Sports and Type 1 evening!

Diathlete (1)

On Tuesday the 28th of April from 6pm until 8pm at Queen Mary’s Hospital, Sidcup (South East of London / North of Kent borders) there will be a DiAthlete evening taking place!

Sharing stories and spreading some motivation, along with some tips for helping better active control in sport, will be Ben Coker – a professional footballer for Southend United FC, who are currently fighting for promotion to League 1! Come and hear Ben’s story and how he goes about controlling diabetes as a pro footballer.

And also I will be there myself, with a different form of endurance as an Ultra Marathon runner and adrenaline junky. So we have a range of experiences to share on the different effects diabetes might have in exercise! Light snacks provided.

If you are travelling, the main lines that go to Sidcup Station from London are London Charing Cross, Cannon Street and Lewisham. And from Kent, Gravesend. It is around a 15-20 minute walk from the train station, keeping along Station Road before turning left to Frognal Avenue.

Bus routes going to the Hospital: 229, 286, B14 and R11

And the address (for those driving there is a car park both at the hospital or else at Sidcup Place just in front of the Hospital) is:

Diabetes Center, 3rd Floor A&E Block (turn right when entering the main doors), Queen Mary’s Hospital, Frognal Avenue, Sidcup, Kent, DA14 6LT

See you there! Any questions tweet me @Diathlete

Ben Coker

Diabetes Desolation

Feeling alone with your type 1 diabetes

Living with diabetes is an emotional rollercoaster, sometimes you are up and sometimes you are down – quite literally when it comes to blood glucose! Through being very involved among type 1 diabetes communities, I certainly know as well as feel that there is a big positive to come from living with it, through the people we can meet and be in contact with all around the world. It has become to me like one large global family. In the U.S last year I saw many local communities that were brilliant, Minneapolis and Miami being some great examples of people with diabetes connecting – and not just associating because of diabetes, that’s just a meet cue, but actually great friends in life through it. And as a Young Leader in Diabetes member, I count well over 100 people from various nationalities worldwide as great friends too.

But what of those who haven’t had that opportunity or haven’t been able to open up that door yet, to connect within those communities we have? Diabetes and depression has often been linked and without support available from experience, hidden dark places can exist. I recall my most difficult times being during school with diabetes, where others didn’t understand what I had, some poked fun at a time when I was most sensitive about it – and the results were not pretty, I had many park or playground punch-ups. At that time I didn’t open the door up to the communities around, I just wanted to keep diabetes as far away as possible – not a good plan when it lives inside of you. Today I’m the boss of it. I’m happy about my diabetes, and by opening that door up I’ve found that many more doors have followed – I’ve been to many locations in the world and hope for many more, to meet all the communities that make the difference where it counts the most.

After starting a new job on the side of DiAthlete I’ve became friends with John Butt, a man aged in his 50s with 20 years experience living with type 1 after an adulthood diagnosis. However, his experience hasn’t been within the community we have, and I imagine that there are many around who haven’t yet, for different reasons, found the way through that accepting door and into the diabetes community.

John has shared his story:

I listened to the Surgeon Vice Admiral as he stated that my medical classification had been revised to P8 PUNS, I knew that P8 meant that I was, at that moment in time, unfit for Naval Service. It was the addendum of PUNS that hurt the most, ‘permanently unfit for naval service’.  My career in the Royal Navy was over. I had served in the Falklands War refuelling helicopters from the hastily constructed flight deck of the MV Baltic Ferry in San Carlos Water (bomb ally) and had served two six month tours in the Adriatic supporting UN troops in Bosnia from HMS Ark Royal. 

I was diagnosed with type 1 diabetes on Friday 13 October 1995, not a date that you are likely to forget, and left the RN on 26 May 1996 at the age of 35.  I had been looking forward to a minimum of another five years in the service of the crown, now I felt it had been cruelly taken away from me.

I had reached the position of Petty Office Air Engineering Artificer (Mechanical), not something to be scoffed at, and had experience of working on the anti submarine Sea King Mk 1, 2 & 5 helicopters, Wessex 5 helicopter in the Search & Rescue roll.  Additionally I spent two years seconded to the RAF servicing Canberra the T17 and T17A aircraft of 360 Squadron at RAF Wyton in Cambridgeshire, finally returning to the Navy and a return to the servicing of the beautiful Sea Harrier FRS1 (sex on four legs).  In the course of my duties I have had the honour to work with some of the finest engineers, pilots and air crewmen; many of who have been honoured by Her Majesty with numerous awards of the Air Force Cross and the George Medal.

This though is where I come to the effect that T1 has had on my life.  It’s not so much the condition it’s self that has affected me but the lack of knowing others with the same illness, a lack of support one might say. The ability to be able to talk and compare experiences I believe it to be fundamental in the way we control our condition, lives and for me it has been a very lonely journey over nearly 20 years.

Ok I can talk to my GP or practice nurse, better still talking to my consultant and DSN at Chelsea & Westminster Hospital. Even better though is talking to someone that lives with the condition themselves, who can empathise with the twists and turns that we, as type 1 diabetics, go through.

I found that not knowing others with type 1 was to a certain extent damaging to my health, not my physical but mental health. I had considered withdrawing my insulin treatment to let time take its course.  I’m glad that I didn’t but I had been in a very dark place.

I returned to work last week having taken six months out, I didn’t want my old job back, I just wanted to go back to guiding here in London on a casual basis, it had been 12 years since I last guided. Out of the corner of my eye I noticed one of the new trainee guides take out a Novorapid pen as he prepared to have lunch; my chance to talk to someone that understood what I have gone through without having to explain any of the terminology or the condition was compelling. I listened to his story, as he did mine.

