Bloods and Booze

imageYou’ll never hear me say, “sorry lads, I am not coming out-out tonight, I’ve got diabetes.” Not unless I’ve got a date lined up which I don’t want friends to know about, and am seeking an excuse.

Whilst ‘playing the D-Card’ is something we can get away with from time to time – like when I flew to Vancouver in firstclass despite holding an economy ticket, as I had a sudden ‘hypo’ on entering the aircraft when conveniently stood by spare firstclass seats – the condition of type 1 diabetes itself is something that, with the right understanding and self care, should never stop us from being social and doing the things we enjoy most in life.

When it comes to a night out on the town, however, that ‘self care’ part should be emphasized. It is very difficult to keep on top of your health responsibilities when you are so battered you find yourself attempting to stage dive across a packed dance-floor, skiiing down underground esculators like James Bond (but falling off) or swimming in public fountains on the way home.

Although I’ve calmed and matured a bit in my mid twenties now, I certainly am no stranger to the wild side, and those past experiences as a teen in particular have been real learning curves, both in general and with diabetes.

In Britain we have a big social drinking culture, you are born and then there is beer. This is partly how the British Empire conquered the world, we had a few and decided places like Canada would be interesting. So especially over here adolescents with diabetes have to learn fast.

For me when I was a teen it was difficult. At that time I was learning the diabetes ropes independently as an adult. I was also misinformed about my insulin management – being told to inject a certain amount of insulin for each meal time following a switch from mixed insulin to basal and bolus, not carbohydrate counting for the meal itself.

So I very much had to learn the hard way in managing my diabetes, from sports to socialising and all else in between.

The initial attitude I had, which many young adults may relate to, was to just get on with it – which is great – but the feeling was to just get on with it and almost ignore my health duties. I would always do my insulin, I realised the importance of that (even if overdosing myself without knowing at the time, 14 units of basal novorapid for every dinner meal was my regime!!) but would seldom test my blood sugar levels regularly enough.

My A1C was well up in the 8s – maybe it should have been worse – but I had a lot of hypos due to the mass amounts of insulin I was told to take. So my long and short term health was at risk. Whilst this all sounds bad though, in the bigger picture it was where I learned all I did, in order to be an advocate as I am today – you have to hit the ground sometimes in order to pick yourself up a stronger person.

In terms of night life, today I am very good at knowing what I am drinking and that is key in keeping safe and healthy(ish). Back in those early outgoing years without that understanding of my blood sugars, I would either be flying hyper or crashing hypos – or both – never well managed. This can create a real monster, out of character, we get angry when we are hypo and can also do so when too drunk – the two mixed together is worse than Frankenstein’s creation.

The added risk with that is if you are out-out and you are hypo, people don’t know your situation, that your blood sugars are low, they will just assume you are drunk.

The bottom-line is that you cannot hide from your diabetes, you have it and if you don’t respect that, you only harm yourself. Confidence is a big deal in life in general, a thing like diabetes can affect it too, but in gaining that understanding that you are still you and can live life to the full – if you just take on that responsibility to keep a check of your blood sugars, take the appropriate amounts of insulin your body needs, to look after your diabetes, your diabetes will look after you.

In living proudly with my British culture, I am well aware of the potential affects on my blood sugars. In fact too aware, when I do go out-out in the present day (which isn’t that often anymore) I go to the level of waking up with selfies on my phone of returning home, after a fair few drinks, of myself holding my blood sugar meter with a good reading and smile on my face.

The smile is the main part – I am more than happy living with diabetes, that is where good control stems from and my A1C is 6.0% by the way! The blood sugar level is not so much the main part before bed, as Dr Annan said at an event with me recently, it is not about the level it is about what that level is doing. You don’t want a hypo in your sleep!

Waking up with a level of 5.5mmol/l – as I did last weekend – that’s when you can say I know my stuff!

On nights out I do confess to switching drinks, if I feel it is necessary. I do not recommend mixing drinks, it messes you up man, but on medical grounds when I have noticed the lagers or the ciders have caused my levels to go too hyper, I switch to vodka and diet coke and drop the levels down. Hence the happy ‘I am smarter than you diabetes selfies.’

This usually needs to be accompanied by a snack before sleeping, to stop the crash later on.

Here is a Alcoholbetic guideline from vast drinking experience:

Spirits, especially vodka: will lower your levels fairly quickly, no carbs here!

Ales and Beers: they are carby but very yeasty (if that is a word), they tend to rise levels on the first few pints but hours later are known to decrease levels.

Lagers: can have the same affect as above but contain more sugars, depending on the drink will rise levels a bit more.

Ciders: going to boost levels! Apples, pears, natural sugars and carbs!

Stouts like Guinness: will also rise levels, not quite like cider, a much slower process, but more carbs in stouts than in lagers.

Wines: tend to rise levels a bit more too, white more than red as white is much sweeter in general. Both with a lot of natural sugars.

Alcopops: just avoid altogether, they are sh** drinks (excuse my french) and are filled with added sugars.

Cocktails and Jagerbombs: can have a rise and crash affect, more so with shots like jagerbombs – a lot of added sugar in red bull but also the spirits will decrease levels. Cocktails depends on the drink and level of alcohol included, as you can get many which include added sugar drinks and syrup, which will make you fly.

Verdict: know what you are putting in your body! You can make slight adjustments with insulin or plan what you will drink through the night. Type 1 diabetes cannot stop you enjoying yourself, just remember enjoying yourself is best done with good health.

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Underdog Spirit

You know when you see those houses which have warning signs up because the owner has a dog? Well I do not own a dog, however, I was contemplating putting a beware of the underdog sign up in my doorway.

The truth is personally I am at my best when some a~hole writes me off. Whether that is because I have this common saaanding, saaaff-east London accent, or due to the fact I am a young adult who has little for money and status, either way they are irrelevant to what I can achieve – and this is the same for anybody. We are who we are and whichever our background, we are living today and that means its in our hands to go out and make something of that opportunity called life.

In living with type 1 diabetes I recall early years where others didn’t understand my condition very well. How could they if they did not live with it every day? Sometimes people wanted to see me shake and shiver in the park or school playground as I suffered a hypo, to have a good laugh (kicking my energy drinks over for example). Other events were in not being able to participate in sports day races during early years of secondary school, just in case something ‘went wrong’ with my blood sugars. Whilst these were negative parts of those early days for me, making a boy hate his condition, do you know what those experiences taught me?

To toughen up and stand my own ground. 

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I am a firm believer today that the greatest positives long term can be taken from any short term negatives. You live and learn. For those living with diabetes as I do, ‘live and learn’ is never truer – when it comes to controlling your blood sugars, always ask that question, why did it not go to plan today? When I first started out running those crazy distances, which is where the idea of DiAthlete – anything is possible – has evolved from, there weren’t any professionals willing to give me advice on how to keep healthy control during the ultra endurances I faced. People and more so big organisations were scared to get involved. So I had to learn the hard way – and I did – I hit the ground a few times. There are a few scars from extreme hypoglycaemic (low blood glucose) fits, in some respects I am lucky to be alive. One time I clonked out in a bath-tub and came round when under the water, unable to move or control my own body as everything had shut down on me. I managed to salmon my way out the tub in the end!

On another occasion I hit the ground when out on a training run, taking on a half marathon distance as I prepped my body for a 70 mile ultra around the Isle of Wight. I was just a teenager back then – but my life lessons in type 1 diabetes were never more vital at the time. Being taken home in an ambulance van for me was humiliating inside; for my Mother completely unaware of what had happened to see a paramedic usher me home, well, can you imagine?

I went down a lot in those early adolescent years, when my ultra distance running days first started – the main reason being I was put on this bulls*t insulin regime after first being introduced to basal (long acing) and bolus (quick acting) insulin injections. Instead of being taught how to carbohydrate count and be educated in how to monitor my blood glucose levels as an independent adult, I was simply told to inject a certain number of units of insulin at certain times each day, before meals. No remote info on what those meals might have been – be it a pizza or a salad I would inject the same amount of insulin. Now imagine being on such a regime when trying to run 29 miles along the coast of Thanet, or 70 miles around the Isle of Wight!

