Wednesday, 19 September 2018

Screening Room

Autumnal scene with trees and pond
Düsseldorf, November 2017
I spent the weekend in London with dad, while mum and Lola II went off to see an interesting museum that involved an overnight stay. One of the jobs I was planning was to surprise Lola II by finishing the dress that is so long overdue. Despite having brought the sewing machine and even doing a quick sewing job for mum before she left, when I sat down to get started on Lola II's dress the machine refused to behave and kept dropping stitches and being generally uncooperative. So I had to pack that in, and instead I spent far too long going through all the films showing at the San Sebastian Film Festival where I shall be in less than two weeks - and there are A LOT OF FILMS. I thought I'd watch a nice movie on Saturday night so I brought my two rented DVDs with me. Unfortunately, I had changed my rental settings back when the old TV died, and the DVDs I'd brought were actually Blu-Ray discs and wouldn't play. On Sunday Sister D visited for lunch, Lola II and mum returned with cake for me, I drove home and that was the end of the weekend.

Two green cushions
Ilf has been at Lola Towers on and off for a week or two, working on the Screening Room / Entertainment Room / Auditorium (I haven't decided on the final name). He has taken up the parquet floor in preparation for carpeting, painted the walls, ceiling and woodwork, fixed the blinds and put up curtain tracks. I have bought blackout curtains, and made two cushions - I didn't like the idea of a curtain or blind for the round window, but the recess is quite deep so I had the idea of putting a cushion each side to block out the light when necessary. I bought some cheap cushion fillers on Amazon but they weren't dense or large enough, so I cut up my very old sleeping bag and made some very decent cushions. I am very pleased with the outcome.

Round window next to front door
Round window from the outside
My large screen woes continue - the company agreed to refund the cost of the unavailable television, but shortly afterwards sent me a message saying that they were in dispute with the company that manages credit card payments and refunds on their behalf. They directed me to instigate 'chargeback' procedures with my credit card company, which I did, and the money was returned successfully.

Meanwhile, I have been keeping an eye on prices at Currys, and it has been most interesting. Currys often advertises 'save £100's' on specific items, and shows the previous history of the price for that item. It is clear that they set a high price for a period of time in order to be able to quote this historical price when they reduce the item to make it into a bargain. When I first looked, the particular television I'd now quite like to get was £200 more than the original one I bought. The price then went up a further £300, and has now dropped by £350. But my £20 secondhand TV is doing just fine for the time being.

Wednesday, 12 September 2018


Me in reflective jacket in the information tent
Leamington Food and Drink Festival, September 2018
Sometimes I seriously wonder whether my choice of activities is driven by the need to provide stories for this blog. But I'm pretty sure I would keep trying new things anyway, blog or no blog.

Today the big story is the Leamington Food and Drink Festival, which is an annual highlight for me. Long ago it featured the 'Taste Trail' which allowed you to go to selected food retailers around town for a taste of what they offered. Now it stays exclusively within the Pump Room Gardens, which this year is undergoing remodelling including the renewal of paths and the refurbishment of the bandstand. This meant there was less room for stalls, so there were about 20 fewer exhibitors this year.

A couple of weeks before the event I started seeing adverts encouraging people to volunteer. Usually I invite people to visit me when the festival is on, but this year Lola II and Mr M decided to go camping instead and I hadn't invited anyone else, so I didn't have any reason not to volunteer. The event is run by BID Leamington, an organisation promoting the interests of Leamington businesses through the formation of a Business Improvement District in 2008. I arrived at the Information Tent ready to serve in whatever capacity was required.

Thankfully I wasn't allocated to litter picking or toilet cleaning. A new initiative this year was set up to encourage public transport and relieve pressure on town parking: people who had come by train could present their ticket and receive a free soft drink, beer or wine in return. I had to record it all in a book, and hand out soft drink cans and vouchers for beer or wine which had to be exchanged at one of the outlets in the field. It went quite well - obviously a trainload of people tended to arrive at the same time, but the queues weren't too long. Sunday was much quieter for the train ticket exchange because there were fewer trains running, but the event as a whole seemed busier on Sunday.