Although my diabetes was late onset his had been diagnosed before he reached his teenage years, but it really helped me to be able to talk. One of the benefits that I see as being diagnosed as a youngster is your parents travelling on that very same journey as you, the term ‘type 3’ has often been used to describe those that care for us as we take that diabetes trip as children. They live through what you do, the good and the bad, and are a constant support. My parents or siblings however, have never been able to take that journey with me having been diagnosed as an adult.  I usually end up with cheese and biscuits and drool as the rest of the family enjoy apple crumble and chocolate eggs at Easter, my mum usually saying ‘are you allowed this John’.

Why not connect with John on Twitter to those in the ‘DOC’ and share your stories too.

Diabetes Bottoms Up!

Drinking alcohol whilst on injections with type 1 diabetes

When outside of preparations for an extreme challenge, it is no hidden secret that I do quite enjoy a good old jolly up; it is a part of many young adult’s lives – my opinion is that in living with type 1 diabetes we should not have to miss out on winding down and being social. Whilst this is my view, we still of course do have diabetes and therefore DO NEED TO BE RESPONSIBLE!

Being responsible and being drunk is quite the juxtaposition… but with diabetes we cannot afford to completely switch off the ball, at any time.

…So what do I do when out on the jolly?

Champs

I feel that my brain is in such a way that even when pretty bladdered, my responsibilities today are still drilled into my head. That’s life with diabetes. Having recently passed a course and began some part-time work as a London Tour Guide, whilst the DiAthlete empire grows, I was out to celebrate quite recently and got speaking to a man named John, who has type 1 diabetes too. Despite being in a merry state, I was still able to share some useful advice! The key for me, however, is all about knowing what I am doing and being prepared for it – and that’s what counts with diabetes long term overall, down any walk of life.

If I am going out to a nightclub, which perhaps includes a few starting drinks in the local boozer beforehand, before leaving I will prepare for it in my diabetes. I’ve always been prepared to make a few tweaks, take a few risks and find the results in my own diabetes – this is how I expanded my knowledge in sports for control. My preparations are built around the fact I am on Levemir with my basal rate of insulin on MDI and take this on a twice daily split.

On an average day, without crazy marathons or a jolly up, my split dosage of basal consists of 14 units in the morning time and another 14 units injected in the evening – roughly 12 hours apart.

The twist I make for a night out is firstly making a decision on what I intend to drink. This would normally be beers. I enjoy a pint of lager, Guinness my preferred option. The ingredients in many lagers and bitters host barley, hops and yeast – which entails flavourings and ultimately means there’s levels of carbohydrates included to the ingredients. As we know with type 1 diabetes control, carbohydrates do make blood sugar levels rise and that is why we have to inject insulin to counteract it, as we do not produce our own insulin. Yet, the likes of ingredients such as barley particularly can actually spin the effect of carbohydrates and lower blood sugar levels. On average with lager there will be a slightly higher percentage in the balance of carbohydrates, which means blood sugars will gradually rise. This will not be instant, perhaps mirroring the delayed blood sugar rise of a fatty meal, yet with every two pints that would be when a single unit of quick acting insulin may be required (on average and depending on the person of course). For a Guinness, it includes more water and barley then perhaps the average lager does, which means blood sugars won’t increase as strongly as other drinks. The likes of Stella and Fosters, for example, have a slight element more sugar included in the mix, but again with similar ingredients such as the yeast and barley – so it is a delayed increase in blood sugar levels.

My method of controlling blood sugar levels on a night out is to decide pre jolly-up what I am going to drink. So for a night on the lagers, preferably remaining on the same lager, I would decide to increase my basal insulin – so where my evening amount is on average 14 units, to boost it up to 15 or, if going for it, 16 units of levemir. This way I have a stronger amount in the background to counteract the increase of blood sugar levels throughout the night. My advice would be, if you are sticking to the lagers whilst on injections, to start with just one extra unit – if in a nightclub you might go dancing, having too much background insulin whilst participating in exercise can cause a crash in blood sugar levels. And furthermore, if you are on the pull and accomplish your drunken goal… you don’t exactly want too much basal insulin in your system if you return home with a partner. Just saying!

The responsible move is to remain on the same drink.

Another form of lager that is around in some pubs is called ‘Pils Lager’ – and this appears to have the balance of yeast, barley, hops, slight carbohydrates and no sugar – meaning it will not really increase blood sugar levels. It isn’t my preferred choice of taste but is a good plus for people with diabetes – particularly those with type 2 as well actually.

Now I cannot make it more clear here but to say if YOU DO TAMPER WITH INSULIN, make sure you keep on the right track. It is an initial risk, trial and error, and if drunk, you have less control over yourself as well. So knowing your plan for the night is crucial. Stronger lagers, (most) wines, cider, yes, go for a slight basal increase to prevent high blood sugar levels. I’ve done this and it works.

What you DO NOT WANT, is a basal increase when on a night out and drinking spirits, shots, Jack Daniels, Vodka… even some types of Champagne. These drinks will cause the opposite effect, in fact if you are going for a night out and those are the drinks you are setting yourself on, you may find you need slightly less basal insulin. Normally people do not drink these straight. You will have a ‘JD and Coke’ – and although generally a normal Coke is something with diabetes we look to avoid unless seriously hypo, when it is mixed with whiskey, it isn’t going to be as harmful. I wouldn’t advise drinking normal Coke all night though, this can be unpredictable: the whiskey could cause a hypo, the Coke a hyper.

Alcohol can and in many cases will cause hypos to happen if under prepared for them. So on one hand whilst playing it safer and drinking beers might be where the increase of basal works, in any other context, do not increase the basal with alcohol.