My greatest lessons were learned during that period of my life, ultimately leading towards taking my own decisions on insulin management, and connecting with others to learn more about carbohydrate counting. Being down on the ground there is one thought: get back up and next time stay up. My A1C is 6% today.

Now I am a type 1 diabetes educator to my own right, I know the condition inside-out through those and many other extreme experiences and adventures – all around the world. Experience is key and whilst this can benefit ourselves living with it on the long run, it can also benefit many others too. Whilst daily struggles continue in terms of paying the bills, finding more work on the side of my commitment to diabetes with DiAthlete, the bottom line is I know I am on the right path. In the last 5 or 6 weeks over 1000 people have been directly reached, in very fun and active styles, passing on advice and going that step further by practically getting young people with diabetes outside, learning for themselves about their body and diabetes. The recent events in Northern Ireland and across Eastern Europe were incredible experiences for me too; it is reassuring to know that a positive impact can be pushed out from this ‘brand.’ When you get people living with diabetes together, wherever they are from, magic happens.

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3 years ago to this date and time-period right now I was out on an adventure of a life-time. The 30/30 Challenge, running like a nutter around the UK, from John O’Groats to Lands End covering 30 mile routes every day for 30 days. That was my greatest ever ‘underdog’ moment as in the build up many CEOs, professionals, board members, whatever status they wanted to brand themselves with, said some very frustrating comments to me, basically telling me I could not do it, when I was just asking for some support. And then out of nowhere some big names were voicing their support of me as I persisted with the project; I was just some nobody kid and there was boxer David Haye recording a support message, Sir Geoff Hurst – England’s greatest footballing hero – doing the same, Kirsty Gallacher tweeting away, TVs Jasmine Harman, Ana Ivanovic, Gemma Atkinson – I had to scrub up! It was incredible.

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What went under the noses of the ‘people of status’ in this cause back then – and to be honest sadly still does in many areas today – is the fact that it was not about a personal challenge, it was a mission to bring unity and positivity to the people who need it, the people living with diabetes – especially the next generation who are currently asking the world, as I once was, can I still live my dreams?

3 years ago I battled, never gave up and nailed that challenge. I’ve been doing this worldwide ever since to provide the answer they need to hear: YES YOU CAN STILL LIVE YOUR DREAMS. Never forget it and never let anybody tell you otherwise. An underdog? Good, that means you’ve got a bit of bite about you.

This year some incredible events and challenges have been lined up, some are still being worked on such as a Florida Tour in June/July – more on that soon – but I will also be working on fundraising and events to try and make a DiAthlete Africa Tour happen next year. Recently I read an article from Yaa in Ghana, who shared how the project in Ghana last year helped give her the confidence she needed to now go on and become a diabetes educator. That really touched me to know going out there in 2015 made an impact, and I saw how it gave my friend Fred a platform to share his story and reach communities, which goes a long way – even more so when you see the struggles for supplies and health education they have out in Africa. The Africa tour plans to create a series of events across multiple communities in West and South Africa regions, maybe more too! Read more on that or donate towards the project here. 

Watch out world, we have an army of diabetes-battering underdogs and you better start listening!

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Finding your Confidence and Living Life to the Fullest

Jillian Rippolone comes from Long Island, New York and was diagnosed with type 1 diabetes in 1997 at the age of 9. I caught up with her for a Team DiAthlete chat about her life with t1 diabetes and ‘finding your confidence back’ with it Here is what Jillian shared:

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“I have been a diabetic now for almost 20 years! It’s been a long road that’s for sure. When I was younger my parents sent my brother (who is also a type 1 diabetic) and I to a diabetes camp, to be around other kids like ourselves and feel accepted, it was cool! I’m still friends to this day with the girl I went to camp with!

“Growing up when technology wasn’t as advanced, it was a bit challenging. Trying to figure out carbs and take needles all day long, it wasn’t easy on my mother having two diabetic children.

“As a teen diabetes didn’t really affect my social life negatively, however when you’re a teen and have a disease, internally, I felt a lower self esteem; it wasn’t until I was in my mid 20’s I felt fully confident.

“I would never advertise or show off I was a diabetic nor tell many people, because I guess I felt it wasn’t necessary. However, at age 28 now, I want the world to know and let others know that I’m a diabetic – to help spread awareness, motivate and inspire others to feel confident and proud to be living with t1d. Nothing should stop us from anything.

“People need a leader, and now I’m that leader. I run a 3k type 1 diabetic Facebook community page (www.facebook.com/type1titans) as well as two Instagram pages, one for diabetic memes (@kissmypancreass) and my personal diabetic/fitness Instagram (@t1dchick). I love posting funny diabetic pics that will make people laugh at jokes we all get! I also love posting about our everyday blood sugars, events, news, activity, questions, suggestions, and people’s photos of how they are living and dealing with diabetes on the Facebook page. It’s really great how we are all coming together and honestly it’s thanks to social media.

“Sometimes people feel alone and aren’t able to fully relate to others because of having diabetes, so having a supportive diabetic community where we can all gather together is really a beautiful thing. I also participate in every Jdrf walk to cure diabetes and also do other events such as the ADA tour de cure to help raise awareness for t1d. I like to stay connected and be around those who I relate with and all gather together in efforts of finding a cure! Faith and hope my friends!

“Let’s talk about my social life! It’s crazy! Although as I got older and more mature it’s settled down, diabetes has never ever stopped me from anything. If you do things in moderation you will be ok. You just can’t abuse anything, like drinking. I don’t smoke, never recreationally tried drugs and I’ll only drink in social settings, and when I say drink maybe have a few at most nowadays! Everyone will go through a party phase. I went through that in college, but as you grow up you realize how unnecessary it is and how it will mess up your blood sugars and make you feel super sick. It’s just not worth it. I think the best thing is having a great group of friends. Friends that don’t pressure you into anything or say anything negative when it comes to drinking and diabetes. All my friends are so supportive and care so much about me and that’s what’s great about my social life I have people that want me to succeed.

“Some struggles that I have faced with diabetes was DKA (diabetic ketoacidosis), unfortunately I went into DKA twice in my life. Once was being young and dumb and not caring fully about my diabetes and the other reason was the insulin resistance not getting into my body. It was horrible and I never want that to happen to me ever again. Other than that I have never had any problems with passing out/ diabetic comas thankfully! I think hearing all these horror stories really shaped me into the person I am now because I don’t want to lose my legs my toes or anything else for that matter. I want to live a healthy, long life.

“I made @t1dchick (instagram) to connect with other diabetics and overnight it felt like I had a crazy following! People are so intrigued with my fitness and daily life with my diabetes! Exercise is a huge part of my life now. I won’t sit here and say I’m in perfect shape or have perfect numbers, because that’s just not true. It’s a constant struggle everyday to eat well, control glucose levels among everything else! I can go from 120 to 340 (mg-dl) like anyone! It’s about control. I like to set realistic goals for myself with my blood sugars. It all starts with baby steps, miracles don’t happen overnight; just like how my muscles won’t grow after lifting once in the gym, just how eating one salad won’t make me thin. Get it? There’s nothing wrong with little goals to end up with achieving your ultimate targets. You have to start somewhere. If you need help or support, ask! People are there for you, I’m here for you, just ask! Building confidence is key. You will be happier, live longer, and maintain a healthy life with type 1. Don’t hide anymore, have a voice, be heard, be seen because life is beautiful, you are beautiful. Let’s stand strong and fight diabetes together!”

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Euro Tour preview

This week I will embark upon quite a packed schedule with many travels and not so much rest. I look forward to every moment of it!

The goal of this upcoming DiAthlete European Tour is to directly reach a number of type 1 diabetes communities and operate events to help strengthen the unity in local areas. Whilst supplying direct advice and education on keeping more stable blood glucose control during exercise to these communities, hopefully this will be combined with a bit of motivation too – there are a number of runs lined up!

On top of all of this, in heading out to a lot of Eastern parts of Europe, I personally want to learn more about type 1 diabetes care in these locations and to use the DiAthlete network to share stories from the people I meet on this journey.