The BID Leamington staff and volunteers were friendly and welcoming, and I had some quite interesting discussions with the Director about various local businesses (including the shop which has just been fined £10,000 for making illegal health claims about their raw juices), and the reasons behind the turnover of businesses in a couple of town locations. The two afternoons I spent with the team were positive volunteering experiences, and I'd be happy to join them again next year if they will have me.

Tuesday, 4 September 2018

What I've been reading

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All Quiet on the Western Front
by Erich Maria Remarque

narrated by Tom Lawrence
"The story is told by a young German soldier in the trenches of Flanders during the First World War. Through his eyes we see all the realities of war: under fire, on patrol, waiting in the trenches, at home on leave, and in hospitals and dressing stations."
I am ashamed. I am ashamed many times over. That I had not appreciated that this common phrase originated in this astonishing work, that I waited so late in my life to read it, that it is fiction but told so powerfully that every word rings true. And more prosaic yet more shaming - that I paid so little attention at the start that I did not realise until about a third of the way through that the young soldiers I was accompanying on their horrific journey were German. The narration is by a young voice and worked so well, and the audio format allowed them the liberty of playing the Last Post at the end. I was in tears.

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The Mulberry Empire
by Philip Hensher
"The courtship, betrayal and invasion of Afghanistan in the 1830s by the emissaries of Her Majesty's Empire, followed by the expulsion of Brits from Kabul following an Afghani revolt."
A account of historical events disguised as a novel, this was rather indigestible. I could tell the author was trying quite hard to tell a story rather than laying out the facts, but it was too dry for my taste. It also seeded a number of parallel stories that didn't converge, making the ending unsatisfactory. I think my most common criticism of all these books I avidly start reading is that they so often end poorly.

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by Sinclair Lewis

narrated by Grover Gardner
"On the surface, everything is all right with Babbitt's world of the solid, successful businessman. But in reality, George F. Babbitt is a lonely, middle-aged man. He doesn't understand his family, has an unsuccessful attempt at an affair, and puts his real estate business in jeopardy when he dares to voice sympathy for some striking workers."
Another author I'd never heard of from my list of 'Classics', this book is set in 1922 during the Prohibition era, which is probably the most interesting thing about it. But the ending is quite good.

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The Language of the Genes
by Steve Jones
"A tale of curious mutations, molecular clocks, and genetic bottlenecks; it illustrates biological principles with memorable examples from everyday life."
I've a strong suspicion that I've read this before, because I have a bias against Steve Jones that I can't put down to any recent experience. This book starts well with genes and inheritance as expected, but makes a detour into anthropology that I find excessively tedious. I don't know why I'm not interested in the spread of language or population across the world, but there it is, and there was quite a lot to get through. It's also an edition of an old-ish book from 1993 that's had one revision in 2000, so not very up-to-date in this most fast-moving field of biology. On balance, though, I'm going to keep it on the basis of the first half of the book.

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The Examined Life: how we lose and find ourselves
by Stephen Grosz
"Simple stories of encounter between a psychoanalyst and his patients, stories about our everyday lives: they are about the people we love and the lies that we tell; the changes we bear, and the grief."
A quick read - just a day during the festival weekend, but very interesting short summaries of cases of psychoanalysis. Maybe a bit too short - problem, solution, end of chapter. It would have been interesting to get a bit more depth, feel a bit more connected to the problems being outlined.

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Eleanor Oliphant is Completely Fine
by Gail Honeyman

narrated by Cathleen McCarron
"Meet Eleanor Oliphant: She struggles with appropriate social skills and tends to say exactly what she's thinking. Nothing is missing in her carefully timetabled life of avoiding social interactions, where weekends contain frozen pizza, vodka, and weekly chats with Mummy. But everything changes when Eleanor meets Raymond, the bumbling and unhygienic IT guy from her office."
An excellent book, beautifully read, and very recently written too. All the things that I have been finding so irritating are completely avoided in this book - just the right pace, all the content was relevant, it finished well and gave me plenty to think about in between chapters. Maybe I can tolerate modern books after all - they just have to be the right ones.

