Birthday happiness

July 2020

In the week leading up to my birthday I signed up to an online Buddhist retreat, to be undertaken at home. Usually a retreat takes you away from all mundane cares, with nothing to worry about except trying not to be late for meals and the scheduled sessions, and there aren't all that many of those. On the other hand, at home there's still all the usual stuff to be done, and in my case many tradesmen to communicate with, and it was difficult to separate myself from phone and Internet and TV. 

I also signed up too late to be able to take time off work so I missed the sessions on Monday and Tuesday, and as well as work there were still my usual evening meetings on Monday and Tuesday, and I had a pre-existing meeting on Wednesday. The retreat sessions were recorded and available through a web page, but I never did catch up. It was a very full week.

The day before my birthday Lola II and Mr M and I went to see mum and dad, and I brought shopping from Lidl which mum misses above all things. The weather was perfect so we could sit outside, and we brought our camping stoves and cooked our own lunch. I went home with Lola II and Mr M and we ordered takeaway Japanese food in the evening, and took part in the latest scheduled Zoom meeting with friends - a quiz.

Lola II and Mr M gave me some plum chutney made from their home-grown plums which I'm looking forward to trying. Such a shame that their grape vine has died, I really enjoyed the grape jam, although the diet doesn't really allow for much jam at the moment. I'm still losing weight but more slowly - 5.7kg down now, and hoping for just 1kg more. I started the diet because my clothes were too tight and I didn't want to have to go shopping for new ones, so there's little point in reaching a situation where I have to go shopping because my clothes are too loose.

The weather for my birthday was as lovely as the previous day, and as I chatted to the man behind the fish counter at Waitrose about it and mentioned that it was my birthday, he stuck a label on my purchase indicating that it would be free of charge! Then when I arrived home I noticed a skip outside my neighbour's house which had a couple of bar stools in it. They looked a bit dusty but seemed intact, and were a perfect match with my existing bar stools and the colour of my kitchen walls. It has occasionally been awkward having only three stools, so I took one out and cleaned it up (with permission from the skip owner who is having a clear out before moving away). 

And so endeth the birthday, with a fish supper, while sitting on a stool, enjoying the glorious sunshine of a lockdown summer.

Several types of progress

Brompton Cemetery, September 2019

Lockdown is ending, and my drive to work twice a week is clogged again with other traffic going about its business once more. More shops are open although I have no desire whatever to go inside them, nor will I bother with pubs, restaurants, theatres and cinemas. The easing on restriction about meeting other people in real life is quite exciting, so I went for a walk with a friend on the hottest day of the year so far. And camping is about to be possible again...

The main bonus of fewer restrictions has been my ability to get started on the LTRP again. Ilf finished painting the front of the house, garage door and gate - I decided not to bother repainting the other sides of the house, which meant we managed to use up the last of the specially mixed paint from 10 years ago without having to buy more. I've had a couple of plumbers in to have a look at turning the shower room into a wet room and solve some of the associated drainage issues, so I hope that will go ahead soon. My gardener returned, and I even managed to find someone to have a look at the damp at the base of the pub wall. The garden is still as wild as ever, but with fewer weeds, especially in the paving. I took the bags of excess greenery to the tip, which now requires online booking for a time slot. All went smoothly.

There have been all sorts of attractive offers in the last three months for your 'heroes' of the NHS. I feel a little guilty given that I have done none of the heroic jobs; all that's happened is that all our consultations are being done over the phone, which is difficult but by no means heroic. Yet I have succumbed to the lure of 10% off shopping in Morrisons with an NHS ID card, and another offer of £10 off a box of 12 different vegan pot meals from The Soulful Food Company for anyone with an NHS email address.

I've had indifferent experiences with various 'meals in a pot' before, but these ones looked so good on the website that I thought I'd have a go. Because there are 12 different types I decided to note down any that I particularly liked in case I wanted to buy them again. The first was delicious! I decided to give it the full five stars. The next was just as good - also five stars. By the time I'd had six of the meals I'd had to introduce a sixth star, and so far only one has fallen short and even that one was still delicious. I'll be buying them again, even without the £10 discount.