Hard liquor such as Vodka has no carbohydrates – absolutely nothing! So there is nothing included in the ingredients to increase blood sugars. In cases, such as what I often share regarding sports, the body can react and release glucose from the liver when it thinks blood glucose levels are crashing – but under the influence of alcohols such as whiskey and various liquors, the hormonal response is impaired and unable to react at all. Spirits are well known for lowering blood sugar levels and therefore I would normally try to avoid them. Normally…

shots 1

An interesting part is that you usually associate people who drink the whiskeys and spirits as being quite grouchy, perhaps trouble starters, when drunk on the spirits – this is without diabetes. The reason being that whilst being completely drunk and not in control of their minds, they are also in a state of hypo as the spirits can increase insulin secretion as well. And in living with diabetes we all know, if we are hypo we tend to be grumpy gits!

Whilst I am normally on the beers, there has been occasions where I’ve been out and felt quite high in blood sugar levels, the feeling of saliva increasing in my mouth an indication I get, and so have made the decision to actually swap tactics. I found myself high on the beers, and so have one or two Vodka and Diet Cokes to lower blood sugar levels. The last time I done this I arrived home, tested my blood sugars, and went to bed calling myself a genius with a level of 9.4!

9.4

The negative effect was of course the hangover the next day though!

Wine shares similarities to beers – some are worse than others. Generally, wine tends to include more sugar and includes fruits, with natural sugars. So a night on the wine is likely to increase blood sugars slightly more effectively than lager. Some wines have a far greater amount of sugars, an example being Port Wine. It has a lot of grapes in there – recently on a night out with family, my Uncle Al opened up a few bottles of Port. It was tasty, I liked the stuff, I’ll give my Portuguese friends credit… my Grandad polished off a bottle to himself! But my blood sugars rocketed and I had to take a correction dosage. Knowing what you’re drinking is the key!

Similar to the sugar-fruit effect is Cider. Cider, although sharing similarities in some ingredients of lagers, is on the whole different and much, much sweeter, so again a greater increase to blood sugar levels and the extra unit(s) to basal insulin if remaining on the ciders is important.

My best advice that I can pass on is to go out, have fun, we all live once – but ultimately try to not get completely trashed as the more trashed we are, the less responsibility we are able to keep up! We are more likely to get drunk faster when living with diabetes as well. It is your diabetes, you make the decisions, you take the control. It can’t stop us from having fun – but know your body, limits and what you are putting into it for the greatest results.

Bottoms up!

I’m now going to finish my jolly up season and aim to get the fitness levels up to standard, there may be some more challenges to come soon enough ;)

DiAthlete

Running Fitness Magazine

Featured in April’s edition of Running Fitness Magazine as their ‘Inspiring Runner’. You can check out the article on pages 20 & 21, aiming to also raise awareness of type 1 diabetes too!

The issue also features the likes of Sir Chris Hoy and Daley Thompson, so The DiAthlete is in a good company of athletes there! The magazine will be out in the coming weeks.

RunFitmag1

DiAthlete Running Notes

“Having type 1 diabetes certainly makes running exciting!”

Diathlete alp running img

I had a training run this afternoon and went at it with a good pace, shorter distance. Good to be back running, although no upcoming races and, as yet, no confirmed major challenges this year (more to come on that) but it’s important to keep positive and ready.

As an athlete you need to work hard to keep on top for both performance and general fitness, whilst looking after your body. As a person with type 1 diabetes, that brings a whole new level to the game! You have to keep on top of everything!

GOOD POINTS in training today: Diabetes! I’m the boss of that:

Started with a blood glucose level of 12.0 mmol/l (216 mg/dl).
Finished with a blood glucose level of 10.5 mmol/l (189 mg/dl)

- Likely to now gradually decrease, blood checks in the next 30 minutes to hour.

Completing the run! (only 3 miles nothing like 900 miles!) but in living with diabetes my opinion is that it doesn’t matter how fast or how far, it is all about finishing what you set out to do and that’s how you stick it to diabetes.

I consumed around 10gs of orange juice and had lowered basal insulin rate by a unit this morning (on split long acting dosage). If I was running further and at a more consistent pace, I would have lowered it much, much more! Shorter distance, 5k, can mean you run faster and can even increase blood glucose if competing (this was training).

Aside from diabetes, I ran with a new technique. Had a bad previous injury 6 years ago and it meant I naturally altered my running pattern to protect weakened ankles. This caused worse effects on joint areas. Thanks to an assessment session with Lisa Jackman, who will be doing a 10 week yoga-fitness development training program on me for running, she highlighted the problem. Legs felt good running today.

BAD POINTS: although there’s not too much on the calendar in the coming weeks just yet, I need to build my fitness levels back. Stamina is there no question, it comes from will power largely, plus I’m a freak. But recovery time has increased after runs, so need to lay off the late night cheese and beers and get the healthy stuff back inside more often! Cholesterol is important with long term diabetes for all types.

Type 1 Diabetes and Sport!

Recently on the DiAthlete Facebook Page I shared information ‘from the horse’s mouth’ on my experiences and knowledge regarding type 1 diabetes and the effects in sports and exercise. Through Aerobic and Anaerobic exercises, there are different occurrences that can take place – and therefore, different methods of control to take on!

Life with diabetes should never be allowed to hold you back from doing what you enjoy in life, performing to the best of your abilities and living life to the fullest. From experience I have built up the education for control in sport that I have today, so I hope this might help you – and to think, I once got awarded a ‘Double E’ grading for GCSE Science… but life with type 1 diabetes taught me what I know!

Run pic 1

Aerobic Exercise

As you might have figured through here by now, I am a long/ultra distance runner. I endure challenges to battle my diabetes with an aim to succeed in order to help inspire you – as it is my sincere belief that this medical condition cannot prevent us from any accomplishment in life, no matter how crazy!

