A good week for puddings

Leamington Food and Drink Festival, September 2016

In the time since that lovely, warm holiday the memory of lovely, warm days has faded and I have taken to wearing socks in bed to avoid waking up in the middle of the night because my feet are cold. The drive home from the airport was dreadful. I thought that because it was around midnight, the traffic would be kind and I would be speeding back home on a deserted motorway. The Powers That Be evidently knew of this plan, because they chose to close the motorway. They also chose to close my alternative route, and it all meant I got home considerably later than planned, although on the positive side I did get to hear lots more of my audiobook. And I think I drove through Surbiton, but I can't be sure.

I am Cold! I am Itchy! but the good news is that the frozen shoulder is almost recovered, with just an odd twinge now and then to remind me. Badminton has resumed with quite a lot of matches as well as the club nights, and an abundance of work events.

The first thing I did on Monday morning after the holiday was to attend a course to introduce ten of us to a shortened version of our four-day carbohydrate counting course for people with Type 1 Diabetes. The course has been created by one of the diabetes technology companies in association with experienced Dietitians, and is designed to be delivered in 3 hours. I have some reservations about the whole thing but we may try a pilot event if we think there is demand. Lunch was available as well.

Badminton club #1 in the evening. Monday puddings = 1. I remained in control of the pudding situation.

Tuesday: day off. Man from Dampco turned up promptly at 8 a.m. just as I was coming in from photographing the car parked outside my garage. 8 a.m! This was because he actually lives 50 yards from me, and he was very helpful and didn't even require payment. Essentially the plaster is wet because it has been compromised by being wet, and although I have dealt with the cause of the wetness the plaster needs to be stripped and replaced before it will behave itself properly. Further chit-chat revealed that his father founded the company, he hopes to pass it on to his nephews, and I offered to buy him a drink if I saw him in the pub. This seems unlikely because I hardly ever go to the pub any more.

Photographing the car outside was because I'm thinking of contacting the Council about the white line demarcating the entrance to my garage, which doesn't quite extend to the full width. A car parked legally can obstruct my access to quite a large degree, although so far I've managed to get around it. A car parked only slightly illegally would properly stop me driving in or out, so I have to make the decision whether to start the process of trying to get it rectified, or just to live with it.

I was also expecting my first HelloFresh delivery on Tuesday, courtesy of Mr M and Lola II. This comprises three boxed meals in the form of measured ingredients and recipes. I had been putting it off for a month because of holidays and not being at home, and I probably should have put it off for longer because last week was particularly full of other people giving me lunch and badminton in the evening (so no evening meal). But when the doorbell rang it was actually Man from the Planning Department making a site visit following the request for planning permission for the kitchen extension. They pay a bit more attention because it is a Conservation Area, but all of the the proposed alterations are at the back and not visible from the street so there shouldn't be a problem. Apparently my neighbours have already been contacted in case they want to object and there's even one of those notices attached to the lamp post with cable ties. I was astonished when someone at badminton mentioned that they'd seen the notice in the local paper too. I had no idea that anyone ever read those notices.

Badminton match in the evening (lost 7-2). Tuesday puddings = 0. I do not keep puddings in the house.

Wednesday was an ordinary day at work without any badminton or puddings. But Thursday was another study day, this time at the Diabetes Education Network conference. I had high hopes but it was most disappointing. There were presentations from the people who created various programmes (DAFNE, DESMOND and X-PERT) about how they had audited their education to prove that it is effective and meets NICE guidelines, but this is neither interesting, novel nor enlightening. One presentation even showed us all the teams around the country who had won awards for delivering the most courses, or getting the best results for their patients, which was simply a waste of my time. The team that developed the course that we deliver to our Type 1 customers spent most of their session finding out from all those present how we had improved upon their course, and didn't give us anything useful in return.

The only worthwhile session was one from a most controversial Dietitian who believes that saturated fat is good for you. She avoided that particular topic but still irritated me by, for example, focussing on how many grammes of glucose are in the whole of the bloodstream of a non-diabetic person as if that were important. The only reason the session was worthwhile is because I may be able to find a ready-made comparison of the pros and cons of various diets in Type 2 Diabetes without having to construct it myself. However, despite the disappointing content of the conference, the puddings at this particular venue were something else.

Badminton club #2 in the evening. Thursday puddings = 4. They were amazing.

On Friday I had an unusual morning in that every slot in my clinic was full, and all but one of them turned up. This was the day that the lunch for our ex-colleague was scheduled, and luckily she was collected to make sure she came, and many people made the effort to turn up. Speeches were delivered, flowers and a card and presents were handed over and it all seemed to go very well. The only thing that made me laugh was when a colleague told me that during the event the departing nurse whispered that she felt "a bit of a fraud accepting all these presents, because I'm coming back to work soon."

Friday puddings = 0 although there were chocolate biscuits. And cheese. Lots of cheese.

Despite having a number of Very Important Tasks to complete, on Saturday I managed to stay in bed for a considerable proportion of the day before I dragged myself into the garden to pay a bit of attention to the lawn and the shelves in the garage. On Sunday I didn't even wake up until 10 a.m. and was similarly unproductive for most of the day. I did manage to make the second of the HelloFresh meals - I divide the portions for two into three and it's still plenty. But because I try to have only breakfast and lunch on badminton days, the ingredients have to hang around for quite a long time unless I cook it all and freeze the portions. All the meals so far have been tasty, but I don't think I can manage a regular delivery.

Borough Market, May 2016

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.