I had a bit of a blip with the weight loss plan when a friend came round and we each got a takeaway wrap from my favourite brunch spot in Leamington. It was delicious, and just proves that without the lockdown I would never have achieved my current status of 4.6kg (10lb) lighter. I'm back on track again, and finding it much easier to plan meals than I did at the start. It's still a pretty restrictive diet though, and I don't see any way round that. But I can fit into clothes that have lurked in the back of the wardrobe for six years.

Still locked down

Adhisthana, July 2019

Here I am again, in my house, walking or running around Leamington's lovely parks, or at work in the Diabetes Centre. With a weekly excursion to a supermarket, that's it. But I'm thriving. I'm eating sensibly and losing weight very slowly, but unlike previous attempts at weight loss I think I can keep this up. While I hear most people talking about gaining weight at home, it's been relatively easy (after the first couple of weeks) for me to keep to my 1200 kcal limit, and even include chocolate every now and then.

I have mowed the lawn and pruned a load of shrubs, and then with the easing of the lockdown I have been in touch with the Lady Gardener to beg the favour of a visit (scheduled for June). I also contacted Ilf about external painting, and he's going to get back to me with an idea of when he might fit me in. Doors and Windows Ulf can do nothing about my front door at the moment because his suppliers aren't working, but Clf the Roofer may be able to help with my hall windows which he was so scathing about when he renewed the roof six months ago. Which then meant that I would need access to the pub garden, and the pub is most definitely still closed.

A sign in the pub window provided a phone number for the security firm responsible for keeping the site secure, and a helpful man even answered the phone. He disclosed a lot more information about the pub management than I was expecting, including the fact that the previous management is still responsible for the pub, but the interior has been stripped of all valuables and will need tens of thousands of pounds to restore it to a functional state. As well as this dire news he provided the combination for the padlock on the gates of the beer garden and told me that the lock is very stiff. So stiff that I haven't managed to prise it open yet - today I applied a load of penetrating oil and we'll see whether that helps.

Other activity at home includes jigsaws, games and socialising via Zoom, Buddhism three times a week at present (and a fourth time when I joined a thing at the weekend) and I re-started a tiny OU creative writing module online. I first started it about two years ago so had quite forgotten what I had done back then, and re-reading my own work after all this time was a delight.

So all is well for me in my little bubble, hoping for the lifting of restrictions on hairdressers while appreciating that such close proximity means I wouldn't be comfortable going to the salon even if it were allowed. The weather has been glorious with more sunshine to come, and the news reports tell of a reduction in the infection rate and mortality figures while warning of the seriousness of the recession to come. We certainly live in interesting times.

Flattening the curve

Juma Lake Inn, Amazonia, April 2019

What with work only being two days a week, I have a lot of time confined to Lola Towers except for my one exercise break a day. I signed up to the zombie-based Couch to 5K programme and it's going pretty well, as it's quite easy to find time for a run three times a week, and on the zombie-free days I usually go for a walk somewhere local, especially in this lovely weather. That was fine for three weeks, then I unexpectedly discovered that you have to pay to continue so I have reverted to a different app. I do miss my zombies, though.

Shopping for fresh goods is no more than once a week, and for two weeks I had a HelloFresh food delivery. The first one was because they offered a hefty discount, and the second was because I forgot to cancel after the first. I'm still on the calorie-restricted diet, which has been quite tricky with the HelloFresh meals because they are pretty rich. I've had to divide their recipes for two meals into three and in one case into four to get them to fit into my daily calorie budget, but it is getting slightly easier to manage and I'm not feeling hungry absolutely all of the time, which I was at the start. Weight loss is only a paltry 1 kg in three weeks, but at least it's going in the right direction and I think it is sustainable.

Along with cooking and running there's been quite a lot of online activity with this great communication tool, Zoom, which nobody seemed to know about a month ago but now we are all experts. I've had Zoom meetings for dinner, three times for games, for several sessions of Buddhist meditation and discussion and team meetings, and for a tour of four paintings in the National Gallery led by Lola II. At one point I actually felt I'd had enough of this social activity and was longing for the old days when I could be properly anti-social. Now everyone knows where you are: at home.