Ultra running, along with the likes of long to middle distance runs, cycling, swimming and even walking, all register under AEROBIC exercises. Motorsports will largely offer a similar effect, as although you are not physically burning glucose, the heat and intensity of it will decrease blood glucose at a similar rate. Other sports such as Tennis, Boxing and Weightlifting, can also offer a similar effect – with a combination of both aerobic and anaerobic.

THE EFFECTS OF AEROBIC EXERCISE:

Aerobic exercise is energy being released with oxygen for cells from glucose – meaning that with the body burning energy at a consistent rate, with say what I do in ultra running, glucose are consistently being burned up too. With diabetes this of course means that our Blood Glucose Levels will therefore decrease.

For me I have been there over the years, on the ground, face down, shaking through the serious effects of almost worst case hypos. I’ve been a runner for 8 years. And through it I have learned. I never had the advice or support from professionals when I first started up, I was just a kid keen to get out there and take the fight to my diabetes. I succeeded in that, yet, had many lessons to learn along the way – which I did. And that has only developed my knowledge. If you haven’t ever had your back up against the ropes, then how will you know how to fight your way off of them? That’s diabetes in my opinion.

I have tested my body out like a test dummy to learn more about my condition. I found in aerobic exercise, swimming to be the more rapid glucose level decreasing exercise, where your entire body is constantly in use – this may alter with different forms of swimming but the front crawl particularly requires a full body effort. Secondly, long distance running burns up energy at a more gradual rate but with a constant decrease. You work your whole body once again, the legs working the most but with the arms pumping and the mind focused. And thirdly, in my research, cycling decreases levels very consistently as well, with the legs working at a higher rate than running but not the full body motions.

Aerobic exercise brings about higher risks to low blood glucose levels DURING exercise. This can also repeat post exercise in the hours to follow, going on the amount of energy burned up. The answer: prevent the hypos!

HOW TO KEEP CONTROL DURING AEROBIC EXERCISE???

Don’t get disheartened if a hypo does take place during exercise and absolutely do not let it prevent you from participating!

Learn from it. Why did this hypo happen? That was what I was asking myself back in 2009 when I attempted to run around the Isle of Wight and found myself on the floor to end the first day of a hilly 70 mile weekend. It cost me big, I fell behind on time on my challenge – a year later though, I came back and completed it.

I figured the need to include more carbohydrates, as I was taking on quick acting glucose through fruit every hour but it often wasn’t enough for the level of endurance I was taking on. I then identified other areas from hourly consumption of carbohydrates (I aimed for 30gs per someone weighing 70kgs), to the most important finding: the level of insulin in my body.

Firstly my intentions was to decrease the quick acting insulin before runs, my Novo Rapid injections before a morning meal and not taking any quick acting for snacks during the exercise. I found this may be better for short distance runs of half an hour to an hour. However, being out there all day running ultras – it was the background rate of Basal insulin which was key. Taking a split dosage of Levemir the first step forward:

Having it split whilst being on MDI meant more flexibility for sports. In aerobic runs, I found my Basal to have a great effect and required much less insulin. I reduced my daily basal insulin by 50% for my ultra running events, where I was on 14 units and 14 units a morning / evening split, I decided to alter to just 2 and 12 units for a ultra day. This will alter with every exercise for every person, but the key is figuring out how much the lower or increase by through testing your blood glucose levels regularly!

I feel for those on an insulin pump, the accurate working out of hourly carbohydrates is more important, as well as lowering the quick insulin rates.

For me, whilst enduring the challenge of running 30 miles a day for 30 days in 2013 across the UK, I then found what worked best for me on MDI was adding a third injection of basal insulin on a split dosage and timing it to perfection: if I injected my evening dose at 10pm, then when running at 9am the next morning some of that evening dose would still be active. Come the afternoons, with only 2 units in my system, despite the exercise the blood glucose levels would increase – as there was no basal insulin in the background. So I added another unit for the afternoons and then had my evening dosage a little earlier.

My main message is, your diabetes is yours; it is your responsibility and you’re the boss of it. It is great to get advice and we have a positive community to help each other. But if you want to try something a little difference, go for it. If you believe that a tweak here and there might work better, try it out, test your blood glucose levels and see the results. You live, you learn, you improve. This week I’ll also post about anaerobic exercise – which surrounded my childhood years!

IMG_2170

Anaerobic Exercise and Type 1 Diabetes

Following on from the last post on aerobic exercise, here shares some experience and advice in facing other forms of endurance. Anaerobic exercise largely consists of exercises surrounding speed and power, with high intensity in shorter durations. Sports such as Football or the majority of activities in Athletics are good examples of anaerobic exercise, which has a reverse effect on diabetes blood glucose levels.

A little thing known as ‘the adrenaline effect’ will cause blood glucose levels to actually rise during exercise, through the sudden bursts or alteration in movement. This causes the liver to react and release more glucose into the bloodstream, therefore increasing the levels. When you consider the 100m sprint, you might have warmed up, psyched up and then be static until suddenly then bursting into full speed. This would possibly be enough to trigger the liver glucose release. In a sport such as Football it is furthermore likely to cause affects, where the game is on going for 90 minutes – you might be walking, jogging and then suddenly bursting into a sprint to chase the ball down. In my football playing years, to my surprise I would quite often come off the pitch with a hyper zoned blood glucose level – instead of what many might think to be the opposite.

