Typically, it would also be relatively expensive too compared to non-diabetic cover.

However, as awareness of diabetes amongst the public has increased, so too the philosophy of the insurance industry has evolved. Today there are many more options than even two years ago, meaning there’s a real chance you could save a significant amount of money every month by having your life insurance reviewed as providers compete to move into the diabetic insurance sphere.

For those with good diabetic control, a significant saving is highly probable outcome – but such is size of the shift described above, these savings are also possible for those of us that don’t quite have the level of control we’d like.

All in all, if you took your policy out before 2022, we would strongly urge you to consider a review as the increase in interest rates has an effect on premium prices.

It’s a free, no obligation service and a real opportunity to bring your cover in line with these updated underwriting views.

An independent committee of scientific experts has published a draft document on how the diet can improve health outcomes for people with the condition.

Now, the Scientific Advisory Committee on Nutrition (SACN) is requesting healthcare professionals and leading experts to review the draft report before it is officially published.

Representatives from Diabetes UK, NHS England, the British Dietetic Association, the Royal College of Physicians and the Royal College of GPs also assisted the SACN in drawing up the guidance.

At the moment, Public Health England’s (PHE) nutritional advice for people with type 2 diabetes is based on the Eatwell Guide. The current approach suggests approximately 50% of dietary intake should consist of starchy carbohydrates such as potatoes, bread and rice.

Typically, a low carb diet will consist of 130g or less of carbohydrate a day. This means focusing on eating fats, proteins like meat, poultry, fish and eggs, and some non-starchy vegetables.

In recent years, studies have demonstrated the low carb approach can be hugely effective at managing blood sugar levels and achieving weight loss among those with type 2 diabetes.

Peer-reviewed outcomes from the award-winning Low Carb Program show 1 in 4 members are able to put type 2 diabetes into remission after 1 year. It is a behaviour change platform for adults with type 2 diabetes, prediabetes and obesity designed to provide the education, resources and support people need to achieve their health goals.

Dr Adrienne Cullum, head of nutrition science at PHE, said: “The Scientific Advisory Committee on Nutrition (SACN), with support from a range of partners including Diabetes UK and NHSE, have undertaken a thorough review of the evidence on low carb diets for adults with type 2 diabetes.

“SACN is consulting on the draft report to make sure it has considered all the relevant evidence, and to invite comments on the draft conclusions.”

Once SACN has considered all the responses to the consultation, it will publish its final report and make recommendations to the government. The consultation period closes on April 30, 2020.

Type 2 diabetes and hypertension (high blood pressure) are the most common underlying health conditions in patients with SARS. [2] There is also evidence that people with type 2 diabetes and the metabolic syndrome (a combination of diabetes, high blood pressure (hypertension) and obesity) may have a higher risk of being seriously ill if they develop COVID-19. There are also specific features of coronavirus infections which could increase this risk.

One type of coronavirus infection, Severe Acute Respiratory Syndrome (SARS) was found to cause more serious disease in those patients who had hyperglycaemia (increased blood glucose levels) and type 2 diabetes. This could be because these patients tend to have metabolic inflammation, which is inflammation that affects the metabolic tissues, such as the liver and the pancreas. This makes these patients more susceptible to enhanced release of cytokines (molecules that circulate in the blood and signal for the body’s immune cells to fight the infection). During an infection the immune system increases the release of cytokines. A cytokine storm (an excessive release of cytokines) occurring in COVID-19 patients can damage tissues and organs and can even cause multi organ failure [3].

Inflammation of the metabolic tissues also affects the immune system, which means it finds it harder to fight infection and slows recovery. A study in animals has shown that type 2 diabetes results in breakdown of control of the immune system and enhances disease severity following infection with a type of coronavirus called Middle East Respiratory Syndrome (MERS) [4]. Although these findings have not been replicated in humans  this data  may support the theory that developing a coronavirus infection with type 2 diabetes causes more serious symptoms.

What are the specific mechanisms in the endocrine system linked to coronavirus infection?

The endocrine system refers to a number of different glands which secrete hormones into the blood and around the body. The Covid-19 virus uses a protein on its surface, which binds to a type of receptor called angiotensin-converting enzyme 2 (ACE2) to enter cells in the body of the infected person. [5] ACE2s purpose in the lungs is to break down a hormone called angiotensin II into another hormone angiotensin 1-7. When ACE2 is blocked and angiotensin II builds up this can cause problems such as an increase in blood pressure and hypoakalemia (low potassium levels in the blood) and increases risk of respiratory distress syndrome (the lungs not being able to provide the body with enough oxygen).

Angiotensin 1-7 leads to anti-inflammatory and anti-fibrotic (reduces scar tissue build up) responses, both of which are required for the recovery of COVID-19 [6].

What is the metabolic link to coronavirus infection?

There is an association between serious complications from the coronavirus and hypertension (high blood pressure), and also to type 2 diabetes. In the pancreas, evidence shows that the SARS coronavirus binds to the ACE2 receptor, which reduces insulin release (7). One study found that patients with the SARS infection with no history of type 2 diabetes became temporarily hyperglycaemic during hospitalisation for the infection. As the human endocrine pancreas expresses ACE2 the coronavirus could enter the cells, leading to acute hyperglycaemia (high blood sugar levels) and temporary type 2 diabetes.

Type 2 diabetes also induces expression of the angiotensin hormone converting molecules (such as ACE2) in other tissues such as the lung, liver and heart, this may help explain why type 2 diabetes could cause higher risk of developing multi-organ failure in coronavirus infections such as SARS [8].

How could this effect treatment for patients with COVID-19?

The data suggests that metabolic control of type 2 diabetes and associated metabolic parameters in patients with COVID-19 may be important. This could help reduce the risk of complications in patients with type 2 diabetes and a severe infectious disease [1].

