Speedy, healthy and fishy

There's been too much going on for me to spend much time enjoying my new expanded electrically-lit living space, but I have dipped into the upstairs room most days to turn the lights on and off just for the enjoyment of it. As Lola II pointed out, the downstairs door that was initially so exciting to open and close must be fairly envious now it's getting no particular attention (although I do still experience a slight thrill when I use it). My delight with the upstairs light will no doubt pass into normality eventually, like the door, and the door handles, and the other lights, and the garage, and everything else. But at the moment simply turning a light on and off is a treat. Planning permission for the kitchen has now been granted, so the fact that I've been able to cope with a few other jobs at the same time makes me feel like a superhero.

In the last week at work I managed to implement a development regarding Christmas cards, whereby I let everyone in my local team know that instead of giving them cards I would make a donation to Diabetes UK. I invited them all to do the same, but only two joined me. It worked well for me, and I plan to extend it to include more colleagues next year.

Two weeks ago the evenings were full of mostly badminton - one club night, one match, one tournament and one Christmas meal, and - unusually - we won the match. The other weekday evening disappeared into the longest working day ever. I got caught up in a conversation with the doctors at the end of the day, which was interesting but not particularly important, and gave me no opportunity to extract myself gracefully within a reasonable time.

Our concert went well at the weekend given that I was sight-reading second clarinet because of a player dropping out at short notice with a broken wrist. Playing the tenor saxophone has been pretty good but I'm going back to the baritone sax next term, and looking forward to it. That weekend I also baked a gluten-free lemon drizzle cake and a dairy- and egg-free chocolate cake because Monday was the last club night before Christmas at the other badminton club, and there are players with dietary intolerances.

Tuesday started with a Speed Awareness course. In November I got caught by a mobile speed camera on the way to work doing 37mph in a 30mph zone. That was actually because I was going to work later than usual; at my regular commuting time the traffic is too clogged up to go that fast.

It was an interesting morning in a large group being reminded of speed limits for various types of road and types of vehicle, and spotting hazards in a short video and still photos. Rather than dry figures for stopping distances at various speeds they used the stopping distance at 30mph as the comparator, and told us what speed we would be doing at that point if we were driving at higher speeds, because most of the speed reduction is achieved in the last few seconds of braking. I found out that there are only 35 fixed camera sites in the whole of Warwickshire and not all of them are active at any one time, while there are 60 mobile locations but only three vans (and generally only two out on the roads at a time). I also know now about gateway signs and repeater signs, which are different ways of telling you what the speed limit is.

The key things are that by attending the course I have avoided getting three points on my licence, and I have to avoid getting caught again for three years because in that case prosecution (i.e. points) is unavoidable. Certainly at the moment I'm being much more attentive to speed limits, especially in the spot where I was caught.

That wasn't the only appointment on Tuesday. I followed up with the routine NHS Check that's offered when you're my age in order to estimate your risk of cardiovascular disease. They measure height, weight, BMI, activity, alcohol, smoking, blood pressure and take a blood sample for on-the-spot cholesterol. My results were as I would have expected - very good level of activity, great blood pressure, BMI not bad (borderline overweight, doh! I can't seem to shift this), very little alcohol, no significant family history. My total cholesterol is higher than is desirable but includes a high level of HDL (good cholesterol), so that the ratio of total cholesterol:HDL is well within the ideal range. Overall my risk of having a cardiovascular event (heart attack or stroke) over the next 10 years is 2.7%. The average for my age and sex is 2.6%. I am considering doing something about my cholesterol level. I could certainly cut back a bit on the saturated fat and I haven't been eating much oats, fish, soya or pulses recently - but making up for it over Christmas with fish at least.

There was more to come on Task-based Tuesday - kitchen shops. Now that I have planning permission and an agreed outline plan of the new kitchen, I thought it would be easy to get some help from people whose job it is to design kitchens. How wrong I was. The two shops I visited (one large chain, one small independent) absolutely refuse to do anything for me without detailed architectural plans that define every measurement of the new layout, including location of utilities such as gas and water. They agreed that it was a Catch-22 situation - in order to get help in designing my kitchen I need to give them a detailed design of my kitchen. I have investigated briefly, and there appear to be a number of online tools that may help me.

From Wednesday onwards there were no more appointments and commitments outside work, my evenings were free, and then four days off for Christmas. I planned menus and put in an order at the fishmonger. I actually went for a run on Thursday! and it wasn't bad at all. Work was very quiet as nobody really wants an appointment on the last working day before Christmas, and it gives me a chance to catch up on clearing out the pile of stuff that I've accumulated over the year. Some interesting items in there!