Many contact sports have the best of both aerobic and anaerobic. A good example is Rugby: a physical battle on one hand which would aerobically lower blood glucose during play, yet, sudden bursts of energy and quick sprints will fall into play. It can also depend exactly what position you play in – for example in Rugby you have positions for ‘forward packs’ who tend to be the warhorse type of 6ft5 powerhouse figures in a team, that you wouldn’t necessarily want to bump into down a dark alleyway – they are the players engaging more into the opposition with scrums, rucks and mulls. Quite the physical side of the game. Backs play an important defensive role too but are the runners in the team, the players who will receive the ball and burst forward with it. So it is more likely that if an entire Rugby squad had type 1 diabetes, the forward pack would be looking to prevent hypos during the game more than the backs, who might be looking to prevent the hypers!

In football: a striker might be walking about more than any other position, other than a goalkeeper, during a match (should always be on their toes though!). But a long ball might be played forward and suddenly that striker is going to be more required to burst into action and get on the end of the ball with a sprint. Whereas, a central midfielder might be covering a lot more ground, box to box. The differences in game styles could create a difference in blood glucose levels and how the adrenaline effect takes place.

Even in running this can take place, more so in competitive running such as 5km races; when your pace is increasing and there’s that sprint push to finish – same thing! What I found, in perhaps taking a few risks, is the alterations of pace could be a last resort saver. On one occasion I was out a running long distance challenge, which is aerobic, and my blood sugars had gone low. The problem I faced was that 5 miles was still to go. The advisable solution would be to stop – but to me, that’s a feeling of giving up. I was out of supplies and had no money on me, so I decided to change my pace from a consistent rate of running to a mixed pace: jog, sprint, half sprint, walk… just repeated until I made it back home. The result:

1. I made it back home safely – and that’s the important part. It isn’t about taking risks, it’s about finishing what we start and showing that diabetes isn’t stopping us.

2. My finishing blood glucose was 6.5 mmol/l (somewhere around 130 ml/dl – good basically!), it had risen up 3 mmol/ls from when I was hypo during the run with 5 miles remaining!

CRASHING TO A HYPO A FEW HOURS LATER??!!

Energy has still been burned nonetheless! So if the blood glucose levels do find their way up to a ridiculous reading in being hyper during, or just after, exercise, it is very common for the hypo crash to follow it up a few hours later.

This can be a serious problem, suddenly catching you out off guard almost – where you might think about being on the higher side and assume the hypo from exercise isn’t coming. One thing that is important in diabetes is that you always have to be on the ball (no pun intended) and so regular blood tests on exercise days are key. If you’ve put in a hard shift for the team, or pushed the limits down the gym, that crash is likely to occur later in the day, or even during the night.

Repeat hypos can also take place. Although are more common when they happen during exercise. Sports where I mentioned there are a combination of both anaerobic and aerobic exercises, are more likely to be the one’s to cause repeat hypos, which may take place more instantly after the exercise and then come on later again in the evening, and even over the next 48 hours it is definitely advisable to keep close checks on blood glucose levels.

INSULIN AND ANAEROBIC EXERCISE

On Multiple Daily Injections (MDI) as I am, one thing that can frustrate during a competitive sports match is not being able to fully concentrate – which can happen if blood glucose levels are running higher! When playing football, one method I adopted was actually taking, on a split dosage of daily background Levemir insulin for my basal intake, MORE of the basal insulin. I figured simply that when I was coming off the pitch with a blood glucose level in the teen or 20s in mmol/ls, I clearly needed more insulin in the background to counteract that release of glucose from the liver.

Did it work? Yeah. In the game, it did. I used to be a good player and type 1 diabetes didn’t prevent that. I would take an extra unit of background insulin and the results were I’d come off the pitch at a respectable level – meaning I performed with a strong level of concentration. However, there are one or two issues in that:

The HYPO CRASH! If you have more insulin working in the background and have endured a tough session or have been putting the work in on the pitch, on the dance stage, you name it, then that crash is going to come more sooner and more rapidly. So for me, upping the background insulin to maintain better control in anaerobic sports, it meant that the risk of hypo would be more forceful much sooner after the game. A way of counteracting it was the post game sandwiches – eating early, within half an hour, after finishing the games and taking less quick acting insulin with the food.

There isn’t really any MUST DO THIS, MUST NOT DO THAT when it comes to it; glucose naturally being produced internally is difficult to control – whichever way you look at it. For aerobic exercises such as long runs, cycling, swimming, heck even going to a club and dancing all night, you can perhaps prepare better given the fact levels will decrease during, with consistent rates of exercise. When it comes to different exercises and quick bursts in anaerobic forms, this brings up challenges and again, it is your diabetes and your decision to make a few tweaks on – although there is more to think about; by testing blood glucose before, during (where possible) and after exercise as much as possible you can keep on top of things! Learn what levels of insulin are working for both basal and bolus and consider what times are best for meals – particularly after exercise.

Ultimately, diabetes can never stop you in anything if you are determined enough not to let it!

Miami event

Lifelong Medical Exemption Certificate (???)

Opening my Wednesday post up on a bright winter’s day in South East London (between hail storms), I was somewhat taken by surprise to read about a £100.00 penalty charge and additional £40.25 prescription charge coming my way…

Medical Exemption Certificate? What would have been helpful, in a view of common sense really, is if the NHS Healthcare Professionals made an effort to explain exactly what this is and also how long it is ‘valid’ for…

Below is my letter to the NHS Business Services Authority, in response to this penalty charge:

Dear the NHS Business Services Authority,

On the 3rd February 2015 I received a letter through the post regarding NHS prescription charges, complete with a Penalty Charge Notice. This seemingly quite random check reflected that I had committed an apparent felony, when collecting my monthly medical prescription for the month of November 2014. I had made an ‘incorrect’ claim that I did not have to pay for my type 1 diabetes essentials, as I didn’t have a valid medical exemption certificate – case reference: 11140788892. As a young adult who has lived with type 1 diabetes for the previous 15 years and 1 month, which medical records will confirm, there is little one can do when diagnosed with such a condition; therefore, I do not agree with the villainised concept you appear to have tarred me with in regards to this penalty. Hereby I wish to present my appeal against these charges.

