done two tests since getting it, it’s not very useful just yet!).
• IanS
  : The accuracy of BG meters is adequate for the purpose for which most of us use them: that is establishing what food we can eat and what we can’t without pushing our BG levels where we don’t want them to be. If you are using your BG meter for purposes where greater accuracy is required (i.e testing to see if you are close to a hypo), then you should follow the manufacturer’s advice and perform a repeat test if you get a reading that indicates trouble.
• Peachymac
  : Could some of you more learned than I tell me why from samples of blood taken from different fingers, within seconds of each other give readings of a full 2 points difference on different monitors?
• Adrian29459
  : The tester is slightly bigger than a usb stick with a full colour screen, three function buttons, a power button on the side and in a glossy black finish. The screen has full text and animation indicating blood sugar in clear bold text, time & date. Blood testing is very fast about 5-3 seconds I think, using the contour strips and their no coding technology. Following a test an option is given to explain when the test was take, pre meal, post meal and also asks how the user is feeling, tired, ill etc.

Sexual health and diabetes are undoubtedly linked, and better diabetes control is also linked with better sexual performance in many cases.

However, sexual health is an extremely personal and private issue. Being able to use an anonymous forum allows people to address these kind of issues and receive the advice and support of their peers – many of whom have encountered the same problems.

How diabetes affects men

There are a variety of ways that diabetes influences sexual health and virility, many of which are also associated with the effects of aging. For men, the most common are erectile or ejaculation problems.

How diabetes affects women’s sexual health

Meanwhile, women may have sexual response problems or lubrication issues. Furthermore, bladder problems and infections in the urinary tract are more common amongst people with diabetes. Keeping good diabetes control can make all the difference in lowering sexual and urologic risks.

Diabetes and sexual health is a complex issue, and isn’t always physical. There is no question that the mind has an enormous influence on libido and sexual response.

However, on a physical basis the damage to autonomic nerves interferes with blood flow, and this is what can hinder normal sexual function. Male sexual problems linked with diabetes include

erectile dysfunction

and retrograde ejaculation.

Female sexual problems linked with diabetes include decreased vaginal lubrication and decreased sexual response. Urologic problems linked with diabetes may affect both men and women.  These include neurogenic bladder and urinary tract infections.

Sexual health risk factors

The risk of sexual health problems for people with diabetes increase if the patient has poor blood glucose control, high levels of

cholesterol

, high blood pressure, is overweight, is over the age of 40, and is a smoker.

Closely managing blood glucose and cholesterol, being physically active and not overweight, and stopping smoking all help to reduce risks to sexual health.

What the community is saying about sexual health

• Fergus
  : Diabetes can damage the blood vessels and make erection impossible. Very often, it improves if control is really good. However, it’s a common problem in diabetic men. I’m horrified to find that most diabetic healthcare teams don’t ask about this routinely. It’s so common. However, if the problem persists, the patient has the right to treatment. He needs to go to his care team, tell them and ask for help.
• Makram1
  : With age a man does lose some power and ED affects some with type 1 or 2. That is not the end of the road. There are many solutions and certainly an expert, i.e. Urologist can treat or diagnose. Buying anything on the internet or by some other means is a great risk. Those who are on mono nitrate would be risking if they take any drug like Viagra. Best person is your GP who can refer you to the Hospital specialist for this particular treatment. Get it and enjoy the life in this advanced era of medicine.
• Goji
  : After the discussion we had on this thread, I wrote to NHS Choices about not listing female sexual dysfunction as a complication of diabetes and they have agreed to change the page and have updated the complications page to include under sexual dysfunction…
• Buachaille
  : In our house everything returned to normal when blood glucose levels returned to near non-diabetic levels.
• Fujifilm
  : I have tried the
  
  more sex makes my diabetes better
  
  balanced argument, but she’s not buying it. And if thinking about it lowers BG I should be in a coma.

Diabetes, like many other chronic diseases, can also affect the mind. Similarly the mind has great power to influence the body.

Knowledge of how to manage your diabetes and prevent complications is an important first step, but understanding how to stay positive and nurture the spirit can also help in a holistic approach to diabetes care.

Allopathic healthcare

Many countries focus primarily on allopathic healthcare – treatment with medication – to the exclusion of a more complete system of diabetes management.

The Diabetes.co.uk forum includes a section on mind, body and spirit to help people with diabetes understand all aspects of care.