Sometimes there's extra online time with mum now that our remote control system is working nicely. I'm still grappling with the task of changing my email address and passwords with about a hundred different people and organisations - alphabetically I've reached the letter M so still some way to go. I've got my DVD subscription and I'm also ploughing through all the episodes of Friends and ER, although I don't like sitting watching the TV for too long. And, due to my pestering mum about the food in her kitchen cupboards I found myself in possession of nearly a kilogram of out-of-date ground almonds, so I've made a couple of cakes and taken them to work.

But I'd say the Buddhism has taken up the most time, all via Zoom or YouTube. On Mondays our study group continues, on Tuesdays it's the local group and on Thursdays I can join a meeting with the Birmingham group if I want to. One weekend there was a day-long online retreat (we weren't online all day - that would have been exhausting). Another weekend there was a seminar for people like me who are involved in the organisation of groups, all about the different ways to take our groups online. And I also watched a public ordination, where an individual became a member of the Triratna Order and took on a new name, all within the confines of the current social distancing restrictions. And I'm meditating regularly, which helps with the confinement.

For the first time in ages my list of Things To Do is getting shorter rather than longer, and I've got out some old jigsaws. Of course what I ought to be doing is going through the stuff I put in the loft to get it out of my line of sight, which worked so well that I've hardly thought about it until now. Maybe next week. And there's the garden, which I thought would be so manageable with the help of a gardener, but I'm back on my own again and it just keeps growing.

Social distancing

Rio de Janeiro Botanical Gardens, April 2019

This is certainly the strangest period of time I have lived through. Nothing has come close to this level of disruption to ordinary habits that I previously took for granted.

Apart from the cancellation of all formal social activities and gatherings, the guidance on what we should individually do is making me think hard about my daily routines. I am more happy than most to spend time alone and avoid social contact, but I have been surprised by the extent to which I miss seeing people. Work is now the only place where I get to talk face to face, and so my work colleagues have become quite acceptable people to talk to where previously they were a long way down the list. I'll be writing more about work in a future post; there's a lot going on.

This period of social isolation has coincided with an interesting conversation with an old friend about an online weight loss program with which he has achieved amazing success (he's lost enough weight to reverse his Type 2 Diabetes). I was persuaded to give it a try, and have been restricting myself as it advises, to 1200 calories a day for the last 12 days.

There is an app, and you log your food and your steps and it gives you little pep talks every day based on evidence of what it takes to lose weight and keep it off. There is very little there that I don't already know, but it is the first time I've tried to log everything that I'm eating, and I have to admit that it works quite well to keep me on track. I still feel deprived - 1200 kcal isn't very much - but I have managed to save enough of my calorie budget to include some chocolate on a couple of days. The app is free for two weeks and then they propose to charge me an absolute fortune - my friend is on a much cheaper plan, perhaps because he had much more weight to lose. So I plan to unsubscribe, but if I keep on tracking my calories and steps using free apps I might actually achieve the change that I'm looking for.

Of course the other side of weight loss is calories expended in movement. No badminton! No unnecessary excursions out of doors! What am I to do?

Well, walking, cycling and running are all that's left while we're still allowed out of doors for our one form of exercise per day. I thought I would have another go at running, and a friend recommended an app for listening to while running that ought to make it a bit more interesting - it's called 'Zombies, Run!' It provides a story to accompany the tedium of running which, as you might guess, involves running away from zombies. I've only listened to the introduction and the first 'workout' so far, so we'll see how I get on. It lets you play your own music in the background as well, which is a great help.

Then there are my Buddhist groups which all shut down for a period of active online discussion about what we should do next, resulting in the use of various online methods. I've done my first two using Zoom and Skype and it's certainly better than nothing, but not as good as face to face meetings by a long chalk. All of the retreats I was so looking forward to in the spring and summer have obviously been cancelled, and the Leamington Peace Festival, and the cousin from Seattle's visit, and family weekends, and even a work study day that I'd somehow been allowed to book. I haven't given up on July and August yet, but I think the chances are slim that the restrictions will be lifted by then.

New approaches to diabetes management

Lily, June 2018

There is much in the diabetes news about developments for people with Type 1 diabetes (Flash Glucose Monitoring using the Libre device) and Type 2 diabetes (Very Low Calorie diets leading to diabetes remission). The Trust where I work, however, is not forward thinking, innovative or dynamic, so we still haven't done much to make either of these available to our patients.