Here’s a look at the busy schedule to come:

  • 13th April: arrive in Budapest, Hungary, and play an 11-a-side football match in the evening for an all type 1 diabetes team with my friend and fellow Young Leader in Diabetes, Dr Daniel Vegh.
  • 14th April: travel for 9 hours to Belgrade, Serbia, to catch Alumni Young Leaders in Diabetes, Tijana Milanovic and Aleksandar Opacic, along with fellow mHealth Grand Tour 2015 cyclist, Uros Bogdanovic, and a host of diabetes community members from Belgrade for a group river run. It looks like we could have as many as 40 people joining us!
  • 15th April: travel from Belgrade to Sofia, Bulgaria, by coach – it could take some time!
  • 16th April: Sofia’s 5km run Bulgaria event – where I will be racing in the 5km in the morning, before speaking to the local diabetes community with my friend and fellow Young Leader from Bulgaria, Rossitza Handjiyska, at a Bulgarian Diabetes Association event.
  • 17th April: flight to Bologna, Italy, where I will catch up with another Alumni Young Leader in Diabetes, Luca Cappellini, who was my roommate in Melbourne at the 2013 IDF World Diabetes Congress.
  • 18th April: a train from Bologna to Venice, lunch, followed by a bus from Venice to Ljubljana, Slovenia. I have a few friends I used to work with in Ljubljana and may check in at their local diabetes centre – who I met with in 2014.
  • 19th April: a bus from Ljubljana to Zagreb, Croatia, for the final event of the Europe Tour, a community run and a type 1 dinner to follow. Joining me to run will be Vedran Krcadinac, who shared info on the event here – and I will catch up with Young Leaders in Diabetes David Klapan, Maja Vukovic, Danijela Susilovic, Ivana Cukrena and Team Novo Nordisk’s Nenad Simnuko – who was my roommate during the mHealth Grand Tour from Brussels to Geneva last year. (I should add that both Luca and Nenad are very brave men to have experienced being my roommate, I do tend to destroy most hotels so they deserve an award…)

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Belgrade Community Running Route for 14th April.

To have so many friends from so many different locations is incredible – and this has all came about in my life because I live with type 1 diabetes and have adopted a positive attitude towards living with it. Extremely excited to be catching up with everybody!

I’ve been overwhelmed by the support and interest from the communities to have me over in these locations and full credit to the names mentioned above, to get the word out there and make things happen. To be honest with dates such as World Diabetes Day and recently World Health Day, a lot of effort is made for awareness, but personally I feel the most valued thing that we can do as advocates ahead of tweets, hashtags and selfies, is to actually get out there on the ground, meet people, speak, socialise and make things happen. All this money that gets spent on aspects such as board meetings and professional conferences, the first class flights and fancy hotels, I want to put that to shame – what comes of most of those meetings? Sometimes they seem to be too far concentrated on personal status they forget the true meaning. Here, I feel that by going out there and taking the time and making the effort to reach communities, a lot more will come of it.

Travel is an area that understandably has question marks for many people and families living with diabetes. I have to take my diabetes essentials with me and be fully responsible for my healthcare. We are responsible for our health every day with diabetes and in this case, when travelling so much, I will have to be that extra bit more so careful and responsible to remember everything and to keep a close check on my levels. With such a schedule, it is going to be tiring, one place after another, and this could affect my blood glucose control throughout the week; so I will keep plenty of gels and supplies on hand!

In terms of the running I would love to be able to say I am going to go there and win the main 5km race in Bulgaria. However this will probably not be the case. For one I much prefer long distance – I am an ultra runner! 5km racing is much different for me, it is a different style -almost full on throughout for 3 miles. As a marathoner I like to reserve my energy and keep the tank full until the end, and then unleash whatever I have left. It is almost a completely different sport with these little whippets! My goal is to do my best for the great support that I have in Sofia and to try and beat the 20 minute mark. I beat it when in Vancouver in my last 5km back in early December, I ran a 19 min 53 race and could have done better as I stopped to tie my laces! That meant a 14th place finish out of something like 500 people, so it was positive! But at the same time I have not trained for 5km and have been coming back after shin-splints to start the year, so lets see how it goes!

Whenever I run, whether it is 5km or 500 miles, my first and foremost aim is to reach the finish line – and to do it with the best control of my blood glucose I can possibly achieve.

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Also back on British soil there are a few events coming soon:

And if you are interested in buying a DiAthlete performance top, we have new stock in with both children and adult sizes, they come in blue and pink and the funds from the tops support the events we are working on supplying directly for international type 1 communities! Thank you 🙂

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Tax for Tat

The DiAthlete’s view on the Chancellor’s Sugar Tax

Chancellor George Osborne has announced in his 2016 budget that there is to be a new UK levy on soft drinks – a sugar-tax imposed in a bid to tackle childhood obesity and the prevalence of diseases such as type 2 diabetes. The big question from here is:

Will it actually work?

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Coming from the perspective of someone living with type 1 diabetes, a form of diabetes which isn’t too often highlighted in the media with no relation to poor health or lifestyle choices – type 1 occurs when the body’s own immune system attacks and kills insulin producing beta cells – there is a view against this new sugar-tax given the fact people with type 1 often rely on sugary drinks to help pick their blood glucose levels up when hypoglycemic. A bad diabetic ‘hypo’ can lead to a diabetic coma at the worst stage. Therefore families dealing with type 1 diabetes could well look at this move and question whether they will be paying additional taxes to treat low blood sugars in future.

Whilst a sugared drink is a strong choice for many living with type 1 diabetes to quickly pick their levels up safely, there are a number of alternative options. Energy gels can be supplied for medical exemption certificate holders on the NHS, whilst it was mentioned that pure juice drinks, such as orange juice, wouldn’t be taxed and can do the job with the carbohydrates and natural sugars they possess.

The prevalence of type 2 diabetes is a global pandemic – at the 2015 World Diabetes Congress in Vancouver the International Diabetes Federation revealed there’re currently over 415 million adults living with diabetes in the world, up from 387 million in 2013 and estimated to rise over 600 million within 20 years. The most alarming fact is that 90% of this figure is linked to type 2 diabetes.

On his 2016 budget speech the Chancellor told MPs “you cannot have a long-term plan for this country unless you have a long-term plan for our children’s health care.”

Indeed this is a statement you cannot disagree with; however, it all comes down to whether that plan is the right one or not. TV chef Jamie Oliver certainly believes so. He has been an active sugar-tax campaigner for a number of years and had already introduced the tax into his own restaurant chains. On Instagram Jamie celebrated the news as a ‘profound move that will ripple around the world.’

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I caught up with a few connections in Copenhagen, Denmark recently, who spoke about the Danish ‘fat-tax’ which took place between 2011 and 2012 before being abolished. In a similar bid to support the country’s health care, the Danes introduced a tax on any food with over 2.3% saturated fats; however, what occurred was a rise in the cost of living and a negative effect on local businesses. The Danish people would hop over the borders to Germany or Sweden and buy their food products from there instead. Whilst prices of deemed unhealthier foods went upwards, the costs of healthy foods stayed up. The Danish fat-tax seemingly failed to decrease levels of obesity, although it was only active for one year.

Despite this not working in Denmark, there is a difference in the fact that the tax which Osborne has put forward is not on fatty foods, it’s on soda drinks. This method has been quoted successful in the world, where it began in Mexico in 2014. Mexico was a country with one of the highest levels of obesity and they introduced a 10 per cent tax on sugar-sweetened drinks, cutting soda drink sales by a major 12 per cent. Whilst the sales-cuts in these sugary drinks seem positive, there is narrow evidence for the time being on whether this has reduced the growth of obesity in Mexico – only time will tell!

A difference between Mexico and the UK is our economies. There is a lot more poverty in Mexico and therefore one would imagine a sugar-tax would be more effective over there, where people generally have less money.

One of the key features in the London skyline is of course the London Eye – or should I say Coca Cola London Eye? Perhaps it is a small contradiction that when the Chancellor was writing his 2016 budget in Westminster, facing him across the river was a giant wheel, which lights up red at night to promote a heavily-sugared soda brand.