The article concludes that good metabolic health is more important than ever for us living through the COVID-19 pandemic

References

1. Bornstein,S.R., Dalan, R., Hopkins,D., Mingrone, G. & Boehm,B.O.(2020) Endocrine and metabolic link to coronavirus infection. Nature Reviews Endocrinology. [Online] Available at: https://doi.org/10.1038/s41574-020-0353-9 [Accessed 07 May,2020]
2. Yang, J. K. et al.(2006) Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet. Med. 23, 623–628 [Online] Available at: https://doi.org/10.1111/j.1464-5491.2006.01861.x Accessed 07 May,2020]
3. Mehta, D. et al. (2020). Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. [Online] Available at: https://doi.org/10.1016/S0140-6736(20)30628-0 [Accessed 07 May,2020]
4. Kulcsar, K. A., Coleman, C. M., Beck, S. E. & Frieman, M. B. (2019). Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 4, 131774. [Online] Available at: 10.1172/jci.insight.131774 [Accessed 07 May,2020]
5. Hoffmann, M. et al. (2020). SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. [Online] Available at: https://doi.org/10.1016/j.cell.2020.02.052 [Accessed 07 May,2020]
6. Simões e Silva, A. C., Silveira, K. D., Ferreira, A. J. & Teixeira, M. M. (2013). ACE2, angiotensin-(1–7) and Mas receptor axis in inflammation and fibrosis. Br. J. Pharmacol. 169, 477–492 [Online] Available at: https://doi.org/10.1111/bph.12159 [Accessed 07 May,2020]
7. Roca-Ho, H., Riera, M., Palau, V., Pascual, J. & Soler, M. J. (2017). Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int. J. Mol. Sci. 18, E563 [Online] Available at: https://doi.org/10.3390/ijms18030563 [Accessed 07 May,2020]

The paper was published by a registered dietitian, a consultant endocrinologist and a general practitioner. Led by Diabetes Digital Media’s dietitian, Tara Kelly, the paper outlines a number of key areas of controversy surrounding the use of low-carbohydrate diets amongst the medical and scientific community.

The authors describe the field as “rife” with controversy:

“However, this is a scientific area that is rife with controversy and conflicting findings which have polarised expert opinion and can cause confusion for health care professionals and their patients.”

Dr Unwin, a GP from Southport, has been advocating the low carbohydrate approach to his patients living with type 2 diabetes, with an impressive cohort of ‘real world’ data, where 73 patients are in drug-free remission.

Professor Francis Finucane, a consultant endocrinologist in Galway, Ireland was the senior author on the paper. Professor Finucane leads the Bariatric service in Galway. His team run a pragmatic service where low-calorie diets, low-carbohydrate diets and bariatric surgery are all used for the treatment of obesity and type 2 diabetes.

The authors sought to “bring the reader on a journey through the controversies surrounding the approach”, says Kelly. Kelly also comments that “many clinicians, especially those not specialist in these areas are not aware of this approach as a viable option”.

We acknowledge this approach is not for everyone and encourage clinicians to have this as “one option in their toolbox”, she says. The authors refer to the current guidelines supporting the use of this approach.

This article outlines 5 points for clinical considerations when using this approach;

1. Guidelines support the use of this approach

“Doctors, nurses and other health care professionals ought to be aware that the use of low-carbohydrate and VLCKD diets in patients with obesity or type 2 diabetes is in fact supported by several sets of guidelines from international bodies and professional groups”

2. Early de-prescription of medication is important

“We have found that early and intensive de-prescribing is often required, particularly in patients with diabetes”

3. Calorie counting is not required

“Rather than emphasizing the need for patients to quantify their calorie intake, we ask them to focus on eating to comfortable satiation and then stopping”

4. Monitor cardiovascular risk factors

“We routinely measure blood pressure, lipid profile and HbA1c in patients adhering to a low-carbohydrate or VLCKD and treat abnormal findings as we would in routine clinical practice, where they have not improved over time”

5. Ensure adequate fibre intake

“We have found in practice that adopting a low-carbohydrate diet which limits ultra-processed foods and includes nuts, seeds, non-starchy vegetables and low-carbohydrate fruits tends to lead to a net gain rather than a reduction in patients’ dietary fiber intake compared to baseline.”

There is clearly much interest in the area, with the paper having over 27,000 views and 7,000 full text downloads since its publication in April.

You can read the full paper here, which is available for free download.

1. Stay hydrated – keeping on top of your hydration is essential, ensure you are drinking plenty of fluids- using a water bottle can be a helpful way to keep track of how much you are drinking each day.

2. Keep moving – why not try a home workout, walk up and down the stairs, use the chair or sofa to do squats – get creative with keeping active.

3. Phone a friend or family member you haven’t spoken to in a while – picking up the phone and talking to others is a great way to keep in touch, engaging with others and letting them know you are here if they want to talk.

4. Keep in contact virtually with family and friends – Whatsapp, Skype or other virtual means of keeping in contact with your loved ones can be helpful. Don’t forget, it won’t only help you, but seeing your face will help cheers others up too!

5. Visit the Diabetes.co.uk Forum – use the community to share your ideas, concerns, worries or anything you wish to talk about – whether it’s diabetes-related or not! There will be plenty of other people on there self-isolating and keeping themselves safe too.

6. Focus on your food and nutrition – Eating nutritious foods and focusing on a healthy balanced diet will keep you in tip-top shape and experimenting with recipes can keep you active for a few hours.

7. Consider taking a vitamin D supplement – if you’re going to be inside more, chances are you’ll be getting less sunlight, especially at this time of year. Throw open the curtains and let the sunlight in! You could also consider taking a vitamin D supplement.

8. Watch a documentary or a film – if you can’t go to the cinema, bring the cinema to you.

9. Read a book – do you struggle to find the time to read normally? With more time on your hands, reading could be a great distraction, whether fact or fiction. You could even set up an online book club with friends and family.

10. Play sudoku, try a crossword, colour in, or paint – challenge your mind and unleash your artistic side.

11. Take the time to organise your cupboards – organising your cupboards – be it food shelves, wardrobes, or the cupboard under the stairs that explodes every time you open it. Now is a great opportunity to bite the bullet and organise it.

12. Wash your hands regularly – good hygiene is extremely important and washing your hands for 20 seconds at a time is important to maintain good hygiene. Sing Happy Birthday to yourself or come up with another song.