In our little team we were hoping that the doctors and/or the Clinical Commissioning Group (CCG) would feel the pressure from patients and organisations like Diabetes UK with all the media announcements that FGM (an unfortunately acronym) technology is now available on NHS prescriptions. Not in our area, it isn't. It has made it onto the local 'Formulary', which is a list of things that can be prescribed, but no protocol or procedure was forthcoming which would make it actually possible to prescribe it. In the end we gave up on the idea that the doctors would do anything at all, so the nurses and I have tried to come up with our own local protocol to put forward for approval Trust-wide.

It is quite an interesting process, because the device is so different from what you normally get when you hand over a prescription to your pharmacist. The Libre consists of a handset as a one-off device at the start, and disposable sensors that last two weeks at a time. At the moment we also believe that users should have some initial training (or at least guidance) about how to make best use of the device. The CCG has defined the criteria that have to be met before the device can be prescribed at all, and other criteria that have to be met if it is not to be withdrawn after six months. A bit different from a prescription for a 10-day course of antibiotics or a tube of ointment.

The criteria for prescription are quite restrictive - Type 1 only, appropriate blood glucose monitoring 8 or more times daily, and one of the following: where success with the Libre would avoid the need for an insulin pump; impaired awareness of low blood glucose; more than 2 admissions a year; or where a third party is needed (e.g. learning or physical disability). And the prescription has to be for a six-month trial period, during which we have to collect data on eight different indicators, and if fewer than two indicators have improved then the trial is discontinued and no more sensors on the NHS.

The Pharmacists have said that they don't want to have anything to do with it, thank you very much, which is fine for the first prescription - we would be happy to handle that, given that we want to have a role in starting people off with some training. After that, though, we aren't in a position to be dispensing sensors every month, so we've got to try to persuade the pharmacists to take that job on. And the Procurement people will have to decide how exactly the handset and sensors will be ordered and recorded, and the Finance people will need to define how the budgets will work and how we will charge the cost to the CCG (because although it's prescribable, it comes from a different budget than for 'normal' prescriptions). And the Doctors are clinically responsible for the prescription so they have to fulfil the criteria set by the CCG. So all of these people have to approve our proposal.

Can you imagine trying to arrange a meeting with people from five different professional groups, at least three of whom are not in the least interested in the extra work that this might entail?

We have started by finding a date convenient to ourselves and our paediatric colleagues (at least the paediatric nurses; I doubt whether there will be a dietitian involved). None of the doctors has replied to the invitation, and we know and work with them (update - one doctor thinks he can probably be there). The Head of Procurement has said that he will find someone to attend; Pharmacist representation is still unconfirmed - we don't have any routine contact with these guys, so I'm not expecting much -  and I have no idea about Finance. I'll let you know.

The other issue all over the news is the effect of rapid weight loss on Type 2 diabetes, which in some cases can induce diabetes 'remission' - a return of blood glucose to non-diabetic levels. The research trial that has generated all the stories is not yet finished, but many people seem to want to try the diet. There's also Michael Mosley who keeps making TV programmes, and the family behind 'Fixing Dad' which also led to a TV programme and more, and every two minutes there's something else in the Daily Mail or on ITV about how you can live forever if you adopt some version of a simplistic and entirely unrealistic lifestyle.

The trouble is that the Calorie* restricted diet used in the (unfinished) research trial was not the sole intervention that led to remission - there was a whole team approach within GP practices, supported by the research team, including dietitians. And not everyone who tried it achieved remission. But the main concern for me is that we know weight loss is difficult to sustain, and the research has not yet uncovered what happens to people who lose the weight but then regain it again. If they experience more serious consequences than if they had done nothing then that changes the complexion of the outcome considerably. We just don't know.

It's still worth losing weight, though, and not eating (or drinking) excessive carbohydrate if you're at risk of Type 2 diabetes, or if you already have it. Even if you do it in a more measured way than by cutting down to 600 or 800 Calories* per day.

(* I tried to write 'calories' because that's how we generally refer to kilocalories, but I couldn't, because it's not accurate and I am a pedant. It's either kcal or Calories with a capital C.)