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The Chancellor further announced that funds from the UK levy on the soft drinks industry would be invested into school sports, expected to raise £520 million in its first year. If this is the case it’s a real positive. If we want to look after our children’s health and long term future, get them active! It could be argued this would actually be more of a benefit in decreasing obesity in young people than taxing sugary drinks! We need to encourage our youth into sports, let’s face it when you look at sports such as football where we haven’t won a trophy since 1966, a lot needs to be done! I spoke at a school recently and when I questioned the class about their favourite sports many referred to their X-Box games…

On a personal view my feeling is that whilst a sugar-tax on soda drinks is a solution and a brave move by Mr Osborne to impose, the real way to tackle the issue of growing diseases related to poor health, such as type 2 diabetes through obesity, is in education. Taxes are one thing but the advertising of poor health brands will still exist. The only way people can learn about what the best lifestyle choices are for them is to be taught, from young ages, about the long term effects poor dieting and lack of exercise can have. Ultimately time will tell on theimpact of this sugar-tax – these taxes won’t come into play for another 2 years – but simply education is the key factor to make a difference.

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The Dia-Legends Club

You know when you see these people from all over the diabetes world on the social network and you think that person is cool, I love them, lets follow them – not in the stalker way it sounds, I promise, but in the totally non-stalkery Brave New World style of Facebook / Twitter etc – isn’t it strange when you unexpectedly bump into those legends in real life?!

During Vancouver (a shocking 5 months ago, where is time going?!) at the World Diabetes Congress, I was running in the [email protected] Race around the Vancouver downtown seawall, hosted by Novo Nordisk. Running is my thing, so all of the Young Leaders I was with were backing me to go and win the race with ease – unfortunately I tend to run long distances like 900 miles, so 5kms are my worst nightmare! I run smart – I save my energy and then burst out with everything I’ve got left in the tank in the final stages; usually after several hours of running! 5k racing to me means sprinting off like a whippet and killing yourself! I was happy with how I coped though, I kept a pace which was fast and was with the front pack more or less, apart from this professional guy from Team Novo who just shot off from the start. And considering I had spent the past 2 weeks inside conference halls and hotel rooms (maybe with a fair bit of alcohol on the evening wind-downs too) – I could hack it pretty well. I wanted to beat 20 minutes and I did that, just, 19 mins 53 – and I’ve ran quicker than that before, plus had to stop and tie my laces, so there’s some potential in the 5km with a bit of training!

At this point I will announce that in April I will be taking on another 5k race, Saturday 16th in Sofia, Bulgaria. To be fair, I have been taking it far too easy since Vancouver and resting the body a bit – as I had many challenges repeatedly to end 2015: cycling 1000 miles over the Alps, enduring the Bear Grylls survivor challenge, running a half marathon in the Ghanaian humidity, the travels to Vancouver and California, it was a lot. It was amazing – diabetes in my life made those incredible experiences happen and did not hold me back in the slightest – but also tiring. The thing about resting up is it always becomes harder to get back into the swing of things, seemingly the older you get. So I am not in ultimate DiAthlete machine-mode right now, but have recently been putting myself back out there and training – and with an A1C now at 6.8% down from 7.4, I am content and also just said it, I am The DiAthlete, anything is possible with this guy, right? He is not all human! It is just a matter of keeping at it, getting out there, being committed and getting back into that character!

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At the end of this mentioned 5k race in Vancouver though I bumped into none other than Kyle Jacques Rose. Who else? When I am at events in London or the UK, chances are at some point I will be at an event with Kyle; when I am climbing up the Alps in France, the chances are Kyle happens to live on those Alps; when I am in Brussels being seen off before a cycling tour I am dreading (as I am a runner and not a cyclist), the chances are that Kyle is the official guy seeing us off; when I am in San Diego to speak at Dexcom’s HQ, chances are Kyle is there at a meeting with them too; when I am in San Francisco, chances are Kyle is property viewing in San Francisco; when I am on tour in Australia, chances are Kyle is also at a conference down under too. Kyle of course is a legend, as well as my stalker. It is more a case of me being like 007 and Kyle being like Felix, his secret service ally from the CIA… He was one of the co-founders of Team Type 1, a professional cyclist and is very active all around the globe for the cause – particularly with the app MySugr.

KyleGav

Kyle Rose introduces me to his giant and cool friend called Bastian, from Germany, who like Kyle and I also lives with type 1 diabetes. Bastian happens to be the founder of the deDOC – which was the original diabetes online community account, started for German diabetes networks. So after a good chat following this race, dressed in running wear, Kyle invites us to this party.

I text Paul Madden, who is like every Young Leader’s uncle and also lives with diabetes, (he was one of the first people to receive insulin from Banting he has been around that long!) so it is important to let Paul know if you are going out and are likely to come home late. The Young Leaders were at an organised dinner but after engaging in great conversation with Kyle and Bastian, by the time I would have made it there all the Young Leaders (the coolest group of people living with diabetes from all over the world by the way) would have eaten all the food! It seemed best to stick with Kyle and Bastian…

So we completely crash this gathering, which is inside a very nice room of a very nice hotel in Vancouver, after a 15 minute walk or so. Luckily some good food was on offer too! And whilst at first I do not recognise any faces, as everybody is spread out from the balcony area to the kitchen – it was surprising how big the suite stretched too! Eventually people just start popping out of nowhere and it is that very moment which I mentioned at the beginning of this post. T1 legend and writer, Riva Greenberg, is hanging out with a glass of champagne in hand! I walk by to go to the bathroom and out of nowhere I end up having a hug with Dr Manny Hernandez from California! I go to take a seat and I’m sat next to this Swedish guy, also founder of MySugr, Fredrik Debong! And when going to view the balcony area I bump into Zoe Heineman from New York, who founded Hypoglycemia Awareness, and we’re having a chat about running marathons. It was a surreal experience because initially I just wanted to finish my race and get some grub, next thing I’ve gatecrashed The Dia-Legends club. And I was still wearing my shorts, despite the very cold Canadian winter air!

I’ve been very fortunate to meet many people from all areas of the world on this journey that life more or less threw me into. It has been an honour and the one thing above all else I can take from it is that whilst living with a 24 hour disease, where you have to be constantly responsible for your health, there’s a big plus side, a reward that can come with it too – against all the negatives you can list, the positive that I wouldn’t change in the world comes from all the people you automatically become connected with, through this cause. The diabetes communities are outstanding, we all share something in common, whatever our race, culture or background, and unite because of it. My advice to those who shut themselves off or who have been recently diagnosed, remember you host a membership in the DiA-Legends Club too!

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Adrenaline vs Humidity

Our duty in living with type 1 diabetes is to do the best we can to manage our own blood glucose levels; not such an easy challenge when our bodies fail to produce a key hormone called insulin.

Everybody has a different body but if you live with diabetes the condition does not control itself; you are the one who is ultimately responsible for your own control. As a little boy, when being diagnosed, my biggest fear at the time was if it would stop me playing sports – I was football mad growing up! The response from medical professionals in my hospital at the time wasn’t entirely convincing – all a kid wants to hear is “YES YOU CAN.” A big reason I do what I do today, with the runs and endurance challenges, is so I can say to others who perhaps are like I once was, YES YOU CAN – you can achieve anything in this life.

As an ultra-marathoner, a guy who has accomplished a number of whacky challenges all around the world, I know that you can achieve anything – I know diabetes brings up it’s own challenges and there is a lot to take on and learn, and that it doesn’t always go to plan, but ultimately you can achieve anything whilst living with diabetes. Before my years of running crazy distances like a type 1 Forrest Gump began, I was a keen footballer – and in this post I wish to share two affects on blood sugars which I’ve often experienced over the years: what can happen to blood glucose levels in both adrenaline and humidity.

In playing football I often found that on a match-day my blood sugars would spike. When starting out as a player the advice I received from the Doctors were to take less insulin, to avoid the risk of hypo. It is fair to say that this risk was absolutely avoided, I would come off the pitch with blood sugars way up in their 20s (mmol/ls)! When you consider that the other players on the pitch, living without diabetes, had their blood sugars probably somewhere between 5-7mmol/ls – in terms of concentration and performance, you’re at a great disadvantage. Now first and foremost that did not stop Gary Mabbutt in the 80s and 90s from a professional career for Tottenham and England – so once again, anything is possible – but of course we would prefer to be at our best and more so, we would prefer to be healthy.