Friday, 31 August 2018

Team meeting and Festival

Rainbow rising from campsite
Festival campsite, August 2018
At work we had a team meeting for the Diabetes Dietitians where the Dietetic Manager came to tell us all about the Outpatient Project that she's in charge of implementing. I like the DM a lot - for example she introduced patients Bob, Bobina and Bobetta to illustrate various points. Anyway, this Outpatient Project involves reviewing and re-classifying every one of our many outpatient clinics in order to be able to assess our capacity and understand exactly who we are seeing, how long they wait for an appointment, how long their appointments are, how many times we see them, what we do if they don't attend, and much more. There are a few niggles that still need sorting out which are a bit too technical and boring to describe here.

The rest of the meeting without the DM was just as complicated, as our new Team Leader tries very hard to understand how things have ended up as they have, and impose some sort of discipline and order onto the amorphous mess. It is even possible, if she is tenacious enough, that she may get to the bottom of the conundrum about how my post is funded and how exactly I should handle various complex administrative situations. Again, too technical and boring to go into here.

The day before the meeting, as is traditional, I checked the previous meeting's minutes to see if I had been given anything to do. I noticed that I had been asked to find out whether the doctors where I work have any official referral criteria to describe who they will and won't see. I asked the most amenable of the four doctors who work here, and he said that he didn't, but if he were to write some then his guidance to GPs would be "No stupid referrals." When pressed, he elaborated that a referred patient should have diabetes, and that the GP should have done something about it before referring them. Good enough for me. I wasn't asked for this information at the meeting, thankfully.

Then came the Bank Holiday weekend in which I went to the Shrewsbury Folk Festival. This was my second year there, and I have to admit it wasn't as good as the first, but that was down to a) the wet and windy weather, b) no Oysterband this year, and c) my failure to pack any bedding. After I'd arrived and put up the tent I realised that I'd brought no sleep mat, sleeping bag or duvet. So I went home again and fetched them.

This ruined my plan for a lazy Friday to include a walk into Shrewsbury for lunch at the sushi place I found last year, but actually only postponed the plan until Saturday, when the weather was fairly nice. The rain came with a vengeance on Sunday, but with a watertight tent and all the sound stages under cover it wasn't much of a problem. Highlights this year were all the female singers - The Fitzgeralds, Gretchen Peters, Edwina Hayes, Miranda Sykes with Show of Hands and Maddy Prior with Steeleye Span. What voices they have! I was too tired to see the end of the Steeleye Span set, but lying down in my tent I could hear the strains of the classic "All Around My Hat" with full audience participation.

Back home after the festival weekend and Ilf arrived at his usual crack of dawn next day to make a start on the decoration of the Screening Room. There is still no sign of a screen for the screening room - my TV woes continue, and the second scheduled delivery of a replacement television was also cancelled by the selling company. They refused to speak on the phone and were only willing to converse by email, so I lost confidence in them, withdrew my order and am now awaiting my full refund. Shortly afterwards I set up a profile on the Shpock platform with a view to selling the old sofabed mattress, but then on a whim I bought a temporary replacement TV for £20 so at least I can watch DVDs. When I have the strength, I will go back to the large TV project. And sell the mattress.

On the subject of selling, regular readers may remember that I was all enthusiastic after checking out my local car boot sale. You may also have noticed that the summer is over and I haven't done anything more about it.

Four dancers in black and red with faces veiled in black
Morris Dancers in Shrewsbury - and no, I have no idea why

Tuesday, 21 August 2018

Life goes on

Spreading tree with person meditating
Adhisthana, June 2018
Terrible news last week - a cousin aged only 48 living in Texas died from a stroke. The last time I met him must have been at least 20 years ago when he was living in Manchester, but Facebook is a marvellous thing and it was clear over the intervening years that he was an active, interesting, funny guy devoted to his wife and two children. It makes you think. It has certainly made me think about the things that I want to change sooner rather than later.

Despite this awful news the following weekend was one of the best for me, starting with a new Japanese cafe just up the road from Lola II and Mr M, followed by supervising them putting up their new tent, which is the same as my tent but a little bit better because it has an extra canopy section. Then I went into London to meet another set of friends and go to a show: The Book of Mormon, which is an irreverent and funny musical which pokes fun at Mormons and Africans alike, without becoming spiteful or particularly critical either. I found it amusing and reassuring that waiting for us outside the theatre after the performance were some real Mormons, taking advantage of a recruitment opportunity rather than protesting about blasphemy. A religion with a sense of humour is fine with me.