13. Practice mindfulness or meditation – staying calm and relaxed might be hard to think about with the heightened anxiety but practising mindfulness and or meditation regularly can help to keep the mind focused but also start to relax the mind and body.

Overall, wherever you are, keep yourself safe and keep up to date with the developments. You can find out more information on our Guide to the Coronavirus, or use the Government and NHS websites to stay informed.

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13/05 – Outdoor Activities allowed in England from 13th May 2020, subject to social distancing rules

From today (13 May 2020) people in England can spend more time outdoors and enjoy a wider range of activities for any length of time, subject to social distancing rules.

• From today, people are allowed to spend more time outdoors.
• They will be able to go to parks and beaches to sunbathe, have a picnic and go fishing.
• Outdoor sports courts can reopen, including tennis and basketball courts as well as golf courses.
• People will also be able to see one person from another household, as long as they follow social distance guidance
• This follows scientific advice that the risk of infection outside is significantly lower than inside
• All of the new regulations are subject to social distancing rules
• The advice is strictly limited to spending time with your household or with one other person and is subject to social distancing rules.

It remains the case that you cannot gather with more than one member of another household for example to play sports. You also cannot:

• Go on holiday.
• Visit and stay overnight at a holiday home or second home.
• Visit the homes of friends and family, unless it’s to help a vulnerable person, for medical reasons, or to take a child to another household with whom parental responsibilities are shared

12/05 – Chancellor extends furlough scheme until October 2020

In complete contradiction to the rumours that the government furlough scheme could be reduced to 60%, today Rishi Sunak said the furlough scheme would be extended by a further four months with workers continuing to receive 80% of their current salary.

• Coronavirus Job Retention Scheme will continue until end of October.
• Furloughed workers across UK will continue to receive 80% of their current salary, up to £2,500.
• New flexibility will be introduced from August to get employees back to work and boost economy.

11/05 – Government of England sets out its conditional plan to return to normal

This guidance applies in England – people in Scotland, Wales and Northern Ireland should follow the specific rules in those parts of the UK

The government has set out its plan to return life to as near normal as we can, for as many people as we can, as quickly and fairly as possible in order to safeguard livelihoods, but in a way that is safe and continues to protect our NHS. The government has set out a conditional roadmap for lifting further restrictions and opening more businesses and venues. The roadmap is dependent on successfully controlling the spread of the virus. If the evidence shows sufficient progress is not being made in controlling the virus, then the lifting of restrictions may have to be delayed. If, after lifting restrictions, the government sees a concerning rise in the infection rate, then it may re-impose some restrictions. Here is a breakdown of the eight key parts of the governments guidance:

Protecting Different Groups of People

This guidance is for the general public who are fit and well. There is separate, specific guidance on isolation for households with a possible coronavirus infection. Those aged 70 and over, those with specific chronic pre-existing conditions and pregnant women are clinically vulnerable. This means that they are at a higher risk of severe illness from coronavirus’. As restrictions are relaxed, this group who are clinically vulnerable should continue to take particular care to minimise contact with others outside of their household. There is a separate group of people who are defined, on medical grounds due to specific serious health conditions, as clinically extremely vulnerable to coronavirus. This group is advised to continue shielding measures to keep themselves safe by staying at home and avoiding all contact with others, except for essential medical treatment or support.

Staying at Home

It is still very important that people stay at home unless necessary to go out for specific reasons set out in law. These include:

• For work, where you cannot work from home
• Going to shops that are permitted to be open – to get things like food and medicine, and to collect goods ordered online or on the phone
• To exercise or, from Wednesday 13 May, spend time outdoors for recreation
• Any medical need, to donate blood, avoid injury or illness, escape risk of harm, or to provide care or to help a vulnerable person
• Where parents or someone with parental responsibility do not live in the same household, children under 18 can be moved between their parents’ homes to continue existing arrangements for access and contact.
• School for children of critical workers – the government has also identified a number of critical workers whose children can still go to school or their childcare provider. This critical worker definition does not affect whether or not you can travel to work – if you are not a critical worker, you may still travel to work if you cannot work from home. However, if you, or a member of your household are unwell with symptoms of coronavirus, you should isolate and should not travel to or attend the workplace.
• Critical workers and parents or guardians of vulnerable children may leave their home to take children to and from school or their childcare provider.
• You can also attend the funeral of a close family member or member of your household (or, of a friend, if no one from their close family or household is attending).
• Religious ministers or leaders can leave their homes to go to their place of worship, but these should remain closed to the public
• You may also leave or be outside of your home in order to access other critical public services, such as social services, support provided to victims, services provided by the Department for Work and Pensions, to fulfil a legal obligation, or to move home in line with the government’s guidance.

A fuller list of the reasons you can leave home is set out in the regulations. When you do need to go out, you should follow the guidelines on staying safe outside your home.

Businesses and Venues

For the time being, certain businesses and venues are required by law to stay closed to the public. These include:

• Restaurants and cafes, other than for takeaway
• Pubs, cinemas, theatres and nightclubs
• Clothing and electronics stores; hair, beauty and nail salons; and outdoor and indoor markets (not selling food)
• Libraries, community centres, and youth centres
• Indoor and outdoor leisure facilities such as bowling alleys, gyms, arcades and soft play facilities
• Some communal places within parks, such as playgrounds and outdoor gyms
• Places of worship (except for funerals)
• Hotels, hostels, bed and breakfasts, campsites, caravan parks, and boarding houses for commercial/leisure use, excluding use by those who live in them permanently, those who are unable to return home and critical workers where they need to for work

Food retailers and food markets, hardware stores, garden centres (from Wednesday 13 May) and certain other retailers can remain open.