The reason for the spikes were due to the movements on the pitch, sprinting for a ball and then jogging, walking, sprinting – sudden bursts and changes of pace continuously for 90 minutes. This causes the body to react and the liver can release glucose into the bloodstream, therefore spiking the levels. This is also made worse by the adrenaline reaction, causing the same effect. In training sometimes I would find I could go lower in blood sugars but on a match-day it was the opposite.

When I played at a semi-professional standard I found this was even worse – that adrenaline on a match-day was really strong, it was my dream as a boy, I would psyche myself right up and my blood would be pumping. This tended to mean higher blood sugars. So the teenage me during my years before being the DiAthlete had to figure things out for myself – what was clear was that the only way to achieve this was by testing my blood sugar levels more regularly, even at half time.

I began to up my basal insulin, on Levemir injections. I would take a unit more than normal in the mornings. I even went up to 2 units. What I found was that it helped control my blood sugars during the game, at half time I was okay and at full time I would be at around 11 mmol/ls at the worst; however, my blood sugars would crash towards a hypo much more rapidly after a game. The crash would normally happen, but usually much later on, often in the evenings. With more basal insulin my blood sugars would crash much harder, within an hour. I personally felt that it still worked as I could keep better control during the game – so I combatted the post-game hypo by stuffing my face with sandwiches after the game and had a large dinner, usually a Sunday Roast, with a unit or two less bolus insulin in the evening.

On my travels I have found that in the warmer conditions, where there is a lot of humidity, my blood sugars tend to drop much faster when walking around. Even more so when running around! The challenges I’ve taken on in various places, running in Australia, the U.S and Ghana for examples, I’ve needed much less basal (background) insulin in my system!

Last October in Ghana whilst over there I joined the locals in Tema, just outside of Accra, in a game of football. It has been some time since I played a proper game of football to be fair and I threw myself in the deep-end by playing centre midfield. It has to be said, those guys can play! I was so impressed by the standard of football on the bumpy, dry pitch – it wasn’t easy for me to settle into but everything about the game was pass, pass, pass… such a high tempo.

It was very humid, as the sun-light faded. As the darkness grew though, the temperature did greatly decrease. I came off the pitch and my blood sugars were at 5mmol/ls  – I hadn’t upped my basal insulin either. Charging about in the warmer conditions, in a climate I wasn’t familiar with,  perhaps meant my blood sugars didn’t spike.

As a teenager, when I was a good standard as a footballer, I was in Goa, India. I went on a wander by myself one afternoon; whilst all the tourists would be based by the hotel and main strip to the beach, I decided to head in-land to the nearby village. It was a quiet area, not a big place in Goa for travellers – and the reactions from the locals resembled that. Many had never seen a white European before.

After being invited into a house, which the man, who didn’t speak any English but pointed enthusiastically at things to show me, had welcomed me into as I walked by, I found a field. Very dry or dead grass on the field, hard ground and very unbalanced. On the field were two football goals, carved out of wooden logs. Further down the field were a few children playing between some cricket stumps in barefoot. I decided to join them, I had a ball with me and kicked the ball over – they were shocked.

I started playing the game with them and then, one by one, adult local men started coming out onto the field, with trainers or football boots in hand. A man named Godfrey, who spoke English, was my main contact – he explained that the two local villages were having a game of football and did this every month apart from in the Rainy season.

“We have not beaten them in 4 years, but today we will – we have you!”

I may have told them that I played for Crystal Palace… (but it is possible they wouldn’t have known who they were anyway…)

It was an incredible game – a range of locals from both towns playing the beautiful game, all age groups. Up front for our village team we had a man they called ‘Chief’, he was the oldest player on the pitch at 70. We won the game 4-0 and I scored all 4 goals – this may have given me folk-legend status in Managoa. Everywhere I went after that I heard my name. In the hotel every person from the barman to the cleaner would call me “GAVINNNNNN”; walking down the road the Taxi driver’s would toot by shouting “GAVINNNN” out the window; ordering a meal in the restaurant, the waiter would offer “GAVINNNN” a discount – I always tipped as the cost of a good meal out there would translate into no more than about £3..

They arranged a second game whilst I was there and it was crazy – the whole village turned out to watch it from the hill by the pieced-together-pitch! I got cheered when I got the ball. We won 5-3 in a much tighter game – the other village had some younger players who were also a good standard. For the last goal I ran through and squared it across to Godfrey, who absolutely hammered it through the goal from 3 yards out (and there was no net) and then ran around as though India had just won the World Cup – the shirt came off any everything!

I recall my blood sugars were a higher level in the good zone at the end, 8 or 9 mmol/ls – I was happy with that. It is possible that the combination of adrenaline and humidity was keeping a good balance of my levels; the movements of my body would have created that adrenaline effect for my liver to release glucose and spike levels, yet, with it being warm and humid, I was working up a great sweat and decreasing blood glucose during the game too. The meals were very high carbohydrate, so I would have also had much more glucose stored in my liver from the higher carbohydrate meals – potentially spiking the levels even more – but ultimately I worked so hard the levels kept well. I did drop towards a hypo shortly after the game, working hard in the warmer climates would mean that the crash in levels would be much stronger through burning more energy. Out there though I was in my element for a recovery – I love a curry!

india

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Sugar Tax and Trailer Snacks

Having attended the IDF World Diabetes Congress 2015 in Vancouver last month, I heard firsthand from the International Diabetes Federation regarding the recently revealed statistics of the 2015 IDF Atlas – which, to be mild, suggest very bleak times concerning the prevention of diabetes prevalence around the world. The stats revealed that in the world to date there are approximately 415 million adults living with diabetes (as a whole) – a figure up from approx 380 million just 2 years ago. Writing this as someone living with type 1 diabetes, an estimated 90% of this figure is concerning type 2 diabetes prevalence.

The question is, what can be done? The estimations are that most definitely within 20 years there will be 600 million people living with diabetes, probably meaning that 95% will live with type 2 diabetes and this is largely down to the growth of poor health and lifestyles, which can be prevented. And that figure of 600 million is most likely to be met within half the estimated time period, with the current rate of worldwide prevalence.

Personally my work is very much related towards type 1 diabetes, I want the best for people living with type 1 diabetes and their families; I want every child, in particular, living with this condition to feel good about themselves, to understand their condition and go on to live full, healthy and successful lives as a result. I’m ‘The DiAthlete‘ – some form of type 1 outlaw that takes on crazy challenges and speaks his mind, but one thing I know is that by taking action you tend to get more done. And regarding this situation, action needs to be taken for the cause of diabetes as a whole, for all types, and furthermore for the world as a whole.

One talked about method in recent times has been the Sugar Tax resolution. Can putting a tax on added sugar substances help encourage healthier lifestyles for people?

In Mexico, negatively known as one of the most obese countries in the world with the highest death-rate from chronic diseases, largely related to consumption of sugary drinks, they opted to take on the soda giants by introducing a ‘soda tax’ on the levels of added sugars to drinks. After just one year there has been a dramatic drop in soda drink sales across the country and many Mexicans have been encouraged to also go back to their roots – with traditional Meso-american diets involving grains, fruits and vegetables.

Berkeley in California, where I recently visited in 2015, has also passed a sugar tax – and the area is very much a university campus base and appeals to young adults. Denmark introduced a fat-tax on all food products which contained more than 2.3% of saturated fat. And a voice in the UK, TV chef Jamie Oliver, has been right behind this development introducing it into his restaurants.

Does this mean though that the people in say Berkeley won’t go to the next Californian city, such as San Francisco 20 minutes on the Bart line, to grab a load of sodas for a cheaper price, or the people on the Danish borders won’t pop down to Germany to grab their pizzas? Education is surely the key area here.

