What I've been reading

The Silver Spoon
by John Galsworthy

"Living in their elegant, fashionable house in Westminster, Fleur and Michael Mont mix with and entertain the glittering society characters of the day. But London after the war is a place of carefree, 'live for today' attitudes which are alarming and baffling to old Soames."

My reviews of the Forsyte saga are becoming repetitive - what else can I say about how good this writer is, and how surprisingly comparable are his accounts of early twentieth century with contemporary life? This is the fifth of the series, so there are just four more to go, and it will be a sad day when I finish the series, as long as the quality remains this high.

Montmorency: Thief, Liar, Gentleman?
by Eleanor Updale

narrated by Stephen Fry

"Fleeing across a roof on a dark night in Victorian London, a thief crashes through a glass skylight to almost certain death. But an ambitious young doctor revives and reconstructs his shattered body, proudly showing off his handiwork at the Scientific Society. It is there that the robber picks up the key to a new existence, and on his release from prison begins to lead a double life."

It was Stephen Fry that did it - I trusted him, and he let me down. I thought that the identity of the narrator suggested a quality read. Maybe it was a classic of its time, but in terms of passing the time on long car journeys, it doesn't cut the mustard. The eponymous hero ends the book in vaguely heroic vein, but I can't accept his transformation to saviour of the nation given the deliberate and heartless criminality of the rest of the story. Mr Fry - you must have needed the money.

Death at the President's Lodging
by Michael Innes

narrated by Stephen Hogan

"Inspector Appleby is called to St Anthony's College, where the president has been murdered in his lodging. Scandal abounds when it becomes clear that the only people with any motive to murder him are the only people who had the opportunity - because the President's Lodging opens off Orchard Ground, which is locked at night, and only the Fellows of the College have keys."

Another book recommended to me, the second I've read by this author but the first book he wrote in the series. He was pretty prolific in his output, and the other one I read was written 32 years after this one. I imagine the print version has a map (as the best murder mysteries do), but even without one I could still make sense of it. My concentration on the 'reveal' at the end made me miss my turning off the A46, because the solution to the mystery was a bit more complicated than I was expecting. So reading this book almost made me late for work.

Renovation and transformation

Graveyard, Salzburg, October 2012

There may not be anything about diabetes in this post! I can't guarantee it - in fact, I think there will be a brief reference to diabetes, because of Mr M. But apart from that, maybe none.

The last week has been most interesting. Mr A and I travelled south to see off his mother in a moving ceremony at the crematorium, marred only by a mobile phone ringing at the very moment when the celebrant (vicar? priest?) pressed the button that lowered the coffin at the climax of the proceedings. Mr A commented afterwards that it was in keeping with the course of his mother's life.

In less sombre mood, Lola Towers is undergoing a transformation. At the moment, it is transformed into a dirty, messy pigsty, but that is only because we have not yet cleaned up after the workers. As soon as we apply a few cleaning products to a few surfaces, things will be different.

First there was the hall and shower room. Those of you who have been around a while may remember my attempts at DIY, which went quite well. Over the intervening period, it has become clear that I should have used bathroom paint on the ceiling in the shower room, and I never did get round to painting the woodwork. The wall between the shower room and the hall has never dried out, and presumably never will unless we find the source of the dampness, which would probably mean the replacement of the entire shower and cubicle. The hall has had unpainted patches of repaired plaster for several years, but all of that is in the past - Lady Decorator did a fine job painting all of the walls, ceiling and woodwork. It looks great.

Then, following our recent assistance to Lola II and Mr M with their household DIY, they repaid the favour by spending the last weekend helping us with ours. The first thing we did was jump in the car and set off for the big DIY store, where Mr A and I bought the light switches and plug sockets that we wanted, and failed to find any suitable door handles. Then, to demonstrate further our commitment to a weekend fundamentally focused on DIY, we all went out for lunch, then Lola II and I visited one of the top ten fabric shops in the UK. On our return, Mr A and Mr M were enthusiastically replacing switches and sockets, and Lola II had a fine time with the industrial strength descaling fluid. I mostly supplied catering and support services.