VISITING PUBLIC PLACES

• From Wednesday 13th May, the “one exercise per day” rule is lifted and you can exercise as often as you want. You are also able to sit and rest outside. Exercise or recreation can be alone, with members of your household, or with one other person from outside your household, while keeping two metres apart at all times.
• From Wednesday 13 May, you can drive to outdoor public open spaces irrespective of distance, but should follow social distancing guidance whilst you are there. When travelling to these outdoor spaces, it is important that people respect the rules in Scotland, Wales and Northern Ireland and do not travel to different parts of the UK where their intended activities there would be prohibited by legislation passed by the relevant devolved administration.

Public gatherings

The government has prohibited by law all public gatherings of more than two people, except for reasons set out in the regulations. These include:

• Where the gathering is of a group of people who live together in the same household – this means that a parent can, for example, take their children to the shops, although you are advised to do so only if there is no option to leave them at home
• Where the gathering is essential for work purposes – but workers should try to minimise all meetings and other gatherings in the workplace

Going To Work

You should travel to work, including to provide voluntary or charitable services, where you cannot work from home and your workplace is open.

ENFORCING THE LAW

From Wednesday 13th May, the government is introducing higher fines for those who do not comply. Once these new limits are in place, if the police believe that you have broken the law – or if you refuse to follow their instructions enforcing the law – a police officer may issue you with a fixed penalty for £100 (reduced to £50 if paid within 14 days). If you have already received a fixed penalty notice, the amount will increase to £200 and double on each further repeat offence, up to a maxmium of £3,200.

In comparison, the fixed penalty notice until Wednesday 13th May is £60 (reduced to £30 if paid within 14 days). If you have already received a fixed penalty notice, the amount will increase to £120 and double on each further repeat offence, up to a maxmium of £960.

Clinically Vulnerable People

If you have any of the following health conditions, you are clinically vulnerable, meaning you are at higher risk of severe illness from coronavirus. You are advised to stay at home as much as possible and, if you do go out, take particular care to minimise contact with others outside your household. Clinically vunerable people are those who are:

• Aged 70 or older (regardless of medical conditions)
• Under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab as an adult each year on medical grounds)
• Chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
• Chronic heart disease, such as heart failure
• Chronic kidney disease
• Chronic liver disease, such as hepatitis
• Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
• Diabetes
• A weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets
• Being seriously overweight (a body mass index (BMI) of 40 or above)
• Pregnant women

As above, there is a further category of people with serious underlying health conditions who are clinically extremely vulnerable, meaning they are at very high risk of severe illness from coronavirus. You, your family and carers should be aware of the guidance on shielding which provides information on how to protect yourself still further should you wish to.

10/05 – Key points from today’s briefing

Mr Johnson thanked the public for their efforts in social distancing but said it would be “madness” to allow a second spike in the coronavirus pandemic by removing the lockdown completely. Instead, he announced the government’s new plan – but stressed the plan is “conditional” and would be led by science. The message has now changed from “stay at home” to “stay alert” in order to help control the spread of the virus, protect the NHS and save lives. Here are the eight key points from today’s briefing:

• A new Covid alert system – The system will be run by a new Joint Biosecurity Centre. The UK is currently at level four of the five-tier system, just below the “most critical” threat – the kind that would have seen the NHS swamped by coronavirus cases. The further down the ladder the country goes, the more lockdown measures could be eased.
• Construction and manufacturing workers to go back to work – People in the construction and manufacturing industry are being “actively encouraged” to go back to work. This also extends to anyone who is not able to work from home.
• Avoid public transport and instead use cars, walk or cycle – Mr Johnson urged people to avoid public transport when travelling to work. Mr Johnson also stated, “But just as with workplaces, public transport operators will also be following COVID-secure standards.”
• Unlimited outdoor exercise – This lifts the “one daily exercise per day” rule and will begin on Wednesday, May 13th.
• Fines for lockdown flouters will be increased – The increase in fines has not been announced yet.
• Phased reopening of schools – Mr Jonhson said the aim is to open the schools for reception, year one and year six pupils. However this plan is conditional depending on the rate of new infections and the progress the country has made in regards to the coronavirus pandemic.
• Reopening of hospitality industry and public places – The Prime Minister said: “Step three – at the earliest by July – and subject to all these conditions and further scientific advice; if and only if the numbers support it, we will hope to re-open at least some of the hospitality industry and other public places, provided they are safe and enforce social distancing.”
• Imposed quarantine on people flying into the country – Lastly, Mr Johnson announced plans to impose quarantine on people flying into the country.

06/05 – Business rates revaluation postponed

The postponement comes on top of the government’s support package for business and workers during the economic emergency including:

• Businesses are set to receive a discount of almost £10 billion on their rates bills this financial year in response to coronavirus, after the business rates retail discount was increased to 100% from 50% for 2020 to 2021
• Over £12 billion for local authorities to deliver grants of up to £25,000 to eligible businesses. As of 3 May, over £8.6 billion has been paid out to over 697,000 business properties
• Protections for UK high street shops and other companies under strain will be protected from aggressive rent collection and asked to pay what they can during the coronavirus pandemic
• The Coronavirus Job Retention Scheme where small and large employers will be eligible to apply for a government grant of 80% of workers’ salaries up to £2,500 a month, backdated to March 1 and available for at least 3 months. The first grants have been paid.
• A deferral of the next quarter of VAT payments for firms, until the end of June – representing a £30 billion injection into the economy
• A total of £330 billion worth of government backed and guaranteed loans to support businesses

30/04 – VAT exemption for PPE

From tomorrow (1 May 2020), PPE purchased by care homes, businesses, charities and individuals to protect against Covid-19 will be free from VAT for a three-month period.

• A zero-rate of VAT will apply to sales of personal protective equipment (PPE) for Covid-19 from 1 May 2020 until 31 July 2020
• Move will save care homes and businesses more than £100 million
• Comes after import duty also removed from PPE

28/03 – Further expansion of access to coronavirus testing helps protect the most vulnerable

• Anyone in England with coronavirus symptoms who either has to leave home to go to work or is aged 65 and over will now be able to get tested.
• Symptomatic workers who are unable to work from home also eligible for testing
• Testing of all asymptomatic NHS and social care staff and care home residents also being rolled out
• New expansion of testing made possible due to rapidly increasing testing capacity.
• For more information regarding coronavirus testing or to book a test using the government’s online portal, click here

23/03 – Key points from today’s briefing

There is a clear message to stay at home and you are only to go out for:

• Shopping for essentials.
• One form of exercise a day.
• Medical need/caring for a vulnerable person.
• Travelling to/from work – where this is absolutely necessary and you cannot work from home.