There is another argument against the Sugar-Tax idea coming from within the diabetes world. From the perspective of a type 1, as we all know hypoglycaemia means low blood glucose levels; a threat more common to the lives of those with type 1 diabetes on a daily basis, meaning they require fast acting sugar to stabilise blood glucose levels. An effective way to do this is by having on-hand a sugary drink, with fast acting carbohydrates. A tax on added sugars could perhaps mean an additional cost to those who really do not deserve it, to those who need affordable and available supplies for the sake of their short term health – an untreated hypo can lead to a very dangerous situation, such as a diabetic coma. As a child, when less experienced in the condition, Lucozade came to my rescue many times – and as the Diathlete when facing the big endurance challenges, I’ve often relied on the energy drinks to keep a stable balance of blood sugars.

So this debate could come down to the bigger picture – and that would be type 2 diabetes prevalence due to the fact 90% of those living with diabetes have type 2 and it is only going to grow. The more type 2 diabetes develops it perhaps also means, for those living with type 1 diabetes, a greater misconception of the condition grows with it. The sugar-tax could be a positive in that sense for both types – there are always two sides to look at things from.

In regards to living in the UK, yes, with diabetes we are very fortunate to have the NHS, a system which may have its faults, every system does, yet it is very effective in keeping us alive! It is a form of free healthcare in the sense of getting all the essentials you need to survive – insulin and blood testing strips above all else.

The UK itself, however, does have a greatly increasing cost of living, especially in London town! It is all well and good if you are one of the multi-millionaires in the capital, but if you are an Oliver Twist character like myself, then you might look at things such as the increase of travel expenses every January and think twice about the thought of paying any remote kind of extra taxes! Wages are certainly not going up as the prices of housing, clothing or even socialising are.

Yet on that cost of living subject, to go to the supermarket to buy the week’s food supplies, what is cheaper – a variety of fruits and tasty, imported vegetables, or microwave burgers? Or even in the fast-food world, which might be sometimes more convenient for workers, what is more affordable, Pret-e-Manger or McDonalds?

As I previously touched upon, I do feel education is a key factor that can long-term make a big difference – and this begins in the schools. If you can educate children into the importance of healthy eating and more so, provide better encouragement into active lifestyles with exercise, they will grow-up knowing this way of life. As they would grow up knowing to read, write and speak. They can then pass it on to the next generation and the next one…

Sport holds a massive power in encouraging the next generation, children look up to their idols. I feel the right motivation greatly lacks, not just in England where the Premier League has a £Billion-Pound£ valued game of football ‘stars’ on the field (!!!) which results in a boring 0-0 spectacule between Manchester United and Manchester City, but across the world. The main issue is the fact that a large part of the money, which spins it all, comes from what is effectively the enemy – the major companies whose business is branding out poor health. I went to an Ice Hockey game in Vancouver and it was absolutely impossible to follow the game because every 5 minutes they stopped for an advert! The banners and endorsements around the stadium were all advertising unhealthy substances. Every sport does the same, you’ll see the familiar brands of Coca Cola, Burger King etc etc everything ranging from fried chicken to greasy pizzas; you cannot go to watch a professional sports fixture without seeing it. Even the innocent Hot-Dog Van in the car-park isn’t helping, is it!

If you take a child to watch a game of sport, the professionals on the field better be outstanding to inspire that kid, otherwise all that will be achieved is an endorsement of poor health into their brains.

In fact I’ve spoken at a few schools and when I’ve asked what sports the children enjoy playing, I’ve regularly had answers referring to their Xbox consoles!

Is a sugar tax introduction a good or bad idea? I’m personally not entirely against it as it is a form of action being taken and has had results in some areas of the world too; however, there are pros and cons to be considered and what I feel is the best option, first and foremost, is to provide more education and encouragement on to the next generation, particularly with health information and practical exercise in schools. The school in Stirling which makes it’s students run a daily mile I believe is absolutely on to the right path!

And the ridiculous price-tags in sports such as football, as the January Transfer window takes place right now, as far as I am concerned all comes from the Devil’s money. Just look at the ridiculous prices of footballers – how can any of them be worth more than £50+ million?? You could get a good house for £200k and that surely would do more than the likes of Wayne Rooney! Professional sports seriously needs to consider their morals and what they are supposed to stand for – and the same can be said for the governments of this world. Actions need to be taken if the long term prevalence of type 2 diabetes and the misconceptions of type 1 diabetes are to be stopped. A sugar tax is a potential answer but it has to work hand in hand with education if it is to work.

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#TeamDiAthlete Interview with Ben Coker

Gillingham 1-1 Southend United, Ben Coker post match about his diabetes and playing the beautiful game:

Ben Coker was diagnosed with type 1 diabetes at the age of 15, where the symptoms came on following being knocked unconscious during a football match. His first question to the Doctors upon his diagnosis: “Can I still play football?!” I once asked the exact same thing! Today Ben examples the answer to that for all young aspiring athletes diagnosed with diabetes, he plays professional football for Southend United FC in League One of English Football.

On Saturday Southend United, who have made a good start to life in League One following a successful promotion campaign last season, travelled to table-topping Gillingham at Priestfield Stadium and were very unlucky not to come away with all 3 points in a battling 1-1 draw. I went along to the game after speaking to Ben in the week and caught up with him after the match for a #TeamDiAthlete interview on how he goes about controlling blood glucose levels as a professional football player.

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Me, Gavin (GG) / Ben Coker (BC):

GG: “Unlucky today Ben but not a bad point against the league-leaders! How did your blood sugars fare throughout today’s match?”

BC: “Yeah it was a close game! My levels were 6.2 (mmol/ls) before the game, at half time they were 9.0 and after the game 11.3 – so around those numbers was good for such an intense game!”  

GG: “You’re on an insulin pump now, how much of a difference do you feel its been going on a pump from injections of insulin as a footballer?”

BC: “I feel the pump has really benefitted me with my football! I feel my levels are more stable and I feel I am playing my best football at the minute, I’m feeling good!”

GG: “A lot of people have asked about this one, what exactly do you do with your insulin pump on a match day?!”

BC: “On a match day I have to increase my background (basal) insulin because of the excitement and adrenaline. So I check my blood sugar levels regularly on the lead up to the game. I take my pump off during the game and re apply it at half time and check my levels again!”

GG: “One thing I remember from my old playing days was a difference in levels from training days and match days. Have you found any differences in blood sugars from training and match days?”

BC: “Yeah my training days are easier to manage than match days because of the excitement of a match day. I don’t have to give myself as much insulin for training compared to for a game.”

GG: “Post game, how do you go about your control?”

BC: “My blood sugar levels tend to rise after a game so I increase my background insulin on my pump and I keep a close eye on it!”

GG: “Have you ever had any bad hypos or hyper levels during a game??”

BC: “Touch wood, I haven’t had any hypos during a game but I was really high during one game a couple of years ago and got really bad cramp – but luckily I haven’t had any bad problems when playing.”

GG: “You seem to have it sussed! So what would Ben Coker’s message to young people living with diabetes be?”

BC: “The message I would give young people with diabetes is to listen to the Doctors that look after you as they do know best. Don’t let diabetes hold you back in any way – think positively and look after yourself.”

GG: “A good message for all to hear. Finally, Southend’s manager is of course Phil Brown and I always remember back in his Hull City days he had this glowing tan – despite being in Hull. So does Phil wear fake tan..?”

BC: “One hundred percent the Gaffa does love his fake tan!!!”

 

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FOOTBALL AND TYPE 1 DIABETES BREAKDOWN

A full match of football lasts for 90 minutes (normal time) and that makes it aerobic in terms of exercise for it is on-going, yet, if you consider the movements in the game, it is also anaerobic in terms of sprinting for the ball one moment and jogging about the next. This is why, as displayed with Ben's blood glucose levels, levels increase during a match - that change of movements combined with adrenaline causes organs such as the liver to release naturally stored glucose into the bloodstream. Chris Pennell also touched upon this when I interviewed him about playing Rugby! 