Firstly, I would like to introduce myself. My name is Gavin, yet some, particularly young fans who live with type 1 diabetes, do also refer to me as ‘The DiAthlete’. What The DiAthlete does on a regular enough basis is kick diabetes’ backside! What my work entails is reaching diabetes communities and passing on some motivation, some encouragement and a sense of stickability; possibly three things missing in the media conception of diabetes. I endure challenges, and by challenges we are not speaking about 50 sit-ups on a local park bench, we are talking feats as extreme to my name as completing the 30/30 Challenge in 2013 – where I ran from John O’Groats to Land’s End (the length of mainland UK) in 30 days, covering 900 miles and defying diabetes. I also proudly represent the UK in a global program where we are one of 70 nations in the International Diabetes Federation’s Young Leaders in Diabetes. And to add to that, I once had the honour of being a London 2012 Olympic Torch Bearer for my accomplishments from age 17 onwards in supporting the type 1 communities. So, please tell me, does that sound like somebody who would be out to ‘cheat’ the NHS system?

The first clear point in my argument against your charges, which has been presented as a £100.00 penalty charge plus £40.25 prescription charge, is the fact that absolutely no effort from the NHS has been made to inform myself, or indeed many others with type 1 diabetes, of awareness about the medical exemption certificate. Personally my local and assigned GP, Dr Thavapalan, is based at Little Heath Road Doctor’s Surgery, Bexleyheath. I have scheduled an appointment with him, which has the earliest date for Monday 9th February (an indication perhaps of how difficult it is to book an appointment, regardless of whether you know or do not know about medical exemption certificates) to discuss this matter. I believe that part of the responsibility does sit with Dr Thavapalan, as he has never spoken to me of the need for a certificate to prove I have type 1 diabetes in relation to receiving my medical essentials; but is that his job? He has signed the approval for every prescription in knowing of my medical condition through records. My parents, Mr Vincent and Mrs Angela Griffiths, were completely unaware of any kind of certificate, and they dealt with my diabetes needs from childhood at the age of 8 until later teenage years. If the Doctor’s never knew to inform them of such a certificate, how were they to know?

To extend this, then upon my progression from childhood care to adolescent care in my diabetes management, where the responsibilities fall upon myself for my prescriptions and healthcare, if my parents were not in the know regarding the certificate, then how was I to know?!

Aside from the Doctor’s surgery, key other areas in healthcare should be where to look? This being my diabetes clinic at Queen Mary’s Hospital in Sidcup or my Pharmacy, Lloyd’s on Pickford Lane, Bexleyheath, where I collect my essentials in prescriptions. Never, never, have I received any information on this. Following a phone call with a lady called Jill earlier today, who works for you at the NHS Business Services Authority, as lovely as Jill was she explained to me that it is my responsibility to research and validate an exemption certificate. That it may be, yet, if no healthcare professional bothered to make the effort to explain the need for this to me, then how am I to know and feel the need to research this? If my prescriptions of insulin and blood testing strips, that are important to my long and short term survival, have always been provided – why would I research exemption certificates when I was put under the impression that I live with type 1 diabetes, a serious medical condition, and that qualifies for the right to be provided with the required resources for me to ultimately live? Perhaps this penalty charge has been given to the wrong person – maybe you should look at the Pharmacy responsible for not checking with patients that they have the required qualifications to be given prescriptions? (Although I am sure, as it would seem they were too, that type 1 diabetes does qualify…)

It could even be proven, if you took this matter as far as the courts, that actually the person who ticked the box of the ‘medical exemption certificate’ for the prescription forms was not in fact me. It was the pharmacist. You see, I have a particularly odd way of holding a pen, which could indicate that I didn’t tick that box. It is possible that my signature is on the papers, but as an unaware individual who had been offered no advice or information regarding this matter by either the Pharmacy or Clinic, a British Citizen with a requirement to receive insulin as my human right to live, how was I to know?

In my lifetime so far I have injected close to 30,000 needles with accurate and worked out units of insulin and have taken close to 60,000 finger-pricks for blood glucose level checks. If I had not have taken these actions, I would not be alive. That is what type 1 diabetes is. I am no ‘fraudster’ or whatever you are making me out to be by sending this penalty, and I absolutely should not be made out to feel that way – or any other person with type 1 diabetes; I am simply an innocent human being who battles a 24/7 medical condition and who really doesn’t have the funds to pay out £140.25 because of having that 24/7 disease. I refuse to make such a payment and request that you revise this penalty and the system, annul the penalty and prescription charge and make it more clear across the nation that we need Medical Exemption Certificates. My suggestion is that validity of such a certificate should also not stand for 5 years, we live with type 1 diabetes mellitus for life and therefore our exemption should stand for that timeframe as well.

Please listen to the common sense that I present here.

 

Yours sincerely,

‘Mr DiAthlete’
Gavin Griffiths

Taking this argument further, I have come to realise that there are many in my situation, within England particularly, unaware of the medical exemption certificate – especially young adults who would have had type 1 diabetes during childhood, progressed to adult care taking the responsibility for prescriptions and long term health independently, and have never been told by an NHS professional about the need for this! It is not as though the majority of young adults like myself can really afford this kind of penalty (for the crime of having type 1 diabetes and not receiving advice). It has also been brought to my attention about the 5 year validation of this mentioned certificate, which is also ridiculous: type 1 diabetes is lifelong, therefore any exemption validation should be lifelong – made clearly aware from the point of diagnosis to both patients and families.