Further points include:

• Do not meet up with friends or family members you do not live with.
• Closure of all shops selling non-essential goods.
• Closure of libraries, outdoor gyms, places of worship.
• No gatherings of more than 2 people in public, apart from those you live with.
• The police will have power to enforce rules – this includes fines and dispersing gatherings.
• Measures will be reviewed in three weeks.

22/03 – UK Government announces guidance and advice to avoid non-essential travel in the UK

Who this guidance is for:

• This guidance is for people planning to visit second homes or holiday premises during the coronavirus (COVID-19) pandemic.
• Essential travel does not include visits to second homes, camp sites, caravan parks or similar, whether for isolation purposes or holidays. People should remain in their primary residence. Not taking these steps puts additional pressure on communities and services that are already at risk.

The main message:

• Following on from the government’s guidance on social distancing in relation to COVID-19, people should avoid traveling unless it is essential.
• The UK Government has also announced people must follow virus advice or ‘tougher measures’ are likely.

21/03: UK Government announces further measures on social distancing

• Measures to close entertainment, hospitality and indoor leisure premises across the country to take place from the end of trading hours today (Friday 20 March) to limit spread of coronavirus
• New measures will further limit people’s sustained social contact as we tackle the spread of coronavirus, guided by scientific evidence
• Public urged to stay at home and limit all but essential travel – people who can work from home should do so

20/03: The UK Government has introduced guidance for households with possible coronavirus (COVID-19) infection.

Who this guidance is for:

• people with symptoms that may be caused by coronavirus, and do not require hospital treatment, who must remain at home until they are well
• those living in households with someone who shows symptoms that may be caused by coronavirus

The main messages:

• if you live alone and you have symptoms of coronavirus illness (COVID-19), however mild, stay at home for 7 days from when your symptoms started
• if you live with others and you are the first in the household to have symptoms of coronavirus, then you must stay at home for 7 days, but all other household members who remain well must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill
• for anyone else in the household who starts displaying symptoms, they need to stay at home for 7 days from when the symptoms appeared, regardless of what day they are on in the original 14 day isolation period
• it is likely that people living within a household will infect each other or be infected already. Staying at home for 14 days will greatly reduce the overall amount of infection the household could pass on to others in the community
• if you can, move any vulnerable individuals (such as the elderly and those with underlying health conditions) out of your home, to stay with friends or family for the duration of the home isolation period
• if you cannot move vulnerable people out of your home, stay away from them as much as possible
• if you have coronavirus symptoms: do not go to a GP surgery, pharmacy or hospital. You do not need to contact 111 to tell them you are staying at home. Testing for coronavirus is not needed if you are staying at home
• plan ahead and ask others for help to ensure that you can successfully stay at home and consider what can be done for vulnerable people in the household
• ask your employer, friends and family to help you to get the things you need to stay at home
• wash your hands regularly for 20 seconds, each time using soap and water, or use hand sanitiser
• if you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after 7 days, then use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency dial 999

Further details on exams and grades announced:

• This year’s summer exam series, including A levels, GCSEs and other qualifications, and all primary assessments, have been cancelled.
• The exam regulator, Ofqual, and exam boards will work with teachers to provide grades to students whose exams have been cancelled this summer.
• There will also be an option to sit an exam early in the next academic year for students who wish to.
• Ofqual and exam boards will be discussing with teachers’ representatives before finalising an approach, to ensure that it is as fair as possible. More information will be provided as soon as possible.
• The Government will not publish any school or college level educational performance data based on tests, assessments or exams for 2020.
• You can find out more here

Online isolation notes launched – providing proof of coronavirus absence from work:

• People unable to work for more than seven days because of coronavirus (COVID-19) can obtain an isolation note through a new online service.
• An isolation note can be obtained without contacting a doctor, this will reduce the pressure on GP surgeries and prevent people needing to leave their homes.
• For the first seven days off work, employees can self-certify so they don’t need any evidence for their employer. After that, employers may ask for evidence of sickness absence. Where this is related to having symptoms of coronavirus or living with someone who has symptoms, the isolation note can be used to provide evidence of the advice to self-isolate.
• The notes can be accessed through the NHS website and NHS 111 online. After answering a few questions, an isolation note will be emailed to the user. If they don’t have an email address, they can have the note sent to a trusted family member or friend, or directly to their employer. The service can also be used to generate an isolation note on behalf of someone else.
• For further information please click here

WHO Health Alert brings COVID-19 facts to billions via WhatsApp:

• WHO is launching a messaging service with partners WhatsApp and Facebook to keep people safe from coronavirus.
• This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.
• The service can be accessed through a link that opens a conversation on WhatsApp. Users can simply type “hi” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.

Further announcements include:

• Driving tests and MOTs for heavy vehicles suspended for up to 3 months to help tackle spread of coronavirus
• Isolation guidance for residential educational settings
• New arrangements for MHRA Good Practice (GxP) inspections due to coronavirus (COVID-19)
• Crucial medicines protected for coronavirus (COVID-19) patients
• Coronavirus (COVID-19): scientific evidence supporting the UK government response
• MHRA services during the Coronavirus (COVID-19) response
• Ibuprofen use and Coronavirus (COVID-19)

19/03 – The UK Government has announced the following:

• £2.9 billion funding to strengthen care for the vulnerable
• Plans set out to support pupils eligible for free school meals
• Military stands up COVID Support Force
• Government agrees measures with energy industry to support vulnerable people through COVID-19

18/03 – School Closures

The Prime Minister has said schools will close from Friday, March 2020 until further notice as a response to the coronavirus pandemic, except for looking after the children of keyworkers and vulnerable children. Read more here.