After a walk around The Green Park and a peek at Buckingham Palace we headed off to a fancy shmancy Japanese restaurant in St James's, which served wonderful food (the best tempura I've ever had and a very fine cherry panna cotta) but indifferent, if not incompetent service. There were cocktails to follow and much relaxation next morning before I travelled to the Chelsea Physick Garden for a birthday lunch with sister D and family.

The subsequent week at work and at home has been indifferent, marked by the failure to deliver my new TV, disc golf and a pub lunch with the badmintonians, and the arrival and installation of a new washing machine. I will miss that launderette. Good news on the BMI - I'm nearly there, just 200g to go. Then there's the much harder task of maintaining the weight loss.

Monday, 13 August 2018

First world problems

Close up of orange poppy with purple centre
I do love poppies. Here's an orange and purple one.
We finally had some rain - thunderous, torrential rain - but very short lived. I was enjoying a brief respite from the oppressive heat in the new kitchen, where I spend much of my time these days, when the rain started - indoors, under the new roof light. A bucket was deployed, a text message sent to Ulf the builder, and the following day Doors and Windows Ulf attended in my absence and left me a written account of the issue. His view is that conditions were abnormal and the strong wind forced rain to travel upwards and under the cap; he has added some sealant or other such obstacle to prevent it happening again.

What I was doing when the indoor precipitation occurred was in relation to my television, which you may remember was purchased in April. Since then I had required support from the manufacturer, which runs a highly effective telephone support service, and which had repaired my TV remotely over the Internet three times - the third requiring me to install a software update from a USB stick that was sent through the post. Each of those three times the problem had been fixed, but I did query at what point would it be regarded as unacceptable for me to be phoning the helpline every time I wished to watch TV? I got no joy from the manufacturer - it was more than 28 days since the purchase, they wouldn't consider replacing it while they continued to fix it.

One Friday, however, I was watching a program on BBC iPlayer, and it just switched itself off and refused to turn on again. This time the support line couldn't help via remote control, but diagnosed a cable failure and proposed sending me a new cable through the post. At this point I got back in touch with the retailer, described my experience, and they acknowledged that it was time to offer me a replacement TV. Except that the TV I originally bought is no longer sold, so I would have to choose a comparable one. Off I went to the shop on Saturday morning, followed by more time on the website, and found that there was no comparable TV within the parameters that were set. I had another discussion with the retailer.

This left me with the option to take a lower specification television which cost the same as I paid, or a comparable specification television for £380 more, of which they would contribute £130. I did a bit of online scouting about, and found that I could get an ex-display model of the exact same TV as I had originally bought, for £200 less than I paid, but from an unfamiliar retailer. The only thing to do was to consult various people (step up Lola II, Mr M and the Decision Assistance Helpline - 'Your difficulties are our business') and also seek advice from the iPod of Fortune.
Need a decision handled with precision? Don't make a fuss, just call us! 
They all gave very good advice except IoF which seemed to have become confused with a different conversation we were simultaneously having about a trip to Israel (IoF's advice was 'Jerusalem').

On Thursday, then, I started by phoning the unfamiliar retailer to see if they really exist, answer the phone etc. Their website had a real location and phone number and I couldn't find any obvious scam opportunities, and although they only answer the phone betwen 11am and 4pm they confirmed the availability of the stock showing on their website. So I plucked up the courage to phone the original retailer again, who confirmed that they couldn't improve on their offer. We agreed on a refund. I went straight back to the unfamiliar retailer's website to order the TV I wanted, at which point I discovered a) although that morning there appeared to be four in stock none was now available, b) actually, all the televisions on their website had disappeared and b) they have a lunch break between 1 and 2pm when they also don't answer the phone.

This is where a spot of meditation can come in quite handy. Phoning back after 2pm I discovered that the website was being updated and the television section should be back tomorrow. The person on the phone couldn't tell me anything specifically about the availability of the item I was after. So I spent an uneasy evening trying not to think about it.

Next morning, as described, the website was back, televisions were still in stock, and... the price had been reduced by another £100! So I ordered one. And waited. And no email came, and at the weekend I tried to log into my account to see the progress of the order, and it didn't recognise my email address. One step forward, one step back. On Monday I phoned them again, and I had indeed made a stupid mistake with my email address, so we corrected that and we are now discussing delivery - they won't even guarantee a day, let alone a time.