Three out of five of my team of adult diabetes dietitians are new, and with fresh eyes they have pointed out that we don't really provide much support to people who want to lose weight. We obviously can't compete with successful and rigorous programmes like Slimming World or WeightWatchers (now stupidly rebranded to be just WW), but we don't even have any leaflets that could help people think about losing weight, let alone provide the intensive and expert dietetic input to a rapid weight loss programme for diabetes remission. So we're going to have a couple of new leaflets, and we'll follow the course of the research and maybe work out how to apply the results within our practice. At some point. Maybe.

Not yet Christmas

Adhisthana, June 2018

Lots going on as usual. Here's a rundown of recent activity, not including trips to Parcelforce in Coventry and Christmas markets in Munich. Those will have to wait for another time.

LTRP

The new television is up and working! I had to phone a friend to help me lift it onto the table, and after I'd connected it all up it didn't seem to want to find the Internet or the sound bar. So, ostrich-like, I left it alone to see if it cured itself. I did have a look at the manual and fixed the sound bar by changing where the cables plug in, and miraculously it found the Internet without any further intervention, so all is well at the moment. Let's hope it stays that way.

So with that little project completed I have visited a carpet supplier of national repute and a local shop to have a little look at my auditorium carpet options. I just want a plain dark grey carpet, which I thought would limit the choices a bit, but even so there were seventeen different carpet options in the big shop which seem to be suitable, and no obvious way to choose between them. There is a free sample service so I asked for four samples to be sent, and we'll see how I get on. The local shop suggested just one option, which seems just as unsatisfactory.

Work

I went to an evening meeting about Pancreatic Exocrine Insufficiency, which wasn't very useful but there was a nice dinner and I sat next to a very chatty doctor. Diabetes is a disorder of the pancreatic endocrine system (insulin is an endocrine hormone), but the pancreas also produces enzymes as part of its exocrine activity. These are primarily lipase, amylase and protease to digest fat, starch and protein, and it seems that this function often fails in people with diabetes. Essentially the treatment of PEI is Pancreatic Enzyme Replacement Therapy, i.e. swallowing large capsules of enzymes along with meals and snacks so that they replace the enzymes that the pancreas is no longer producing. The main lecture was about symptoms and diagnosis rather than management, so I now know how prevalent it is in people with diabetes, but no more about what to do about it.

My Team Leader was also there, and she brought me up to speed on what is going on with the DESMOND Type 2 education programme in our region. I mentioned previously that the Clinical Commissioning Group is getting very 'hands-on' with DESMOND, and it seems that courses have a very poor attendance rate and keep getting cancelled in the main area covered by the NHS Trust I work for. Apparently the Trust's Clinical Director for Diabetes (who is also Clinical Director for another couple of specialities) had a very uncomfortable meeting with people from the CCG. I don't have a great deal of time for our Clinical Director because he seems to show no interest whatsoever in directing clinicians, clinics or anything else that is clinical, so this was a very interesting move on the part of the CCG. I don't know whether anything will come of it, but it's testament to my new Team Leader's dogged persistence that this meeting even came about.

Talking of the CCG and education: I had to attend one of the CCG's regular meetings about education for people with diabetes in order to present the results of my evaluation of our short Carbs and Insulin course, which we're calling CANDI (see what we did there?) This was one of the last times I had an idea at work before I became determined to have no more ideas, and it has resulted in a lot of work for me but not much progress. The results show that the people who attended got a lot out of it subjectively, but objective measures don't show much improvement. I then compared the objective measures of CANDI with those from a similar population who attended the longer 4-day carb counting course, and those were no better. What happens next is anyone's guess, but now that we have our tenacious Team Leader I suppose she will have to decide, so I've put it on the agenda for our next team meeting. Which is the day after Boxing Day when I will have even less than my usual motivation to talk about matters at work.

Badminton

Matches and club nights continue twice a week, My duties as Social Secretary led me to try and arrange a 'Not Christmas Social' in November so that we wouldn't get caught up in all the pre-Christmas shenanigans. I offered various dates so we could include the maximum number of people, and Friday 30th November was chosen. Unfortunately in the chosen venue, this night was already designated as a pre-Christmas shenanigan, so the event became the 'Not Not Christmas Social' and fourteen people came along and enjoyed themselves at a local pub. I had the best vegetarian option I think I've ever had in a pub (a pie with mash and veg).

and the rest

I can't remember exactly how it came about, but Lola II was interviewed for a project focussing on views and opinions and thoughts on childlessness from people who have consciously chosen not to have children. She passed the contact on to me, and this week I was also interviewed. It was very interesting and I'm still mulling over some of the things we discussed.