PLEASE SIGN THIS PETITION FOR A LIFELONG MEDICAL EXEMPTION CERTIFICATE TO ALL WITH TYPE 1 DIABETES IN THE UK IF YOU AGREE!!!

DiA-Gadgets

Last week I was invited by Medtronic UK to come up to their head quarters, in the delights of Watford, and attend a meeting regarding their latest development in diabetes technology and the world of insulin pumps, the MiniMed 640G.

Pump

Personally I’ve always been a more straight forward type; for example in my days on the football pitch I was never the pink boots, twinkle-toes and make-up type of player… I was always the sleeves up and battle hard type, coming off the pitch drenched in mud and blood. And that’s the mentality I’ve always had in diabetes too really, to get stuck in and get on with it.

In the time I have lived with diabetes I have seen some major changes and developments in care come about, which continue to progress – this latest meeting with Medtronic being an example of that. There are insulin pumps as an alternative of the multiple daily injections I have always been on, continuing blood glucose monitoring systems, developments of an ‘artificial pancreas’ and all kinds of improved devices in terms of blood sugar meters and even insulin pens (check out Timesulin who have a simple but effective cap for insulin pens, so you don’t forget when you last injected insulin).

With all the diabetes ‘gadgets’ now in the world, I recall Alex Silverstein saying: “it is an interesting time to have diabetes!”

Indeed it is, especially when you consider once there was a time when people would take a slash (urinate) on an ant-hill and see whether their natural liquid was sweet enough, with high glucose, to attract the ants out to it.

In the modern world, personally, I’m not all that technically minded it is fair to say. I have some key skills in creating events and organising crazy challenges, as well as the heart to succeed in those challenges in my fight against diabetes; yet, I’m very old school for a young adult. An example, I prefer to listen to The Rolling Stones way ahead of One Direction. The fact One Direction now twice got a mention on my blog offends my pride. There’s simply no comparison between those two. None at all. In light of my old-schoolness, I have always remained on multiple daily injections, where in being an active diabetes advocate in the Western world, I have had opportunities to make a change in the past and go onto the insulin pump.

Last year with the United States tour for Marjorie’s Fund I had my first DiA-gadget taste. Firstly, I am absolutely delighted to hear that the funds we raised on that adventure will be used by Marjorie’s Fund to help support diabetes supplies in Gambia this year; with Dr Baker working with my IDF Young Leader pal Lamin on that!

In the U.S Tour I was on Dexcom’s G4 Platinum continuing blood glucose monitor (CGM). It was a good experience for me. The first time I wore the sensor I had an incident with some blood drops coming out, but after support from the #DOC passing on advice, it was easily solved. And I never had a situation like that with it since. What I really liked about the Dexcom was how it detected whether my blood glucose levels were rising or falling – I think that is key for anyone with type 1 diabetes.

It’s importance increased really for me given that I do not have very strong hypo-awareness symptoms. Once upon a time I used to have strong symptoms, which probably acted in a similar way to the CGM in terms of awareness: I’d get shakes and shivers when dropping low in blood glucose, and alternatively a quench of thirst and a regular need to urinate when rising high in blood glucose. In not having those symptoms come on too strongly anymore, having a device that beeps, vibrates and makes you aware of that is a great advantage. I successfully completed the 7 marathons challenge of running around Long Island and Manhattan, New York, and only had 2 hypos in the process, which isn’t bad considering 180+ miles of endurance…

I did kick myself for those two hypos though as they both came on the very last run! I injected my normal rate of Levemir basal insulin without thinking, where I usually lower my daily intake by 55% on a split dosage on run days (see, mathematical skills enhanced through diabetes..).

In travelling to Watford, home of the Hornets who Crystal Palace of course beat 1-0 in the 2013 Championship Playoff final, to attend Medtronic’s advocacy group meeting, I wasn’t sure what to expect. I knew all other attendees were on the pump and so I wasn’t quite in the know as they were. My technological terms are along the lines of “sticking the needle in” and so I had to quickly adapt! I guess what has put me off from going onto an insulin pump over the years has been two things really:

1. The idea of being attached to something

2. How will it affect me in sport?

From the latter of those two I know most in sport and exercise talk fondly of the pump – it is something that helps their control better for that. A few years ago I remember seeing Dr Gallon and he was strongly in favour that someone doing the level of endurance I was should be on an insulin pump. However, I have built many experiences up and have loved gaining the knowledge of control on injections – it is what I know and what I do. So why change? Has always been my question.

In the meet it was great to see numerous familiar faces and also meet people that I knew of through their online advocacy but had never met in person before. And Kyle Rose was there, of course, he is every-bloody-where I go! The Alps, San Diego, Melbourne, Watford…

In hearing all about this Medtronic MiniMed 640G, initially my thoughts were… who names these devices? Dexcom G4 Platinum, Medtronic MiniMed 640G… my assumption is J.K Rowling. The evidence is in the Nimbus 2000…

But actually from what I was hearing, and granted what I was hearing needs to be released (end of Feb in the UK I believe) and proven, I was really impressed. Their aim was clearly laid out to provide people with better health in diabetes, improving both the short term risks and long term control in health. What appealed to me the most regarding this device was the ‘SmartGuard’. Now I’d never heard of a SmartGuard before, it sounded to me like Stephen Hawking in a Red Coat outside of Buckingham Palace. The concept of the SmartGuard in this insulin pump of Medtronic really did intrigue me and seems a potentially great step forward in diabetes. And where I am concerned, a great step forward in sports and exercise for diabetes management too!!