Physiological response

There is no doubt that the mind has great capacity to affect the body and its physiological response to illness. Much mind-body intervention stems from Eastern healing practices, some of which have been taken up as adjunct care in the case of diabetes. The Mind, Body and Spirit forum is a place to discuss and debate aspects of diabetes care that fall outside standard healthcare.

Emotional, mental, social and spiritual

Many believe that emotional, mental, social and spiritual factors can all have a direct influence on health.

There is no denying that the mind has an influence on the body, and advocates of alternative healing practices maintain the power of this relationship. The number of patients using, or at the least taking an interest i, alternative practices has soared in the last decade.

Mind and body care for diabetes may include relaxation and calming techniques, imagery, biofeedback, meditatio, hypnosis, yoga, tai chi and many others. These approaches can help patients to deal with their diabetes in new and different ways. Each approach has distinctive techniques, many of which can be learned in the home.

• Diabetes Mind, Body and Spirit Forum

If you are interested in the relationship between mind, body and spirit when it comes to diabetes please use the Diabetes.co.uk Mind, Body, Spirit forum to discuss.

What the community is saying about Mind, Body and Spirit

• Rushy
  : I agree that Tai Chi is beneficial. I’ve been doing it for some years now, since before I was diagnosed in fact, and I feel so much better in all kinds of ways after doing my forms.
• Caroline W
  : I’m type 2 and practice tai chi whenever I can. As far as I am aware, because it is so relaxing, it helps reduce glucose levels in the blood, but you still need to keep taking your medication be it insulin or pills.
• Dragongirl
  : There is a therapy called Emotional Freedom Techniques (EFT) that uses body meridian work alongside a cognitive focus to shift some aspects of bodily complaints, including pain management. You’d have to look it up!
• Davewoods
  : It is funny how many times I have seen deep breathing mentioned in various things I have been interested in. Whether it was acting or singing, or a brief interest in martial arts and yoga. I think we sometimes forget that breath is the thing that keeps us going.
• Dendan
  : It’s true that visualising can actively help to relieve stress. It isn’t just imagery that can help – scents and sounds can also trigger emotive responses which directly affect blood pressure, thus calming and relaxing the body. Music therapy can help alleviate stress. If you have a favourite piece of music DO NOT use it for this type of exercise. The emotions that are triggered are specific and whilst they engender a “feel good” factor the feelings they engender may not be suitable for your needs.

One of the natural feelings when diagnosed with diabetes is to ask questions – what does this mean, how does it affect men, and how can I treat my diabetes?

This type of enquiry is very common, and throughout the process of living and dealing with diabetes questions will inevitably arise.

Diabetes management

is complex and can be confusing, with each individual case different. For this reason, all sorts of questions are likely.

What are your diabetes questions?

These diabetes questions can cover all sorts of topics including

diet

,

exercise

and

medication

One of the key functions of Diabetes.co.uk is to provide a neutral community framework that people with diabetes can use to seek the advice of their peers and more experienced patients.

Clearly, this is

not

intended to conflict with or replace medical advice from a qualified healthcare professional.

Asking a question on the Diabetes.co.uk forum is as simple as registering and getting the answers you need. One of the sub-forums in the Diabetes.co.uk forum is simply called

Ask A Question

, and provides an ideal setting for

people with diabetes

to

ask questions

Studies show that diabetes patients can find reassurance, support and friendship from diabetes forums. Going it alone is always frightening, and having the support of the

Diabetes Forum

could help to deal with key issues as they arise.

• 
  Ask a Question forum
  

Recent topic titles include:

Why does blood sugar have to go haywire? Who monitors diabetes? What to expect going on MDI? How to change prescription? What am I doing wrong?

There are hundreds more topics from real people with diabetes in search of answers. The Diabetes.co.uk forum is free for the diabetes community to use, all you have to do is register.

What questions are being asked?

• Bluestar
  : Does any one know if these slimming clubs can help in controlling BG levels? I want to join slimming world and I do not know if I will be doing more harm than good? I once lost weight with them before I was diagnosed with diabetes.
• Wallplug
  : I am completely confused! – I have been taking regular readings and making notes on my diet to try and get an understanding of what makes my Blood sugars fluctuate. I was bad yesterday at a family event, had a few to drink, and even some cake (my Doc said it was OK once in a while). My BS wasn’t too bad at the end of yesterday (9 ish), and by this morning (fasting) was down to about 7.5, (my recent 7 day average for the same time) then I had porridge made with water for breakfast with a tad of sugar free soya milk, and since nothing, but have just done a test to find I am up to 10.8 (way above my average for the same time) – why has it gone UP so much in relation to the morning reading?
  