I went to see mum and dad and this time mum had a great job for me to do. Often the jobs I am called upon to perform involve either the computer or a ladder (there were jobs of those varieties on this visit too), but this time it was all about the sewing machine. As well as using the zigzag option to sew hems in shortened sleeves, we took down the kitchen blinds and shortened them by about a foot, cutting off the dirtiest part and revealing fresh fabric. It all went very well and they look great and it felt like we had really achieved something.

There have obviously been other activities at home and at work, but having ended the weight management effort my weight has obviously gone up by a kilogram. I knew it would because I haven't been feeling hungry lately and there have been celebratory meals and food provided during work events (which always leads me to overeat). Now what shall I do?

Kitchen Goddess and Mega Marshal

Run Forest Run, November 2018

My last trip to London combined a study day for work, staying with Lola II and Mr M, and a gathering for mum's birthday. I'm writing about the study day separately, and because it's taking ages and I've been rather busy, I'll do a quick round of other news in this post.

Mum's birthday gathering was slightly marred by Lola II losing her handbag, but the story ended happily when it was handed in without loss. The following day I accompanied Lola II and Mr M to a Games Cafe in Richmond where we tried out three new games: Quirkle, Exploding Kittens, and Sushi Go! We liked Quirkle best.

Between then and now I had a busy week with the usual work, a District Council meeting on Monday evening, a car mini-service, chimney sweep visit and meditation on Tuesday, a trip to Birmingham on Wednesday evening, badminton club on Thursday evening and a match on Friday evening (we lost, but it was good fun with friendly opposition, which isn't always the case).

The Council meeting was about the proposed replacement of a decaying car park combined with the relocation of elderly Council offices. Many local businesses are dismayed at the 'parking displacement plan' and feel that shoppers will be put off by a potential reduction in car parking spaces in the town. Residents are also up in arms at the loss of 42 mature trees (although more saplings will be planted in their place) plus the failure of their planning proposal to follow the Council's own guidelines of including 40% affordable housing. By attending the meeting I achieved my aim of understanding what all the fuss is about while being depressed by the poor standard of debate and the attitudes and arrogance of the Council leader and officers.

The trip to Birmingham was much more fun: I went to a meeting of 'Skeptics in the Pub' at which The Angry Chef was speaking. As the name suggests he is a chef, and I have been following and been hugely entertained by his profanity-filled blog for some time. He writes very eloquently and at length about the rubbish that is promoted by celebrities and others aimed at telling people how and what to eat, or 'nutribollocks' as he terms it. I enjoyed the meeting a great deal - he talks a lot of sense backed up by proper levels of evidence, and I bought his book and he signed it for me.

This weekend was the fifth annual 'Run, Forest, Run' event in Surrey, where this year there were more runners than ever. Lola II and Mr M were marshalling out in the forest along with J from Family JJL&J, and another two J's actually did the 10k plus obstacle course. I was again put in charge of the kitchen, and apart from running out of bacon and teabags it all went very well. I was very proud to be awarded the 'Mega Marshal' trophy for services rendered to mass catering.

Weight loss has stalled, but it has remained 4kg below what it started at (rather than the 5kg I was aiming for), so I'm going to take that as a win. Nothing new with the LTRP except that I briefly went into a carpet shop and now I need to decide who to invite to estimate for the job and whether to choose wool or synthetic fibre (any opinions from readers would be very welcome).

The television saga continues - the price of the TV I am after did drop to a level where I was happy to buy, but by the time I got to the website in a secure WiFi zone there were no more in stock. Stock suddenly appeared a week or so later, but the website claimed that delivery was not possible to my postcode, and when I followed that up with the retailer we agreed that there was actually no stock and it was a website error. However, I guessed that the American phenomenon of Black Friday might influence prices, and so it did. The television appeared on the website at an even lower price on Thursday evening, I placed an order successfully, and all being well it will be delivered today.