It uses modern technology such as the cgm’s ability to predict the increase or decrease of blood glucose levels. It notifies you when dropping high or low, and this alarm can be altered, say if slightly hyper after dinner (as often expected) and turned to vibrate so you don’t have the annoying beeps continuing. Then this SmartGuard operates to keep your levels safer from hypoglycemia – stating that it will prevent 80% of hypos. When the blood glucose levels (in mmol/ls) are 3 mmol/ls above the level you put in for your HYPO mark (say 3.9 in most cases) and decreasing , it will automatically stop the insulin into the body to prevent the hypo. You don’t have to do a thing.

My question was: “What about in exercise where your levels might be dropping at a much faster rate than normal?”

And the answers I received suggested that this device will automatically adapt through the SmartGuard, calculating how rapidly the levels are decreasing and acting to prevent the hypo. I also asked about whether you need to tweak your insulin for the exercise and the response was that no you do not. The system works to prevent hypos in any way, shape or form and the further remark was that you wouldn’t even need to load up on carbohydrates beforehand to prevent hypos with exercise. Medtronic seemed very confident in this.

I made a suggestion at the other end. If this is effective and prevents 80% of hypos, brilliant! In terms of hypers, currently they are able to alert you through vibration that the levels are increasing and reaching your high threshold level. This allows for you to then act and stop the hyper yourself. The suggestion I made was whether they could also prevent hypers from happening, automatically releasing insulin at a certain level. This isn’t in the device, yet, according to Medtronic, that is the next step. They might owe me a few drinks on that one!

From what I understood in being at the meeting is that the DiA-Gadgets are so advanced now that anything is possible for the future. This MiniMed 360G really does appear a great way of bettering control of diabetes both short term and long term and I was really impressed by Medtronic’s ambition here.

Would I go on to the pump? Who knows… que sera sera!

(with Dave, Mike, Lindsay, Lesley, Kris and Kyle – the Taxi Team of diabetes advocates heading back after the Medtronic meet. Step aside Ellen DeGeneres!)

Pump Team

Running with Diabetes

IMG_0225

Running is the ultimate competitive hobby, even for those not intending to compete. From taking on races in actual competitions, 100ms like Usain Bolt, relays, 5kms, 10kms, marathons… to going for casual runs in general, there is always a purpose: to succeed. To run to keep fit, there’s a purpose; to run to lose weight, there’s a purpose; to run for the thrill of it, there’s a purpose! For those living with diabetes, every time they run they are competing against their diabetes…

Type 1 diabetes can have short term challenges in sports and exercise, for the blood glucose levels can lower and present a risk of hypoglycaemia. Type 1 diabetes management in exercise takes key decision making and understanding; an accurate consumption of carbohydrates per hour and precise intake of basal and bolus rates of insulin, to correspond with the level of exercise, is where the answers sit.

Constant rates of exercise will lower blood glucose levels gradually, however, with type 1 diabetes the body cannot dictate how much insulin is supplied. A basal rate of insulin is what a person with diabetes injects to replace a daily level of insulin to work in the background, which means in exercise if there is too much insulin stored in the background it will work with the rate of exercise and lower blood glucose levels rapidly. Injecting a reduced rate of basal insulin therefore proves key for control in an exercise such as long distance running.

On the contrary, particular exercises can trigger the opposite effect, otherwise known as the ‘adrenaline effect’. Blood glucose levels can actually be made to rise during exercises, by triggering the liver to release natural storage of glucose into the bloodstream. This can take place through sudden bursts of pace, such as altering the pace from a slow jog into a sprint. Contact sports such as football are quite common to cause hyperglycaemia in blood glucose levels; however, the level of exercise takes a delayed effect and hours later can crash the blood glucose levels lower.

Low blood glucose levels isn’t normally a problem that connects with type 2 diabetes but exercise  brings many advantages for it long term, which it can do for type 1 diabetes likewise. The benefits which a healthy lifestyle and regular exercise provide go without saying in general; exercise boosts a healthy blood flow and blood sugar levels, reducing risks of further complications developing such as cardiovascular disease.

Running is a hobby for enjoyment and for fitness, from casually taking in the scenic views to competing for fulfilment; running with diabetes adds a whole new level of interest to the hobby, it is all about control.

IMG_5160

Pharmacy Fridge

Does anybody have an old/spare FRIDGE hanging about that they wish to rid of?

Following my second trip to collect my diabetes prescription, the charming (in a sarcastic tense) boss lady of Lloyd’s Pharmacy in Pickford Lane, Bexleyheath, stated (not for the first time) that her fridge is not big enough to keep my things…

Now, I would have been apologetic but for the fact I have already mentioned this was my second trip there, and I had previously been to collect all my essentials on the 19th December, when due. On a wasted trip to get my prescription previously, they did not have the full amount there on time, “no worries,” I said as I was fortunate to have spares remaining in going away the following morning, “I’ll have to collect after Christmas though, as I am going away.”

Personally I do not mind the fact that the decent employees of Lloyd’s Pharmacy in Pickford Lane, Bexleyheath, regularly load up a bag with the wrong insulins or with test strips missing, as it rather amuses me to correct them. I do not mind that they quite often have to ask me to come back a day later, for the right prescription to come in. I DO mind, however, being spoken to in a rude, undermining manner with little respect.

I am very fortunate that in the UK, where I am from, access to insulin is quite comfortably available and therefore, even if I sometimes have to wait an extra day, I am going to get exactly what I need to keep on top of my health. Other countries around the world, over 90 years after the founding of insulin, are not remotely so fortunate and this needs addressing. But, living with diabetes is not my fault and not something I can help too much, although with a positive attitude I can turn it into a positive input to my life too; for this lady to talk to patients in that tone is unacceptable.

I have an answer! If I can get hold of a Fridge, I will generously wheel it up to Lloyd’s Pharmacy, Bexleyheath, and present the charming boss lady there with it. Maybe this will be one less problem for her charms to handle… just a thought.

small fridge

How I envision that ‘small fridge’ she always talks about…