I'm spending the difference in price on a washing machine. I've even ordered it at last. I'm hoping that this will be the end of my first world consumer issues for the time being.

BMI update - as predicted, the two weeks of holidays sent my weight drifting up a little bit (but nowhere near previous levels), and then I managed to get it going back in the right direction. Latest BMI is 23.9 kg/m². Back on track. I can't remember what dark chocolate tastes like any more. The next challenge will be to decide exactly how much to relax the regime, assuming I reach my target. At the moment I am certain that I will go back to semi-skimmed milk instead of skimmed, but no idea about anything else that I am currently denying myself.

Tuesday, 7 August 2018

What I've been reading

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Master Georgie
by Beryl Bainbridge
"When Master Georgie - George Hardy, surgeon and photographer - sets off from the cold squalor of Victorian Liverpool for the heat and glitter of the Bosphorus to offer his services in the Crimea, there straggles behind him a small caravan of devoted followers; Myrtle, his adoring adoptive sister; lapsed geologist Dr Potter; and photographer's assistant and sometime fire-eater Pompey Jones, all of them driven onwards through a rising tide of death and disease by a shared and mysterious guilt."
This is the first Beryl Bainbridge I've read, and it's a lot better than most of the 'classic' books on my list. Quite short, a bit odd, it follows a group of people all connected by family or events, describing life in Liverpool and the Crimea with six vignettes set between 1846 and 1854. Enough to encourage me to try another of hers in future.

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Golden Hill
by Francis Spufford
"One rainy evening in November, a handsome young stranger fresh off the boat in New York pitches up at a counting-house door in Golden Hill Street: this is Mr. Smith, amiable, charming, yet strangely determined to keep suspicion simmering. For in his pocket, he has what seems to be an order for a thousand pounds, a huge amount, and he won't explain why, or where he comes from, or what he can be planning to do in the colonies that requires so much money."
I borrowed this book on the recommendation of the friends who were with me at the festival. I read it within the weekend, and it's wonderful. Such a relief to find a good book written within the last few years. They (the friends) told me that they usually buy The Economist magazine's books of the year, and this is one of them.

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The Secret Adversary
by Agatha Christie

narrated by B. J. Harrison
"Tommy and Tuppence, two young people short of money and restless for excitement, embark on a daring business scheme. Their advertisement says they are ‘willing to do anything, go anywhere’. But their first assignment, for the sinister Mr Whittington, plunges them into more danger than they ever imagined."
One of her earlier efforts I believe, and utterly unrealistic when viewed through the lens of the 21st century when well-meaning amateur sleuths are unlikely to get approval from government mandarins to track down murderous traitors. Our happy-go-lucky heroes also emerge from significant periods of imprisonment by the bad guys with their financial resources intact, ready to hop into a cab or a train at a moment's notice. Small gripes, I admit, but distracting. Perhaps you didn't need any cash in those days, just a plummy accent and a convincing manner.

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Gravity's Rainbow
by Thomas Pynchon
"Set in Europe at the end of WWII, the novel's central characters race each other through a treasure hunt of false clues, disguises, distractions, horrific plots and comic counterplots to arrive at the formula which will launch the Super Rocket."
Reader, I couldn't do it. It was too difficult, with all the tens of characters introduced without any context, no points of reference, no narrative path to follow, and no discernible plot. I got halfway through and realised that I'd have to put in the same amount of effort for the whole of the second half, and it wasn't worth it. I should have known when I read somewhere that it was comparable with literary masterpieces Moby Dick (couldn't finish it) and Ulysses (not even going to start).

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Mrs Dalloway
by Virginia Woolf

narrated by Juliet Stevenson
"A June day in the life of Clarissa Dalloway –a day that is taken up with running minor errands in preparation for a party and that is punctuated, toward the end, by the suicide of a young man she has never met."
There are many, many people, mostly women that I'm aware of, who cite Virginia Woolf as one of the leading forces in their lives. It doesn't look like I'm going to be one of them. I'm pretty sure I read The Lighthouse a long time ago and thought it was OK - same with this one. It's not bad, and Juliet Stevenson is a fine narrator, but I won't be bothering with VW any more.