[Diabetes note (I thought there would be one) - Mr M has a new tubeless insulin pump, with a handheld wireless controller. At lunch, he gave me the controller and insisted I was in charge of insulin delivery. Half way through the afternoon I caught him with glucose meter in hand and a lovely hypo in progress. I blame the higher level of activity and the fact that he didn't set a lower temporary basal rate (i.e. turn down the insulin).]

Obviously the power had been off all afternoon while the boys were tinkering with the electrics. Switching the power back on was accompanied by a tiny explosion, and it became clear that something was not right with the lighting circuit. Lola Towers is equipped with a prehistoric fuse box (none of your fancy trip switches here), and because it was getting late we decided we could live with a blown fuse and no downstairs lights for one night, and the wiring fault could be fixed the following day.

How wrong that decision turned out to be was demonstrated at about 2 a.m. when we were woken by a burglar alarm. It was quite loud - loud enough to wake us up and make us look out of the window to see if there was any suspicious activity in neighbours houses. It took several minutes for us to realise that it was our own burglar alarm, and the suspicious activity had taken place in our house earlier in the day when the power had been turned off to the alarm circuit. It had taken several hours for the backup battery to be drained, but now there wasn't anything we could do to stop the racket short of fixing the wiring, and that wasn't going to happen in the middle of the night. Eventually (and it seemed like hours) the bell stopped of its own accord, we all went back to bed, and hoped that it wouldn't go off again, which it didn't.

Sunday dawned, and we surveyed the scene afresh. Mr A decided to focus on the electrical issue, while I directed Lola II and Mr M to clean the velux windows, mow and strim the lawn, and deal with the weeds on the patio, where Mr M discovered the hard way that bees are nesting in our compost bin. Mr A made heroic efforts to untangle the mysteries of the multiple black and red wires, otherwise known as the two 2-way lighting circuits for the stairs. After several attempts and a great deal of hard thinking and help from the Internet, he triumphed. I managed to avoid most of the hard work again, because someone has to make the drinks/cook supper/provide cleaning equipment/wash up/hoover etc., haven't they?

Just as Lola II and Mr M had gone home, all was quiet, and the delight in switching lights on and off was beginning to wear off, Alf rang to say he was coming next day to do the plastering and the drains. We suspect the plaster near the fireplace had decayed from long leakage of water from the bathroom before we had the bath and pipes replaced. The drain problem came to light more recently, when we finally deduced that the damp wall was probably caused by water rising from outside (rather than descending from inside). This was confirmed when Alf told us that the two drains in question were both cracked, exposing the bottom of the wall to pretty much constant water contact. By Monday night the new drains were in, we were banned from using the bath, sinks and shower for 24 hours, and the burglar alarm was still out of action (although mercifully silent).

So in the space of a week we have acquired a newly decorated hall, new switches and sockets, sparkling velux windows (for the first time in more than ten years), a freshly mowed and strimmed lawn, descaled bathroom fixtures and fittings, another newly plastered wall, two new drains, and a layer of dust and dirt over most of the downstairs floors and furniture. But we are allowed to wash again, and, although braced for a burglar alarm service call-out charge, we have even managed to re-set the alarm to normal working. All we have to do now is a lot of cleaning up, and wait for the plaster and damp walls to dry out, and then it will be time for more decorating.

ED

Monastery in Melk, October 2012

There's not much I can write about on this blog, due to my self-imposed rules of not breaching patient confidentiality and trying not to write anything that isn't positive and constructive. That's why I am so delighted when something happens at work that I can write about.

In the diabetes department we have quite a few lunchtime educational talks, often from reps trying to sell something. Doctors, Diabetes Specialist Nurses, Therapy Assistants and Dietitians all attend on an irregular basis - there is no compulsion, but the lunches are often attractive. This week, a talk was advertised entitled 'ED and lifestyle'.