• Hoolyuk
  : Finally succumbed to medication yesterday and now take 500mg in morning and 500mg with evening meal… how long does it normally take to see glucose level start to drop? Hasn’t been any drop in 2 hour post-prandials I’ve checked so far!
  
• Fergus
  : I have tried looking for this answer on Google, but seem to be drawing a blank. This site is where I seem to get the best, most reliable diabetes related information so I was hoping you could help me again. I am type 2, diagnosed at 39, as far as I know my Gran was the only other diabetic in my family, she was diagnosed in her late 70’s. My Mum (her daughter) and both my brother and sister so far do not have any diagnosis of diabetes. So what are the chances of my three year old developing diabetes?
  
• Redmans
  : I am a type 2 diabetic and have just started using insulin. What are my expectations for reducing my blood glucose levels which are currently moderately high?
  

Many people with diabetes are unaware about what an insulin pump is, who it is for, and how an insulin pump could help with their diabetes.

The

Diabetes Forum
includes an insulin pump board. Here, people with or interested in getting insulin pumps come to discuss every aspect of pumps, how to use an insulin pump, insulin pump brands and getting an insulin pump in the UK.

In the community feature this week, we look at how the diabetes community feels about insulin pumps.

What are insulin pumps?

Insulin pumps are small medical devices that contain a reservoir of insulin. The insulin pump is connected to the body and it is programmed to

deliver insulin
at a constant rate. This means no more injections, a major advantage for those scared of needles.

• 
  Insulin pumps guide

What is the advantage of an insulin pump?

The advantages of an insulin pump mean that you can adjust dose spontaneously with immediate effect. The body absorbs

short-acting insulin
more easily, meaning that less is wasted. Insulin absorption is small and regular, rather than a larger amount at less frequent intervals.

Are there needles involved?

The insulin pump is attached using an infusion set which doesn’t have to be a needle. Many insulin pump infusion sets use cannulas. If properly inserted, the patient cannot feel this at all. Many modern insulin pumps have automatic insertion devices. For needle-phobic diabetics that require insulin, a pump is the obvious choice.

Aren’t pumps clumsy?

For many people, such as athletes, pumps are essential. Having the pump attached may take some getting used to, but it is often possible to disconnect the infusion set briefly. This allows the insulin pumper to do exercise, take a shower or dress without worrying about the pump. Usually, people attach insulin pumps to their clothing. Insulin pumps are tough and some are even designed to be submerged.

Insulin pumps mean greater flexibility, less

injections
and the potential for a better quality of life amongst those who require insulin to manage their diabetes.

Which pump should I choose?

Your healthcare professional should be able to tell you more about the latest pumps and pump availability. The insulin pump market evolves quickly.

• 
  Getting an insulin pump
• Fergus

What the community are saying about insulin pumps?

• Hellyb
  : The pump can be hidden anywhere and then you operate it by using a remote control. You use the remote to test your BM, once your settings are done the remote will work out your insulin and any corrections that need to be made, all you have to do is put in the amount of carbohydrates in the food you are about to eat. All the information can be transferred to your computer where you can display it in many different formats and you can see where trends may be forming.
• Jonesy
  : We asked our GP to refer my 9 yr old son elsewhere. The referral took a while. The first 2 letters went unanswered, but we finally got through to the right person. Last week we had our first meeting with a psychologist, a dietician and a diabetic doctor. First meeting and they gave us the ok for a pump! Needless to say, we are over the moon. Gotta decide what pump now, but liking the DANA diabecare R.
  
• Lisaw
  : The needle sets can be painful to insert and sometimes also are painful when i, but they are reliable. I use Cavilon spray as I am allergic to adhesive and for some reason the needle sets hurt a lot more to insert when I have sprayed my skin which is very weird I think.
  
• Janrou
  :I’ve got my pump on my household insurance and didn’t have to pay any extra for it, however if you don’t want to put it on your household insurance I would suggest contacting several companies to see how much they will charge. Your DN will advise you the value to insure it for.
  
• Fergus
  : I have been using the pump for a month now, and still working closely with the pump specialist to get the correct basal rate. Before my pump, my BG results would always lower during the night meaning I would ensure it is around 8mmol before bed so I don’t wake up with a hypo. But since having the pump, it’s always hyper in the morning. I can go to bed with BG between 5-8 and wake up with it at 14-18.