16/03 – Further social distancing guidance

The Government is advising those who are at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures.[2]

This includes people:

• aged 70 or older (regardless of medical conditions)
• adults under 70 with an underlying health condition including diabetes, chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis, chronic heart disease, chronic kidney disease, being seriously overweight, or pregnant.
• If you are instructed to get a flu jab as an adult each year on medical grounds, then you are part of this advice.

What is social distancing?

Social distancing measures are steps you can take to reduce the social interaction between people. This will help reduce the transmission of coronavirus (COVID-19).

• Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough;
• Avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible; Work from home, where possible. Your employer should support you to do this.
• Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs
• Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media.
• Use telephone or online services to contact your GP or other essential services.

Saudi Arabia, the largest Arab state in Western Asia by land area, is filled with gloriously beautiful buildings such as Al-Masjid al-Nabawi, the second holiest site of Islam, and Quba Mosque, one of the oldest mosques in the world.

Travelling to Saudi

British pilgrims travelling to perform Umrah and Hajj are required by Saudi government regulations to travel with a United Kingdom travel agency that is accredited with the  Royal Embassy of Saudi Arabia.

Shariah law

Islamic law is strictly enforced in Saudi Arabia, which will require researching traditions and customs to ensure you do not offend locals. These include not eating, drinking or smoking in public during the daylight hours of Ramadan.

Getting there

Travelling to Saudi Arabia from the UK is only possible by airplane, with flight times vary depending on which airline you choose.

Flights from London to Riyadh, Saudi Arabia’s capital, can be booked for the shortest trip of fewer than seven hours, while the average time takes roughly 10 hours.

Time difference

The time difference in Saudi Arabia is two hours ahead of British Summer Time and three hours ahead of Greenwich Mean Time, which should not necessitate major changes to your diabetes management.

However, if you are uncertain about managing your diabetes in Saudi Arabia, you should consult a member of your diabetes team.

Climate

Average summer temperatures of 45°C and high temperatures of 54°C are common.

If you take insulin, you should attentively check your blood sugar levels as insulin consumption can be enhanced in warmer weather.

You could consider reducing your dosages before periods of physical activity if you are concerned about hypoglycemia.

Currency

The currency used in Saudi Arabia is the Saudi riyal. Most ATMs accept a substantial number of both regional and international cards, however, there is usually a fee for using ATMs which are operated by banks other than your own.

Vaccinations

You should seek to visit your doctor no later than two months before departing the UK to assess which vaccinations you may require before entering Saudi Arabia.

Visitors who are travelling to Saudi Arabia for the Hajj and Umrah pilgrimages to Mecca will need to produce a certificate of vaccination with a quadrivalent meningitis vaccine before they can be issued with a visa. This is also recommended for travellers not going to Mecca.

Otherwise, there are several recommended vaccines for all travellers entering Saudi Arabia, which include hepatitis A, hepatitis B and influenza.

A yellow fever vaccine is required from all travellers entering Saudi Arabia from a country where yellow fever is prevalent. Otherwise, this is not recommended.

Under 15s

Travellers under the age of 15 are required to undergo a polio vaccine if arriving from a country where polio still occurs. A one-time booster is recommended for adult travellers who have not had a vaccine as an adult but completed the childhood series.

A rabies vaccine is also recommended for travellers at high risk for animal bites or involved in any activities that might bring them into direct contact with bats. Both animals are known to carry the disease in Saudi Arabia.

The opportunity to ensure your existing vaccination against tetanus is up to date should also be taken.

Ensuring access to medication

UK citizens with diabetes will not be entitled to any free medication services while in Saudi Arabia. Securing comprehensive medical insurance will be essential in order to obtain even basic treatment.

Diabetic medication is available in Saudi Arabia, but payment will be required from all pharmacies. Blood urine testing kits are available from most pharmacies.

Most pharmacies open from 0930 to 1300, close for the afternoon, and then reopen from 1630 to 2230. Many hospitals in Saudi Arabia also have 24-hour pharmacies in which medication can be collected.

The emergency services number to call for in Saudi Arabia is 997.

Insulin

You should note which syringes are available in Saudi Arabia, with U-100 syringes the most commonly used.

The vast majority of insulin in the UK is U-100 insulin. If you need to take a different strength of insulin, say in an emergency, it’s important that you use the correct device and syringes for that insulin.

For example, you would use a U-40 syringe for U-40 insulin. You will need to work with a doctor getting the right dose if you’re using a different form of insulin.

Diabetes associations

It is important to note the diabetes associations in the country you are travelling to in case of an emergency.

The diabetic association of Saudi Arabia is the Saudi Diabetes and Endocrine Association, which has been a member of the International Diabetes Federation (IDF) since 1991. The address is:

• Saudi Diabetes and Endocrine Association
  Al-Thuraya Building, 4th Floor,
  P.O.Box 1498,
  31952 Al-Khobar,
  Kingdom of Saudi Arabia
  Tel: +966.38878970
  Email: sdea@sdea.org.sa

Questions

• How is blood glucose measured in Saudi Arabia?
  Unfortunately, we do not have the information of whether blood glucose is measured in mg/dl or mmol/l in Saudi Arabia.
• What language is spoken in Saudi Arabia?
  Arabic is the official language of Saudi Arabia, but English is widely used throughout the country.
• Will I need an international driving license when driving in Saudi Arabia?
  Yes
• If I want to hire a vehicle during my visit, will I face any form of discrimination?
  It is illegal for women to drive in Saudi Arabia.
• What sugar free drinks are available in Saudi Arabia?
  Most diet drinks available in the UK such as Diet Coke and Diet Vimto are available, as are most artificial sweeteners.

Our mission is to use digital media to shape the future of healthcare. Whether that’s through our education programs or interactions on the forum, we want to improve health outcomes in every aspect of diabetes care. People with diabetes are the experts in their own condition, and we seek to bring power back to where it belongs: with the community that lives with diabetes every day.