Eating Disorders afflict people with diabetes in the same way as in the general population, but Type 1 Diabetes brings with it the 'opportunity' for weight loss by under-dosing insulin or omitting injections. Glucose from dietary carbohydrate enters the bloodstream after digestion, but without insulin it cannot leave the bloodstream to be used for energy or stored as fat. The level of blood glucose increases, and when the renal threshold is exceeded, it is excreted by the kidneys into the urine. Incidentally, this is how diabetes used to be diagnosed before insulin treatment was available - the urine tastes sweet because of the glucose in it. So by ensuring that there is little or no insulin about, calories in food are disposed of before they can cause any weight gain.

The drawback of this strategy is ketoacidosis. If glucose is unavailable as a source of energy because of a lack of insulin, then fat is burned instead, resulting in the production of ketones, which are toxic. If ketones accumulate in the blood then the blood becomes acidic, and this is called Diabetic Ketoacidosis (DKA), which is a very nasty condition, and can be life-threatening. It is what diabetics used to die of before insulin therapy was invented. In addition, maintaining the kind of high blood sugars that are necessary to achieve this metabolic state greatly increases the likelihood of complications such as blindness, kidney failure and nerve damage.

The practice of under-dosing insulin and continuously hovering on the brink of ketoacidosis has been termed 'diabulimia', and it has been proposed in some quarters that it should be formally recognised as an eating disorder associated with diabetes. So when RSB and I found out that there was to be a talk on ED and lifestyle, we thought it would be really interesting, and very relevant to our work. Unfortunately, another meeting about student placements that we really had to attend had been scheduled at the same time.

Nobly, RSB volunteered to go to the student placement meeting while I attended the ED talk. The room filled up, and the speaker started with some slides about how inactive the UK population had become, and how this is contributing to the obesity epidemic. Nothing new for me here, but I wondered what the relevance was to Eating Disorders. I also wondered why so many doctors had turned up, because they are busy people and I didn't think that the topic would be a priority for them.

Two minutes later I quietly slipped out of the room, and went on to the student meeting, which had pretty much finished. RSB filled me in on what had happened there, and asked what I had learned in the ED lecture.

"You thought the same as I did, didn't you, that ED stood for Eating Disorders" I said.

"Yes," he replied, "Doesn't it?"

"Ah," I said. "No. It turns out that ED doesn't stand for Eating Disorders where diabetes is concerned."

"Oh." He thought for a moment. "What does it stand for, then?"

"Erectile Dysfunction."

Once he had finished laughing, he amused me further by telling me that he had met the speaker just before the talk, and apologised that he wouldn't be able to stay, but said that we were very interested in ED and lifestyle and I would be there and would feed back to him, and we could take the speaker's contact details if we needed to follow up later. On reflection, I don't think we will.

Another local meeting

Durnstein, October 2012

I continue to attend meetings of the grumpiest Diabetes UK local group, purely because of the occasional useful speaker. This time they had advertised a talk about 'The D-Diet', so I arrived nice and cynical, with my Diabetes Dietitian hat on, ready to do battle with some nutter with a passion for some crazy diet or other.

In fact I couldn't argue with the lecture in terms of nutrition. The speaker was from an animal welfare charity, which had clearly done their research and realised that their target audience could include people with diabetes as well as animal lovers - the diet for diabetics being advocated was vegan. And not just vegan food, but low-fat vegan food. And not just low-fat vegan food, but low-fat, low-glycaemic index (GI) vegan food.

It's usually possible to sustain a healthy vegan diet, forsaking all animal products including meat, dairy, eggs and even honey. A vegan diet is by definition low in saturated fat, and generally high in fibre, so low-fat and low-GI aren't too hard to achieve unless you go crazy with veggie burgers and banana fritters. The main nutritional risks are likely to be deficiency in vitamin B12, iodine, vitamin D and omega-3 essential fatty acids.