I followed up my Thursday run with Parkrun on Saturday, picked up my order of fishy treats from the fishmonger, then a few jobs in town and then Christmas arrived. The oysters were surprisingly enormous and almost defeated me - they definitely defeated my oyster knife. I was planning to eat half a dozen in each of two meals, but they were so huge that I went with just four at a time and it was plenty.

Now Christmas is almost over and I have to motivate myself into greater activity. I was going to prune the Wisteria but the online gurus seem to be saying February not December, so I'd better wait. I need to get rid of the compost bin and carry on tidying away the various items like flower pots, buckets, planters and such which have seemingly found a permanent home in the garden. There's always something to do, although sitting and reading or watching films has certainly been significant in this household over the last few days.

More meetings and pump clinic

Bridge over the Danube, October 2012

It's becoming increasingly difficult to know what I have and haven't written about, especially now that there is so much going on. I have related different stories to family and friends starting and stopping at different points in the saga of getting to grips with a new job and all that entails, and I can't exactly remember what I've put in this blog. It's tedious to keep reading back over previous entries, and I don't have a great deal of time to do it, so I'm just hoping I'm not repeating myself too much.

Last week was a good week, I observed lots of things and didn't get too tired. This was probably because events prevented me from playing badminton: a social event organised for new starters, a Diabetes UK meeting, and a planned dinner with previous dietetic colleagues that ended up not happening. This week I have already played badminton three times, and now I am very tired.

The large and important departmental meeting about convergence of the hospital diabetes services from two sites to one was more interesting than I was expecting. There was general consensus about the principles of a re-modelled service, which was the point at which I made my getaway. Those who remained endured another two hours, and those I spoke to next day seem to agree that I departed at the perfect time, because no further progress whatever was made.

The local Diabetes UK meeting was its normal unfriendly event - would it kill any of them just to say hello? The subject was Driving and Diabetes, and the talk was given by someone from Diabetes UK. It was mostly about the change of law in 2011, the circumstances in which the DVLA can take away your driving licence, and what you can do to get it back. I left before the raffle.

My colleague RSB has been working hard to devise a timetable to allow us to cover all clinics in an equitable manner. I'm not entirely sure why this has been so difficult to do. At the moment, my only disappointment is that it looks as though I will be covering an ante-natal clinic on a Friday afternoon, which means seeing all those women who are newly diagnosed with gestational diabetes. Given the nature of the condition, it is possible that there will be any number of patients from 'none' to 'all' of the clinic list, and may make my Friday afternoons run rather late.

As well as this clinic, I will be doing general adult clinics. These will mostly contain patients with Type 1 diabetes, because the newly formed Clinical Commissioning Group (which replaces the Primary Care Trust) has demanded that Type 2 patients are discharged into the care of their GPs in the community. RSB will take care of the pump clinic and patients using continuous glucose monitoring, the main ante-natal clinic and the young persons' clinic. Given time and more experience and I may well need to cover these when he is away. But not yet.

I observed a pump clinic this week. Attendance is optional, but it is for patients who use an insulin pump instead of multiple injections to control their blood glucose, and runs for two hours once a month, covering a different topic each time. An insulin pump delivers insulin subcutaneously via a metal or plastic cannula that remains in place for 2-3 days at a time, and has a number of advantages: no need for separate injections, a little bit more discreet, and potentially greater accuracy in insulin dosage and delivery, ideally leading to better control and fewer instances of unwanted high or low blood glucose levels.

For example, secretion of insulin in someone without diabetes consists of a continuous background trickle that may vary according to levels of stress or hormones or time of day, plus increased bursts to match the surges of blood glucose following digestion of carbohydrate foods. For someone with insulin-dependent diabetes who doesn't have a pump, the background insulin is supplied by a once- or twice-daily injection of a medium- or long-acting basal insulin, and the post-prandial insulin is injected as a bolus of short- or rapid-acting insulin, ideally shortly before eating. The background dose can't be changed easily, as it is released slowly over many hours. Although the action profile of the basal insulin is relatively flat, there is a period of maximum effect, and if not matched precisely to carbohydrate intake this peak can be at an inconvenient time (e.g. during the night) and cause hypoglycaemia.

With a pump, both background (basal) and bolus insulin is rapid-acting insulin delivered from the same reservoir in the pump. The pump rep who also attended the clinic answered lots of my questions, and also described the research they have done to map the requirement for background insulin through the day, which can be set up on their pumps. This means that a circadian profile of a trickle of insulin varying hour by hour can be delivered to mimic the 'normal' insulin profile for any individual, to try and minimise nocturnal hypoglycaemia. A step forward indeed.