Filler

Spanish cow, September 2018

Yes, I know it's been ages, but I've been on holiday with Lola II and Mr M and J (from Family J,J,L&J). I am expected to provide a full summary of that trip, which will take me a good deal of time, so here's a filler just to keep you going.

It was a really good holiday. We went to Spain. There was Art, Culture, Food, Film and Physical Activity. We were all ill for some of the time. More detail to follow.

Before I went, the LTRP took a step forward with the completion of the Screening Room decoration as well as repairing the parquet floor in the living room, the attic windows and some other small jobs. Then there was a step backward as the new washing machine started leaking water. I thought the problem would be that I simply hadn't tightened the pipes sufficiently, so Ilf helped me get the machine out from under the counter at which point we discovered that some of the polystyrene packaging material had been left underneath, and this is what has probably done the damage. So I've had to become reacquainted with my old friends at the launderette and as soon as I can retrieve the receipt I'll be back on the retailer's help line.

Back to work is always difficult after a holiday, but I had my usual Tuesday off with an enormous list of stuff to do. I'd also ordered a HelloFresh box, so there was cooking, launderette and attempted blood donation. What with the paracetamol taken on holiday, the lingering cold infection, and ongoing gum disease (have I mentioned the dental appointment? Refractory periodontitis. Look it up) they really weren't interested in having my blood at all. Which is fine by me.

I also did some Culture in the evening - I went to a lecture given by journalist and war reporter Max Hastings on the back of his latest book, which is about the Vietnam War (1945-75 - An Epic Tragedy). He wasn't as dynamic as I expected and read the whole thing from his notes in under an hour, although he answered a few questions at the end and then signed books for those who had bought them. He has clearly got enormous insight into the politics and practicality of warfare, and his conclusion was surprisingly similar to my own uninformed position - there's no point getting involved in someone else's war without 'something to join up to', i.e. a practical local link that, when achieved, allows the war to end. If you're bombing the hell out of somebody to stop them doing something you don't like, you need to be able to hand over the reins to someone if they eventually stop doing it. If there's nobody left to hand the reins to (Libya, Afghanistan) or they don't stop doing what you don't like (Vietnam) then your intervention, and its cost in money and lives, has been pointless. He also spoke from first hand knowledge about the attitude of the US government to the Vietnam War, which was utterly focussed on its effects within the US political system and winning the next election rather than the enormous and obscene slaughter of soldiers and Vietnamese civilians.

Quick update on the weight loss programme - having got within a whisker (200g) of my goal, I now hover at 600g over, but consider that to be a great result considering how much cake I ate on holiday. So I am back on the wagon for one last push to the finish.

Life goes on

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.

First world problems

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.

Things done and not done

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.

What I've been doing instead of filling in my tax return

Updates

Adhisthana, June 2018

Pub update - the news is not good. My local councillor replied very promptly, forwarding a message from the Licensing Team Leader. The Deregulation Act 2015 states that:

"Live amplified music is deregulated between 08:00 and 23:00 up to a maximum of 500 people on a premises authorised to sell alcohol for the consumption on the premises."

It was also clarified that the definition of the premises in the license plan extends to the garden outside as well, so I don't have any options unless I wish to make a noise complaint. There is a local 'night noise service' which runs from 9pm to 1am on Friday and Saturday nights and seemingly will come and 'witness the noise and disruption levels first hand'. But I don't want to fall out with my neighbour, and I certainly don't want anything in writing that may affect the sale of my house in future times. And anyway, the music wasn't repeated last Friday.

Bathroom scales update - my BMI this morning was 24.3 kg/m² so still going in the right direction, despite the colleague's leaving do on Friday followed by the weekend's excess. Actually, the family party at the weekend was quite modest and I managed to get the guests to take away most of the leftovers. The best thing about it, apart from seeing my lovely family and enjoying their approval of the LTRP, is that leading up to the event I cleaned the house more thoroughly than I think I ever have before, which I continue to enjoy.

Badminton update - I ended up having to go to the League EGM because the two people in the club more qualified than I came up with much better excuses not to attend than I could think of on the spot. I didn't really know why the EGM had been called except that the new Chair of the League thinks that badminton is in a fatal decline and wants to halt it using various measures which are regularly defeated when proposed at the AGM. So the reason for the EGM was to come up with a different, 'fairer' voting regime for meetings so that 'progress' could be made, and it was all over in only 90 minutes which I consider to be a good outcome. In case you're interested (but why would you be?) the new voting regime gives each team in the league one vote up to a maximum of four votes per club, with a voting majority of two thirds.