Wednesday, 1 August 2018

Closed loop insulin delivery

Interesting tandem cyclists on their Grand Tour, July 2018
In the world of Type 1 diabetes, the holy grail (apart from a cure) is the 'artificial pancreas' - a way to control blood glucose levels so that they resemble as closely as possible those of a non-diabetic person. There are a few barriers, however. One is the subcutaneous delivery of insulin analogue into the peripheral circulation rather than endogenous secretion of insulin from the pancreas directly into the blood vessel serving the liver. Another is the role played by other pancreatic endocrine hormones, principally glucagon, which may or may not be affected by autoimmune beta cell destruction. The third is the minute by minute nature of physiological insulin and glucagon adjustment, which cannot reasonably be replicated by a human being.

The best case scenario which is licensed and available to a person with diabetes (PWD) at the moment consists of a Continuous Glucose Monitoring (CGM) system linked to an insulin pump, which alerts the PWD when glucose levels are rising or falling outside certain parameters. One system available in the UK will suspend insulin delivery when low glucose levels are predicted (low glucose suspend), but the PWD is always expected to manage the situation. They still have to pay close attention to carbohydrate intake, estimating insulin for meals, drinks and snacks, taking account of any number of other factors such as weather, health, activity, location of insulin delivery site, time of day, when you last ate, what you've just done, what you're going to be doing next, and more. It's still a full time job for someone with diabetes.

The situation described in the paragraph above is known as 'open loop' - the CGM and pump provide information to the PWD who is the third party in the loop, and who must make the vast majority of the decisions on insulin delivery. If it were possible to monitor glucose levels minute by minute and automatically deliver the 'right' amount of insulin without consulting the PWD then the huge burden of continuous glucose management and insulin delivery would be lifted. The pharmaceutical companies are working on this artificial pancreas idea, which is more accurately known as 'closed loop' (because it isn't really anything like an artificial pancreas at all). There is one system (not yet available in the UK) will adjust the background insulin up and down according to the CGM results, which is the first licensed partial closed loop option.

Insulin is what keeps people with Type 1 diabetes alive, but it can also do great harm if the wrong quantity is delivered. As you can imagine, ensuring that the closed loop algorithm used by the CGM and pump combination is 100% safe (or safe within whatever boundaries are required by the licensing authorities) is a huge regulatory burden, given that this equipment cannot be restricted to sensible or intelligent people.

So there is a movement which has adopted the slogan #WeAreNotWaiting. People with programming knowledge and open source software are getting on with the job, and have produced their own unlicensed closed loop solutions using the technology that's already available. The three necessary components are a CGM system, an insulin pump, and a device to communicate with both and run the algorithm. A fourth element is cloud storage, mostly for reporting and analysis, but also for third party monitoring (a parent seeing real-time results for a child, for example).

Anyone with a modicum of technical skill and some disposable income can create a closed loop system using these components, and the results I've seen are sometimes astonishing - not quite non-diabetic blood glucose levels, but so much closer. The reason for the disposable income is obviously that being unlicensed, the total solution is not available or supported within the NHS, although the pump and the CGM system might be, and the algorithm and cloud storage are free and open source and can run on a mobile phone.

I've been trying to understand the technology for a while, and I joined a Facebook group relating to looping in the UK. There I discovered that one of our patients has set himself up with a closed loop, and I invited him to come and show us what he's been doing. He didn't respond to the invitation, but another slightly less local person did, so we arranged for him to come to the Diabetes Centre at a time convenient for the two consultants, three nurses and myself. And he did come, and so did I, and the nurses were there too, but neither of the consultants turned up.

Our guest was extremely helpful, and brought along some examples of the different bits of kit that can be used, as well as a presentation that took us through it all.

The choice of other components depends on the type of pump, so that is where to start. Then there are options for how to run the algorithm, which can be on a bit of specialist kit (RileyLink, Linux) and/or a phone (iPhone, Android). The AndroidAPS is the one I understand best, but perhaps that's because I'm not familiar with the iPhone, Linux or the Apple watch and have no idea what RileyLink is.

