PDR, VLC group and DUK PC

Peckover House, August 2014

I haven't written much about work for a while, so here goes.

I had my annual Personal Development Review (PDR), I hosted our monthly Very Low Carbohydrate group, I went to the Diabetes UK Professional Conference in London, and of course there were the usual clinics.

It's going quite well, although I'm having rather too many good ideas. When I have good ideas I tend to get a bit obsessive, the ideas blossom and grow, they expand beyond the available space and instead of a tidy achievable project designed to meet defined goals I end up imagining the biggest, best, most complete and perfect solution to put an end to all conflict in the world. Then I realise it's totally unachievable and start to doubt whether I can do anything at all. I have a good deal of respect for people who can come up with a sensible and successful idea, put together a plan and then see it through into practice.

I'll give a small example - Carbs and Cals. This is a book, and much more. The author is a Diabetes Dietitian who got together with a photographer friend and took photographs of different portion sizes of various foods, then put them in a book with labels showing the amount of carbohydrate in grammes and the calories in each portion. It was the perfect solution to a problem faced by every person with Type 1 Diabetes and a lot of those with Type 2 - how much carbohydrate is in that portion? Carbs and Cals will show you.

The book was so successful that it has expanded to show Carbs, Cals, Protein, Fat and Fibre; there is a website, a phone app, flash cards, teaching resources and much more. One manufacturer in the diabetes world includes a copy of Carbs and Cals in the box with one of its blood glucose meters. Diabetes UK has lent its logo to the cover and sells the book via its online shop. I met the author at the conference last week. He is the nearest thing to an A-List celebrity in the diabetes world - every single person of the thousands in that conference centre would have heard of him and his book, but he seemed pretty modest and unassuming.

The point is, he came up with an idea and saw it through. He probably spent an immense amount of time and money on it, presumably found his own publisher, designer, editor, set up sales channels - and I can't tell you how much I admire and envy the talent and commitment he shows, because I think it is unlikely that he was given much time to do it at work - I don't know for certain, but I'm guessing he did it all in his spare time.

I want to create an online resource to support our patients who have taken on the very low carb lifestyle, and I am in the wild imagining stage. My idea has exploded to include more than a website: I am imagining a discussion forum, recipes, pictures, an app, published research papers, a blog, a secure section where people can record their blood results, live interaction with Dietitians, links to SMS text messages, Facebook, Twitter, Instagram, Pinterest, anything and everything. I need to scale back my ambition and make it achievable. At the moment I cannot access any of these elements from work, due to restrictions imposed by the IT department. Almost everything is blocked and my browser is so old that many ordinary websites can't be used properly.

This project is one of my PDR objectives, so at least I should be supported to do it in work time, although I expect I will have to put in a bit of extra effort if I want it to succeed. My other main PDR objective is to get more involved in pump clinics. Up to now I've concentrated on acquiring the basic knowledge that applies to the majority, but for a number of reasons, this is a good time to focus down on the minority who use CSII - continuous subcutaneous insulin infusion, or insulin pumps.

The number of pump users is increasing as more adults acquire them, and as those who were started on pumps as children transfer into the adult service. Every adult on a pump should be equipped with the skills to use the pump effectively, but it is not so clear cut with children. Anyway, because the general level of diabetes knowledge and skill in the adult population with pumps, I have rather left them alone and concentrated on less able people coming to clinics. But our pump service is set to expand, and there is quite a lot I could be doing to help and support pump users. More on this at a later date, I expect.

The conference. It turned out to be pretty difficult getting funding to attend the conference. I approached the dietetic and diabetes departments and every industry manufacturer and rep that came within two feet of me, which was bordering on humiliating and completely fruitless. In the end, a colleague managed to get a company to pay our attendance fee, but nobody would stump up for accommodation. We eventually had to apply for funding to the hospital's charitable funds, and I got an email 15 minutes before the end of my last working day before the conference letting me know the accommodation cost had been approved. I won't get any reimbursement for travel.

Apart from this, the conference experience was excellent. Being fairly new to diabetes I hadn't been to this event before, but in my old life I had staged a conference with my team and have been to many in this country and in the USA. This one had a lot more money spent on it by the Pharma companies exhibiting and sponsoring the talks than in the world of disability and visual impairment, which shouldn't really have been a surprise.

I saw too much to write about here, but the highlights included:

• a heated 'debate' between one maverick Dietitian who is promoting a diet high in saturated fat, and the rest of the dietetic community who don't believe that the evidence is strong enough to support this approach
• a session on exercise and Type 1 Diabetes (this is one of the most complicated areas I've encountered yet)
• a very useful summary of pump usage given that I'm going to be focusing on this area, and 
• links with various people who talked to me about whether and how their NHS employer allows them to use state of the art technologies.

So lastly, my low carbers. I started to worry that the group would fizzle out - a few people have left, either because they are successful or because they can't manage it any longer, which is why I'm so keen to create something online to help them. For this month's meeting I bought a cookbook of Low Carb Gluten Free Vegetarian recipes which source their protein mainly from eggs, cheese and tofu, and I reckoned the group probably hadn't cooked with tofu before. So I cooked one of the recipes (teriyaki tofu with broccoli), bought a few different types of tofu (firm, silken, marinated) for the group to taste, and printed a selection of tofu recipes. It was one of the most successful meetings so far. And they are all doing well, still losing weight and maintaining great blood glucose control.