The
Diabetes Forum
started as the first place that the diabetes community could talk openly to one another about their condition. Since starting out in 2003, we’ve grown into Europe’s largest diabetes community, with:

• More than 500,000 members from 300 countries
• 1.2m unique visitors per month
• More than 350,000 social media users across Facebook, Twitter and Instagram

Our research shows that our ideas are resonating with the people who matter most. In 2013, we learned that:

• 73% of members improve their understanding of diabetes thanks to do the diabetes forum
• 44% of members improve their blood glucose control
• 35% reduced their HbA1c levels thanks to the forum
• 55% of members improved their diet choices after joining the forum

It’s simple – connecting and sharing with each other is affecting health outcomes, positively. Not only is it affecting real-world health, but it is also changing diabetes-research and understanding, too.

Education has always been at the heart of what we do, and for good reason. There are thousands of people disillusioned and frustrated by the lack of clear, accessible diabetes information. With the continuing support of the diabetes community and medical experts, we are committed to making that a thing of the past.

Transparency

Diabetes.co.uk is built on community. It’s the community that shares its expertise on the forum, and it’s the community that provides feedback so that we can make our education programs the best they can be. It’s the community that makes it possible for us to keep growing. We’re built on togetherness and collaboration, and we’re grateful for that. We wouldn’t do anything to jeopardise it.

We pride ourselves on being open about our business practices. Because we’re not a charity, it’s important to our community that we’re open about how we make money. We understand and respect that.

Some of our revenue comes from advertising, but we know that ads can get annoying. That’s why we don’t show ads when you’re logged into the forum. We also respect your right to use ad-blocking software.

Occasionally, we run promotions for clinical trials. This

does not

mean we sell your personal information to pharmaceutical companies. It means that we’ll let you know when a trial’s going on, and you can sign up if it sounds of interest to you.

The only data sharing we do is in bulk, anonymous form. It’s not personal information, it’s anonymous medical data that nobody can trace back to you. This kind of data sharing is a good thing. It makes people healthier.

For example, the NHS can use anonymous data to monitor the performance of a particular hospital, or keep an eye on the spread of certain risk factors, or judge the effectiveness of treatments. It’s a nationwide initiative to make sure we all get better, and we’re proud to be a part of it.

Our values

Better together: digital media and the future of healthcare

Digital spaces can provide support that traditional healthcare can’t. On the forum, users have access not just to a first or second opinion, but to thousands. Advice is tailored to the individual. There is time for dialogue and nuanced explanation – something which GPs may not have time to provide.

Digital healthcare also has the potential to revolutionise diabetes education, giving millions of people unprecedented access to key information. We will continue to be at the forefront of this movement.

Our first education project, the Hypo Training Program, is the world’s first structured education program for people struggling with hypoglycemia. The statistics suggest that the Hypo Training Program has had a very real, positive effect. 87% agree that they have improved their ability to treat a hypo, and their knowledge of hypoglycemia and driving. 88% know how to avoid hypos.

We’re proud to have been awarded the inaugural Positive Social Impact Award at the National Business Awards, recognised for “using innovative, engaging but simple behaviour change and digital strategies and the use of data and mobile”, which is resulting in “saving NHS budgets, and saving lives.”

Our work is saving the NHS money. By using digital spaces, people are lowering their HbA1c levels, and thereby reducing their risk of complications – by far the biggest cost of diabetes. People are improving their health. We’re not working

against

the advice of doctors – we’re enhancing it.

Finding the right diet: diabetes and low-carb

On the forum, we’ve seen a staggering amount of anecdotal evidence in favour of the low-carb diet. Dr. David Unwin, inspired by the stories he read there, has since conducted several studies and found that the low-carb diet reduces HbA1c levels and aids weight loss in people with type 2 diabetes.

We don’t push the low-carb diet onto anyone – for some people, it won’t work. We encourage people to make their own decisions, and we offer our support regardless of what diet they follow. We urge people with diabetes to check with their doctor before making any major dietary changes.

That said, we’re committed to providing comprehensive resources to anybody interested in following the low-carb diet. We believe dietary guidelines need to change, to provide more flexibility and encourage improved diabetes control, and it’s our mission to demonstrate the benefits.

In complete control: self-monitoring of blood glucose for people with type 2 diabetes

It’s our belief that people with type 2 diabetes benefit from structured self-monitoring of blood glucose, but people with type 2 diabetes who aren’t dependent on insulin often can’t get test strips on prescription.

In response, we developed the Type 2 Testing Program, which provides test strips, a free blood glucose monitor and comprehensive structured support, for a quarterly or annual fee. Again, we don’t insist on it – we appreciate that diabetes can be controlled without testing – but we think people should have the option.

Prevention better than a cure: prediabetes

Type 2 diabetes is in many cases a preventable condition, and we see the need for “at-risk” individuals to be identified. However, we think that prediabetes is a flawed label, and people with prediabetes are overmedicated. Prediabetes can be understood as an opportunity – an opportunity to make changes in order to prevent type 2 diabetes. Not everybody has that chance and there are plenty of people around for
support.

We’re committed to providing educational resources for people with prediabetes so that they can feel empowered to take control of their health.

Burnout and beyond: diabetes and the mind

Research suggests that people with diabetes are twice as likely to go through depression, and diabetes burnout is rife. Since our inception, we’ve pioneered research into the effects of mindfulness-based meditation on diabetes burnout, and our findings are encouraging. Not only does mindfulness address the emotional impact of burnout, but it also has a positive effect on blood glucose levels. We intend to continue our research into diabetes and meditation, and we hope the medical community does the same.

• 
  Contact Diabetes.co.uk:
  
  Click here to
  
  contact Diabetes.co.uk

We take a look at some of the contributing factors behind ‘skinny’ type 2 diabetes.

Insulin resistance and fatty liver 

Our body produces the hormone insulin to utilise glucose as fuel or store it for later use in the muscle and liver, or as body fat. The main characteristic of type 2 diabetes, insulin resistance, occurs when the cells in the body can no longer respond effectively to insulin. Insulin resistance leads to higher insulin levels as the body attempts to maintain healthy blood glucose levels, but this creates a vicious cycle that further promotes insulin resistance. Eventually, the body can no longer keep up with the increasing insulin requirements, resulting in excess glucose in the bloodstream, also known as hyperglycaemia.