There isn't usually a problem with the CGM end because almost all of them will do, it's just a question of budget and availability - all the Dexcom CGM systems work, as does Medtronic. The Libre needs to be adapted to turn it from 'Flash glucose monitoring' to true CGM, which can be done using one of three devices: MiaoMiao, Blucon or LimiTTer. Our guest brought the MiaoMiao option so I've seen that, but I don't know what the other two are like.

There are some variables to consider, including three levels of glucose - minimum, maximum and target - and at least two levels of temporary basal rate, so that the algorithm can adjust its behaviour according to these parameters. The AndroidAPS option is more structured than the other two, because it guides the user through 'gates', introducing more features gradually and providing access to the next feature only when the previous step is successfully implemented.

The potential benefits of closed loop are longer times in range, fewer hypos, improved HbA1c, and less effort day-to-day required to achieve these results. The downside is the cost, the effort required to set the system up in the first place, and the possible mental strain of maintaining your unlicensed technology. Your diabetes team may have little or no knowledge of what is involved, and this may be a problem, but I hope that awareness is rising. It is very likely that a looper would be asked to sign some sort of waiver which will absolve the professional team of liability should something go wrong - these documents are being considered and consulted on in my region as I write.

Joining the 'Looped UK' Facebook group has given me a lot of information and access to UK expert and non-expert volunteers. Clearly each PWD is expected to manage their own technology, there is no commitment from the group's volunteers to provide help or support, but they can be extremely helpful in answering questions, showing how it's done and helping with the trickier aspects of the setup. 'Information days' and 'Build days' take place occasionally to help new loopers, and I'm hoping to attend one soon to find out even more.

Friday, 27 July 2018

The camping season begins

View of forest looking out of the tent
July 2018
Lola II and I have been off for our first joint camping trip of the year. In fact I don't think we have another trip planned together this year, but you never know. We went to Badgell's Wood in Kent, and the heatwave continued, but we survived because the campsite is a forest and all the pitches are in deep shade - it was almost chilly for some of the time. Lola II was a bit disappointed that they weren't allowing any sort of open fires because of the drought and heatwave, but I can take it or leave it when it comes to camp fires.

We shared my tent, partly because I drove and Lola II went by train, but partly because my tent is so good that we heard two boys who passed our pitch in the woods saying "Look at that tent, it's so cool!" It's been a while (decades) since I possessed anything that could be described as cool by a young person. My tent is also so good that Lola II and Mr M have finally bought one just the same.

There were a couple of downsides to the camping situation. The campsite had no drinking water, so we had to buy some - not really a problem. We also discovered only as we were about to leave that the office would have charged our phones for us overnight if we had asked, but instead Lola II covertly plugged hers in whenever we were in an establishment with available sockets. I just spent the last two or three days without any phone except when I could charge it in the car. Nobody ever phones me except Lola II so this wasn't really a problem either. The site was really quiet when we arrived on Wednesday, but a lot of children arrived on Friday night and made a tremendous racket.

After I picked up Lola II from the station we headed off for a fine lunch at a local pub, pitched the tent then went foraging for water, milk and other provisions in West Malling. Frank's restaurant was advertising their Mussel Night the following evening, so being fans of the bivalve we booked a table and it was delicious - Lola II triumphed with her fennel, chorizo and cream sauce (no onion or garlic), although mine was good too.

The mussel feast came at the end of a day when we visited Eltham Palace and gardens, which was built by Stephen and Virginia Courtauld on the site of a 14th or 15th century hall that they also renovated and used for balls and parties. Both the house and hall were opulently and lavishly decorated - the owners were astonishingly, mind-blowingly wealthy. Virginia was a keen ice skater, so her husband built her an ice rink in London. Anything they wanted, they could have - gold plated taps, underfloor heating, sound-proofed bedroom walls, a pet lemur... and then war broke out, and they just couldn't get the staff. They had bought the place in 1933 and moved in three years later, but by 1944 they were tired of getting bombed and headed off to Rhodesia, where presumably there were plenty of workers.