Ben shared that he ups his background insulin before the game on the insulin pump. As someone who injects, I used to do something similar in my playing days, upping my basal rate of insulin. I used to take a unit or two more basal on game days, I'd still normally find that I had gone higher in levels but not ridiculously high - meaning I was able to concentrate. What I would also find is that post game if I had upped my basal I would come crashing down in levels within a few hours. So this was something I counteracted by stuffing my face with the club's Sandwiches before any of the other players! Ben mentioned he tends to go higher still after the match and ups his background insulin then - everybody is different, there are different insulins and of course the pump and injections are different, so the best thing you can do as shown in the interview is to TEST YOUR BLOOD SUGAR LEVELS! 

Another thing we spoke about is training - I would sometimes find that I could go hypo during training but this would hardly ever be the case for a match day. And Ben shared that he takes more insulin on a match day than he has to on training sessions. You don't have the same level of intensity during training and there might also be other physical exercises involved in training as opposed to that constant change of pace for 90 minutes of a match day. 

Ultimately Ben is playing first team professional football and doing well at Southend United - a fine example of how life with diabetes doesn't have to hinder you at any level! Whilst I am a Crystal Palace boy through and through, I always keep an eye out for how the Shrimpers are doing - I'm sure there are many of the diabetes crowd adopting Southend as a second team with Ben as an inspiration!    
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Challenges, Changes and Unity

Gav and Fred

I have very recently returned home to London from Ghana, where I decided to venture to after a WhatsApp catch up with my friend Fred Appiah-Twum (pictured with me in Lethal Weapon style), who was an IDF Young Leader in Diabetes for Ghana when in Melbourne in 2013. It was a case of ‘LETS DO IT!’ a search on Skyscanner for cheapest flights and we went from there… In venturing to West Africa, I knew it was going to be very different in diabetes care compared to what it is like in the United Kingdom and I wanted to find out more about how communities go about handling their diabetes, whilst connecting with groups and passing on encouragement and education from my experiences.

Education is a key area in diabetes management, which with DiAthlete progressing into a social enterprise, we aim to deliver in fun and practical methods – particularly for young people. The vision is to empower a positive generation of DiAthletes in the future instead of the negative feeling of ‘having to be a diabetic.’ To go to West Africa and produce educational programmes for local communities and raise awareness was something with the potential to be very positive.

Shortly before the journey to Ghana I had visited Pembrokeshire in Wales and met the local type 1 diabetes community over there, with a talk and an educational programme. It went down very well and I met some wonderful people – namely young Jarvis who at 13 is perhaps at a difficult age in terms of diabetes management, yet I saw a very strong attitude in the lad – enhanced by his love for football and sport. I believe the world of sport is an area to benefit people with diabetes, a good and active lifestyle is ultimately the best way to 1. learn our bodies and diabetes and 2. improve long term control.

newspaper pembroke

The education programme was fun, everybody seemed to enjoy themselves whilst picking up good advice and tips in improving diabetes control during sports and exercise. I am working on developing these programmes for communities in the future! And having operated them in Miami, London and Belfast, I wanted to bring these experiences to Ghana too!

Pembroke1

I received a few tweets before my travels from @Diabully – which I found the views quite interesting. DiaBully was being critical of me for a twitter view shared of ‘beating diabetes.’  Well I actually shared a view of diabetes in my life, ‘diabetes is not my enemy it is my competitor and you should respect your competitors in order to beat them’ – as each day we have to balance blood glucose levels with decisions on insulin management, diet and exercise, in that sense we compete with diabetes for control. Viewing it as an enemy won’t help you in living life with it. In @DiaBully’s criticism of me a view was shared of working with your diabetes and not ‘beating’ it. I respect that – effectively we are talking about the same thing though. It was a good post made however and I recommend reading it – although I suggest [email protected] less of the ‘Bully’ concept as we are a community, a team in diabetes around the world and that is how we strengthen, by working together. Remarks made with ‘*smirk*’ just comes across as unpleasant – don’t rub people the wrong way as you can do a lot of good with the information you share.

In going to Ghana there was one person I wanted to connect with in advance, who continues great commitment and awareness to support developing areas of the world in type 1 diabetes care – Elizabeth Rowley and her organisation T1International. We caught up with a few calls to see how we could directly share awareness and Liz tipped me with how care was in Ghana from her connections and interviews.

Diabetes Youth Care is an organisation based in Ghana, operated by Dr Nana Ama Barnes, who Liz and T1International have worked with and I happened to have made contact with through my research of diabetes care in Ghana. In connecting with Dr Barnes, we had planned for some events in my visit to Ghana, to meet schools, hospitals and the Diabetes Youth Care group. DYC bring young patients living with diabetes (type 1 and type 2) together to support education and advice whilst socialising. In meeting them, as I will share, I was really impressed by their unity.

Arriving in Ghana it was a completely new experience for me – I had never been to Africa before. In advance I had to get a visa and all vaccines arranged. Whilst I had thought I had got myself a good deal on Skyscanner for the cost of flights, that was swung out the window in regards to £70 for a yellow fever vaccine, £70 for a visa (for arrival in 3 days but it arrived in AMT ((African Man Time))  in 7 days) and all else… fortunately, for me, a good friend of mine’s trip to Kenya was cancelled and he had in date Malaria tablets which he wasn’t going to use, so that saved about £80… despite the many costs I knew we could start something positive on this journey. Not only in Ghana, but in receiving supportive messages from the likes of Adejumo from Nigeria and Yemurai in Zimbabwe, who I know through being a Young Leader, perhaps this was just something small and in one part of Africa, but maybe in future we can grow something. They call for change in many areas of diabetes care around the continent. 

It was great to catch Fred and I stayed with his family when in Accra – who were all wonderful people and his mother, Vida, cooked excellent food and absolutely spoiled me! After a day to explore – where I also met Dr Nana Ama Barnes in person to discuss our plans – a day later was the first mission. The empowerment factor – we had planned a 25km route, so just over half marathon, from Tema to Labadi Beach on the other side of Accra. My objective was to keep control of blood glucose levels through the run – putting what I preach into practise – and along the way we had a few diabetes community members meet us.

In meeting some of the DYC group members on the run, we had to plan for the run timings to be in the afternoon, to meet the guys outside work and school hours. This meant the challenge was somewhat more challenging – running in the full extent of the West African heat at its warmest point of the day. I had to make a decision on my insulin for the run. Now my tactic which works for me in long distance running is to greatly lower my basal insulin injection in the morning – operating on a split dosage, morning and evening with Levemir insulin. The decrease of my basal means I have less insulin working in the background when I am performing aerobic exercise for long spells. Marathon running is on-going, at a constant pace, so blood glucose levels decrease during the exercise by burning energy at a consistent rate.  

In general for being in Africa, where the weather is a lot warmer than Britain and of course very humid, I decided to lower my basal insulin a little more from average any way, as in the heat you sweat more and blood glucose levels will decrease when moving about just walking, if too much basal insulin. Instead of 14 units of morning Levemir insulin, I began by taking 13 to see how it went.

The evening before the run Fred turned around and said he wanted to give it a crack and run as much of it as he could. It was very brave of him considering he had no preparation for it!

With the run taking place in the afternoon, it meant a big call on insulin. To reduce my basal insulin would mean throughout the course of the day, when not exercising, my levels might soar hyper. I decided to reduce but not to the extent I would have done so if I was starting the run in the morning – I injected 6 units of Levemir, so around 55% of my normal split morning rate was reduced. I injected two units more bolus (quick acting) insulin with my breakfast.

This turned out to be a bad move – I found myself  on a mild hypo just before the run! The key to success for the run for my blood glucose control was consuming carbohydrates for the rate of exercise and humid conditions. Fortunately, following the mHealth Grand Tour the month before cycling across Europe, I was stocked up with a load of energy gels that were left over. We were in good store for carbohydrates – important for both myself and of course Fred.

We endured the run  with a support Taxi – the Taxi driver had our glucose supplies in his car and he would pull over and meet us every couple of kms. It was probably the warmest day I experienced whilst being over there – to make matters easier. We have a saying back home, ‘Sod’s Law.’ Fred battled on and we kept a nice and tame pace, I could tell he was struggling but he kept pushing as far as he could with great determination. He achieved a good 10km in harsh conditions! Then Fred was in the support car and turned photographer!  On my own running along the long road out of Accra to the beach I was getting some funny looks – I was the only white guy and I was running in ridiculous heat! This provided an opportunity to raise awareness – and Fred excelled at that part, explaining the details of what diabetes is to onlookers.