• B12 is only found naturally in animal products, although there are some fortified foods like marmite, so supplements are often needed. 
• Iodine is mainly in seafood - salt used to be fortified, but nowadays in the UK it isn't, so many people are deficient in iodine, and not just vegans. Green leafy vegetables and seaweeds like kelp are recommended vegan sources.
• Vitamin D is a hot topic for all of us, because the cancer campaigners have been so successful in persuading us to cover up, stay out of the sun and use high factor sun blocking products. This has helped no end in reducing the incidence of skin cancer, but the main source of vitamin D is from sunlight, so deficiency isn't just a vegan problem. A bit of safe exposure to sun, plus fortified foods and supplements are the answer.
• The omega 3 essential fatty acids are mainly found in fish, but also seeds and nuts and some marine algae - I'm not sure whether vegans consider algae to be animals or not.

I'm sure that a low-fat, low-GI vegan diet would be beneficial in terms of blood glucose control and cardiovascular health for most people, whether Type 1, Type 2, or not diabetic at all. With my cynical hat on, however, I think the main benefits would arise from weight loss due to the difficulty of working out what on earth to have for dinner, and then packing enough calories into a diet of wholewheat grains and high-fibre pulses, vegetables and fruit (but only low-GI vegetables and fruit). It would challenge a committed animal lover who had an active interest in food. The idea of anyone in this audience, mostly aged 60 and upwards, changing their diet to beans, tofu and kelp - with a sprinkling of hemp and linseeds on their natural oat cereal, then tucking into their Quorn and bean dinner and soya dessert - well, let's just say it seems very unlikely.

I think the audience probably agreed with me, because the questions at the end weren't really questions. One lady said she'd been a vegetarian nearly all her life, and she had still developed Type 1 diabetes, although she acknowledged that maybe it had arrived later in her life than it might have. Another man advised the speaker to read New Scientist magazine, because there were much more helpful developments towards curing diabetes in that publication. A third claimed that Type 2 diabetes had much more to do with genetics than lifestyle, and told someone else in the audience to 'shut up' when they tried to interrupt. They really are an unattractive bunch. And still nobody has voluntarily talked to me, or asked me my name or what I do for a living.

The group committee are going to ask the members for feedback about how we find the meetings, and what kind of activities or speakers are wanted. I haven't yet decided what I might say.

Holiday and home

Great Glasshouse, National Botanic Garden of Wales, May 2013

Have you been waiting impatiently for a report from our holiday? Or are you more interested in that teaser for the gestational diabetes blog? Or perhaps you are just one of the elite readers (for 'elite' read 'very few') who continues to support my blog despite its increasingly dry and technical content, either because you know me or because we are directly related? You are all heroes to me. As are other readers, although I doubt that there are any.

Cardiff pub

The holiday was pretty good, it didn't rain, we stayed with friends (Thank you, Bee Lady and Landrover Man!), then in a B&B, and then in a tent. It was mostly in Wales, and the highlights (in brief) were a lovely long walk with BL and LRM, the Cardiff pub nearest to our B&B, and the trip to the National Botanic Garden of Wales. This last has supplied me with many lovely images that will be presented on these pages in future posts. I'm not short of blog images at the moment; I've still got plenty from the German holiday, some from the park up the road during an unexpected bike race, and even some from the cruise back in October last year.

Local cuisine

We came home for the bank holiday weekend, which remained fine and even warm at times, and I did quite a bit of tidying up in the garden while Mr A mowed the meadow. Lady Decorator will repaint the hall starting next week, and we are waiting for the saintly Alf to come back to us with a date when he can start some work which should hopefully cure a chronic damp problem in one of the outside walls. So the deterioration of Lola Towers may be halted for a brief interlude before entropy kicks in again without mercy.

Since coming home from the holiday, I have finally decided to give in and look for a room to stay in for work during the week. I went to view one this week, which would be a Monday-Friday rental for about the same cost as the fuel I'm using to drive back and forth. The main downside is that I will have to leave my current badminton clubs and find new ones, but I will gain precious hours of leisure time and be much less tired, especially towards the end of the week.

Bute Park, Cardiff, May 2013