A trip to Sevenoaks another day was underwhelming except for the James Corden lookalike in the watch shop. We tried to get a bit of culture in the Sevenoaks Museum and Art Gallery, but the fire alarm went off after we'd been there for no more than two minutes and we had to evacuate the premises. Maidstone was another matter altogether - a large museum and art gallery which was quite interesting in parts (and no fire alarms), many many shops, a theatre and a river. We even went to a show, which stopped us spending much time near the river. It was an amateur local company performing 'In The Heights' and it was pretty good but stiflingly hot.

Lola II has taken up crochet in a big way. By this, I mean that she is obsessed with it, and seems to have several projects on the go at the same time. To my certain knowledge she has made a cushion cover for Mr M, I received a unique (translation: slightly non-rectangular) tea towel and also a dish scrubber, and she has made at least one scarf and probably some more things too. What this means is that each morning I was able to sit and read a book quietly for at least an hour while she crocheted, which I'm pretty sure hasn't happened on any of our camping trips before.

Lola II had ordained that I would be in charge of ridding the tent of anything with more than two legs, which duty I fulfilled despite my own squeamishness. We tried to play a game one evening in the dark lit by one head torch and two wind-up lanterns which had to be regularly wound during the course of the game. It required sets of cards to be laid out flat, which was pretty precarious without a table as we had to balance everything on our duvet-covered laps while vigorously winding up the lights. The most interesting moment came when an eight-legged guest made its presence felt at a crucial moment mid-game.

LOLA II: "Aaaargh! Get it! Get it!"

LOLA I (trying to trap spider in paper towel without scattering game cards throughout the tent): "Missed it!"

LOLA II: "There it is! Squish it! Squish it!"

LOLA I: "I can't! I'm a Buddhist!" (not true but I really don't like squishing creatures)

LOLA II: "I'm not a Buddhist! Squish it for me!"

The spider escaped, but was evicted along with its mates next day when I could approach the situation unencumbered by wind-up lanterns, game cards and duvets.

Camp cooking included a cracking onion-free spiced chickpea concoction with watercress in pitta bread, mozzarella with pesto and tomato in pitta bread, and pasta with mushrooms and truffle pesto. Snacks included wasabi peas, strawberries and cherries, anchovy-stuffed olives and a can of gin and tonic. On the last day we thought about going to Chatham dockyard but in the end, after striking camp, we went to a local Country Park for a late breakfast, walked around for a while, ate some cake and went home. It was a very hot holiday, but a good one.

Saturday, 14 July 2018

Things done and not done

Irises and waterlilies
Adhisthana, June 2018

Things done

I went to a festival in Leicestershire. It was very hot - this made it difficult to get enough sleep because the tent was uninhabitable when the sun came out, but was a distinct advantage when all the music and dancing is in the open air. The dress code extended from total nudity to someone I saw who appeared to be wearing a Victorian ball gown complete with parasol. Trends included thongs, nipple rings, skin-tight leggings for men, and lots and lots and LOTS of glitter. I danced for three days and came home exhausted and filthy but happy.

Then I went to London for a work visit with four colleagues to a hospital which is a centre of excellence for its diabetes service, led by a very dynamic and charismatic doctor. It is also where my previous Room Share Buddy and Really Supportive Bloke now works (he was introduced to the blog here), and he came over to say hello before going off to deliver a course elsewhere. I miss him - he is an excellent chap as well as being good to work with. They have 800 patients on insulin pumps compared with our 125, and a further 170 on Continuous Glucose Monitors compared with our 2. They are ahead of us in so many more ways, but that after all was the purpose of the visit, and maybe soon we can do more of what they are doing.

The weight loss program continues successfully, BMI now 23.9 kg/m², but a week off work and two jolly trips coming up next week may slow progress a little.

Things not done

  • I am still a loyal customer of the local launderette
  • I haven't replaced the tablet that I broke in frustration at its slowness and inability to connect to my wifi extender
  • Lola II's dress has been started but is now languishing on a shelf
  • The stuff for the car boot is still cluttering up the hall
  • The new TV and old DVD player have not been themselves since the lightning strike, although the way that they have been failing takes a variety of forms. I have spent more than two hours altogether on the phone to the support team on three occasions so far, and each time the immediate problems were fixed, but only temporarily. Resolving this issue is going to require some considerable effort.
  • Tax return. Again. Every year.
Fairy lights draped around me in the dark
What I've been doing instead of filling in my tax return
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