Accra BG

I cracked right on… the pace improved and improved, I felt strong in my strides – which surprised me as only the week before I had endured a tough Survivor Challenge which physically demanded every bit of my body – and of course not long before that was the cycling tour of 1500km in 9 days, including the Alps!

The further I went the quicker I went… I do always bide by the rule of finish stronger than you start – but this was ridiculous!

Ghana Run 1

Every 5km or so I would check my blood glucose and take on a gel if needed. At one point I ate a loaf of bread which Fred’s family make at home – I had crashed from 9mmol/ls to 4.1 – bordering the hypo zone. Carbs, carbs, carbs! Although the long, long road which went on for the majority of the route was mentally challenging – I picked energy up from  engaging with the community really, people waving at me, kids running parts behind me, cars tooting… it seemed to be creating a carnival atmosphere. I got to the beach to run the final 5 k a bit early, so Fred and I stopped for lunch and we soon met Issaka and Israel from DYC. Issaka was a bit shy to begin with but then opened right up and asked many questions on type 1 diabetes – before running the final bit beside me! Israel has type 2 diabetes, diagnosed in his 20s despite being a fit and active basketball player. You see type 2 diabetes isn’t all about poor health or obesity, it can develop for multiple reasons and is common in ethnic genetics.

Issaka did a great job in running with me – he has bundles of energy too! And we got the job done at the Afia Afrikan Village.

Ghana Run 3

We held a talk at Legon Secondary School and I was amazed by the level of interest by the students – who did not have diabetes but really wanted to learn about it, find out the symptoms and ways of living with it. Whilst there was a stern interest from the students to hear from me as a ultra marathon runner living with diabetes – what I really enjoyed was how they wanted to also engage with the subject of diabetes. This gave a platform to both Fred and Israel who were with me to thrive in passing on education and awareness. I believe that real change for the positive future of healthcare comes from within the cause itself , particularly in developing regions. In encouraging a platform for advocates from within, who have been there, experienced it and have stories to share, to rise up and make a difference, I think that is where development can excel from. I saw that in Fred and Israel.

Ghana School Talk

Over the weekend we travelled to Cape Coast, Fred and I supplying a DiAthlete Education Programme with Diabetes Youth Care at the Hospital. In knowing I was doing this programme with a large group of young adults and children living with diabetes, initially before going I requested from a diabetes associated pharma company to receive a few testing meters and testing strips for blood glucose management. The reason for my request was because I am aware that in Ghana and most of Africa, whilst there may be supportive organisations around such as Insulin For Life and Life For a Child, within the countries themselves for many to receive crucial supplies such as insulin and blood testing meters / strips, people have to pay good money to get a hold of these supplies. In the UK we have the NHS (National Health Service) a system which may have faults in areas but ultimately is the best service in the world – tax payers across the nation effectively supply a free healthcare system. With type 1 diabetes this means we do not go without essentials such as insulin! Imagine having to buy it every couple of weeks?

I wished to approach a company that have blood testing supplies as to do a diabetes education programme without  patients having to use their own blood testing strips they paid for, producing education where needed in a practical way without cost.

Bayer were the company in this instance and I write this in a productive way for them as suppliers to an area in need of more support. Bayer rejected my request with the reasoning explained on a phone call that in West Africa they test their blood sugar levels in mg/dl, not mmol/ls like their devices in the UK. They were mistaken in this instance, in Ghana and I believe most of West Africa they test their blood sugars in mmol/ls. My suggestion is to better research your market if supplying out there for a small benefit and respect to those living out there with diabetes. I tested each group member with my own blood testing strips and meter – which took up a lot of time for the programme and now means I need an emergency supply of testing strips provided from the NHS , which isn’t entirely fair on them.

On testing blood sugar levels it was clear to see the majority of those living with type 1 diabetes had high blood glucose levels. Issaka managed an impressive 8.9, the two with type 2 had good levels and the ‘type 3s’ family members of course were in good range. A big problem is the insulin in my opinion. Mixtard, which Novo are the main supplier of, is the main insulin available. It is most affordable – with Lantus in second, which from my understanding is because Sanofi lowered the direct costs. I would love to see more of that from the Pharmas. Whilst access to insulin is the most crucial aspect of survival with diabetes, the problem with Mixtard insulin, from my own experiences on mixed insulin as a child, is it absolutely limits your flexibility and range of control. If you are injecting just once or twice a day, with that insulin supposedly lasting for the whole day, then everything has to be taken into account upon that injection and daily routine – from what time you eat to what you eat, what you can do in the day regarding exercise and what happens during the night.

Ghana Blood SUgars

On mixed insulins it becomes a lot harder for control, no question. It becomes even more important to have lower carbohydrate meals and to test your blood sugars more regularly. PROBLEM! In Asia and Africa the diets are more consistent of high carb meals, a lot of rice dishes for example. There is an unpredictability in a mixed insulin and so testing blood sugars is particularly important – and yet people can only really afford to have enough supplies to test blood sugars once per day (at best). To be perfectly honest when I went around the room with the blood testing meter and finger-pricker (with changed needles for each member) a lot of people were quite shy about the concept of being pricked. As though they had not done it much themselves. And they hadn’t – some might only be able to test blood sugars once every few days. The facilities need to improve. Maybe my very brief experience can help open an eye or two?

Having met the Diabetes Youth Care group in Cape Coast what I can say is this – these are fantastic people. All willing to learn, all willing to work together in a community and support each other – type 1 and 2 – to share their experiences. Fred once again thrived in the opportunity to educate too. Dr Nana Ama Barnes is a credit to any healthcare professional, if the healthcare pros in the UK had half the level of her commitment our care would improve greatly too. And she does this with a lack of resources and funding, on her own personal time.

Diathlete GH

Shortly after my trip I shared small view of what I witnessed and where support lacked on my social network and was hounded by a lady in a power position in terms of diabetes care in Ghana. I mentioned at the beginning positive change can come from within – by giving the likes of Fred Appiah-Twum a platform to reach out from and the people living with diabetes likewise. Although I am for national organisations to operate for they can reach large networks across entire countries in diabetes care, they have to be run professionally and with all communities. What was displayed to me by a Mrs Elizabeth was the complete opposite, signs of clear problems from within. One person cannot make all the decisions alone and run things independently on a national scale, I know what is right and what I publicly received, with an alarming photo shared on insulin and blood testing supplies in a warehouse ‘awaiting to be picked up by my host’ when I had met many people short on supplies, summed up what is wrong. 

Elizabeth Denyoh message on FacebookAs Nigerian young leader Adejumo replied: How comes there are lots of supplies of essential commodities if that picture is what am thinking and yet Gavin could meet those who don’t even have access to them?’

Here are some of the public quotations in an attack against me by Mrs Elizabeth of the National Diabetes Association I found very alarming:

Please remove this post immediately as you did not come to Ghana through the proper Chanel’s, and did not do your home work, no child and I repeat no child in Ghana needs blood glucose meters for diabetes.’ (many children I met can test just once a day – at best)

‘It’s sad how people are so selfish and use the name of diabetics to enrich themselves.’ (I am so selfish I paid around £600 of my money to go over and meet diabetes communities, selling my own Dexcom to support funds.)

(An attack on Dr Barnes:) ‘Stop lying to people about our status in Ghana, you know very well there are supplies for children with diabetes in abound acne, but due to your selfish gains have refused to pass through proper channels to operate.’

There was many more insults and remarks made – does this sound like someone who should be in a high position for diabetes care across a nation?

I look at the likes of Adejumo and I see a real leader from within, he has created Nigeria DOC and regularly interacts with people in Nigeria on diabetes care – giving them an opportunity to share their views and be heard. I saw how well Fred thrived in Ghana, spreading awareness and education on the opportunities in this tour. We need to continue the opportunities and hearing the voices of the people from within – Africa is developing and the next generation of diabetes is with it too!

freddo

 

 

 

 

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