While one of the leading causes of insulin resistance is being overweight or obese, there are several other factors that are also associated with the condition:

• You are white and over 40 or are over 25 and are African-Caribbean, Black African, or South Asian.
• You have a close family member who already has the condition.
• You have high blood pressure or cholesterol.
• You have a sedentary lifestyle.
• Find out about other risk factors.

Insulin resistance and type 2 diabetes are also associated with non-alcoholic fatty liver disease (NAFLD). Insulin resistance results in increased levels of fat in the blood, which can accumulate in the liver. High insulin levels (hyperinsulinemia) also promote the production of liver fat from excess sugar in the body.[1]

Over time, having too much fat in the liver creates more insulin resistance, in turn leading to the production of even more insulin. [2]

Read more about non-alcoholic fatty liver disease.

Thin outside, fat inside (TOFI)

We all have a layer of fat under our skin called subcutaneous fat. Although subcutaneous fat is part of our overall weight, visceral fat stored within our abdominal cavity is associated with health conditions including type 2 diabetes, heart disease and cancer.

Visceral fat can be found wrapped around vital organs such as the liver, pancreas and intestines and is often associated with insulin resistance.

The term TOFI or ‘thin outside, fat inside’ is attributed to individuals who do not look overweight but have a disproportionally high amount of abdominal fat. Someone with TOFI has less subcutaneous fat but large amounts of visceral fat. Those with TOFI have been identified as being at a higher risk of developing insulin resistance.[3]

Someone who is unable to store subcutaneous fat might have a condition called lipodystrophy.[4] Individuals with lipodystrophy have an increased risk of insulin resistance and type 2 diabetes, with almost all of their fat stored as visceral fat within the abdomen.

As discussed above, while being overweight is associated with type 2 diabetes, there are various other factors at play. Someone may be considered a healthy weight but will be diagnosed with the condition. In these individuals, type 2 diabetes might be caused by insulin resistance and the accumulation of visceral fat around internal organs, including the liver.

Adopting a healthy lifestyle can help reduce the risk of developing type 2 diabetes. Following a low-carb diet and regularly exercising can lower insulin levels within normal range and keep insulin resistance at bay.

References

[1] Marjot, T. et al (2019). Nonalcoholic Fatty Liver Disease in Adults: Current Concepts in Etiology, Outcomes, and Management. Endrocine Reviews, 41 (1), 66-117.

[2] Intensive Dietary Program (n.d). Fatty Liver – T2D 25.

[3] Zdrojewicz, Z. et al. (2017). TOFI phenotype – its effect on the occurrence of diabetes. Pediatric Endocrinology Diabetes and Metbolism, 23(2), 96-100.

[4] Herranz, P., de Lucas, R., Perez-Espana, L., & Mayor, M. (2008). Lipodystrophy syndromes. Dermatologic clinics, 26 (4), 569-78.

Working for the NHS

Bruce works as an emergency care support worker for the NHS, at one of the three main hospitals in Lincolnshire. He was also diagnosed with type 2 diabetes in 2000 and begun managing it with insulin in 2006. One of the biggest obstacles he faces at work is his night shifts.

Managing blood sugar levels while working night shifts can be exceptionally hard, especially when there are no set times for breaks. Many night workers see their blood sugars creeping upward. Bruce told us that he generally tests his blood sugar levels 3-4 times per day and more so at work as he is driving and has no set meal breaks.

Food and the family

Bruce lives with his wife, and for this couple, food is a team effort. Bruce’s wife is highly supportive and helpful when it comes to what he has to eat; she prepares his packed lunches to take to work, which often include tuna and oily fish. At home, she is conscious of the food on the table at mealtimes. During the coronavirus pandemic, shops like Sainsburys and M&S food halls have been fantastic to people like Bruce, allowing NHS staff in at certain times when there are not so many people about. This has made it much easier to keep up good social distancing, something Bruce said helped him to feel at ease, while still having access to good, nutritious foods.

Keeping moving

Of course, getting enough exercise has always been important, but nowadays we have to take extra care to make sure we get enough per week. We asked Bruce what exercise looks like for him following the coronavirus outbreak.  He said that on his days off from work, he maintains regular daily exercise with his golden retriever, out and about at the parks, but of course, always keeping social distancing in mind.

Staying safe

Personal protective equipment (PPE) is key to keeping our healthcare workers safe, and Bruce is not any different. He has been very vigilant with his PPE, simply stating that “we can’t take any chances.” It is important to remember that people with diabetes are generally more prone to catching illnesses.

His team leader and colleagues have been a huge help, keeping Bruce as safe as possible. He doesn’t go on house calls to see patients confirmed with COVID-19 if it is possible for one of his colleagues to go in his stead. They also work in a secure ward, meaning that the patients that come into the ward for an appointment have already been vetted by the 111 nurse, then triaged by the NHS practitioner, so they have a good idea what is wrong with the patient before they step inside the building. The knowledge of their patients’ conditions and control over the flow of patients through their ward mean that they can limit Bruce’s exposure, let him continue his hard work, and reduce his risk of contracting the virus.

What does Bruce want to say to you?

When asked for tips to pass on to other people with diabetes, Bruce made it clear: talk to other people in similar situations. They are probably experiencing similar worries or thoughts, and it can help to reduce the stress of these unprecedented times. He added that PPE is incredibly important, and for other workers not to forego it. And, above all, be wary and follow the Government’s advice.

Bruce wanted us to share his story, to show how he is managing at work with his type 2 diabetes. It can be done, and he is thinking of all the other key workers with diabetes every step of the way.

Read more:

• Coronavirus: should I be worried
• Update for those vulnerable to Coronavirus
• Dr Dipesh Patel on diabetes and vulnerability to COVID-19
• Rhonda Green: Working on the frontline with type 1 diabetes
• Laura Thornton: A diabetes hero on the Coronavirus frontline
• Joanne Wignall: Working on the hospital frontline with type 1 diabetes