LTRP update - the lovely tiler is on site as I type, and the plumber has just departed having reinstated the fancy stopcock device and repainted the skirting with one coat. If I am lucky this will represent the final work on the kitchen and it will be complete, except I suppose for the dead washing machine which I have made no progress towards replacing.

On retreat

Adhisthana, June 2018

I had to spend more than a week without WiFi in the end. It's back now, but I have yet to knuckle down and replace the washing machine, which is officially dead.

During this period offline I finally reached a point where I had to take notice of what the bathroom scales were telling me. It's been quite easy to see the numbers creeping upward and do nothing about it, although it's been seven years since my main weight loss event took place so less than a kilogram gained each year isn't too bad. But on Tuesday I couldn't ignore it any longer, and I have embarked on a serious weight loss plan. I have written it all down, and unlike all my recent half-hearted attempts I'm telling everyone. My Tuesday BMI was 25.6 kg/m², and I'm aiming for a BMI of 23.5 kg/m² which requires 5 kg reduction. After one week I had reached 24.9 kg/m² which is excellent, but I don't imagine every week will produce this sort of improvement.

There's been quite a lot of Buddhism recently, which has also helped my resolution in the dietary department with its vegan approach and emphasis on managing the mind. Because it's all about the mind. After just a week on the new diet regime I had stopped craving something sweet after supper, and if the craving is gone it's much easier to stick to the plan.

I went to the Birmingham Buddhist Centre for Buddha day and did some meditating and chatting with interesting people, including a few who I'm starting to get to know. I avoided the formal ceremonial stuff which I don't enjoy but happens at the end so it's easy to leave early. Then the following weekend I went on my first weekend residential Buddhist retreat, at a centre in the Herefordshire countryside. It's where the founder of the particular Buddhist movement that I've become involved with still lives at the age of over ninety, but also contains a number of residential houses for longer stays as well as the rooms let out for weekends. It's a beautiful setting, which is handy because I'd just run out of pictures for this blog.

Meals were vegan, the timetable included meditation, discussion and free time, some of it in silence which suits me very well. People on my more commercial holidays accuse me of being 'anti-social' if I don't want to join in their alcohol-fuelled evening activities, but here you are expected to spend time with your own thoughts. Many of us went for a lovely walk in the glorious weather on Saturday afternoon and I got the chance to chat to the leader of our Tuesday group. There isn't much time for chat on a Tuesday.

Morning meditation was a revelation - 50 minutes starting at 7 a.m., followed by a 10 minute break and then another 30 minutes. I thought I'd have a go at the long one, thinking I could always duck out and skip the following session. Being away from everything with no pressure and nothing to do made it so much easier than trying to silence all the chatter in my mind at home. I sat for the whole 90 minutes both mornings without difficulty.

The theme for study was a tale about a rich man and his wayward son, who represented 'the enlightened mind' and our ordinary minds. We didn't spend overmuch time in study, but I couldn't avoid the formal ceremonial stuff this time. Sitting through it again hasn't changed my mind about it. Altogether the retreat wasn't the transformational experience that others have reported, but I'm planning to do it again. At some point I'll have a go at a week rather than a weekend.

Back home, there's bad news about neighbourly relations with the Pub Next Door. For the first time in the 16 years I have lived here I've had to consult the terms of the pub license. The only thing I've objected to in all that time has been music in the beer garden, and up until Friday there has never been a problem. But they put on a live band, and although the music was good and it only lasted two hours there wasn't a room in my house where it couldn't be heard very clearly. I spoke to the landlord who told me that he was planning to do this every Friday night through the summer. So I have asked our local councillor to clarify some of the terms of the licence, spoken to a couple of the other neighbours, and will decide what to do when the position is clearer.

Some good news though - the new lawnmower blade arrived, I fitted it without a problem and it works a whole lot better than the previous blunt stick of metal.

Progress

Krakow Botanical Gardens, July 2016

The upstairs spare room is starting to become properly habitable. I've cleaned and polished the floor and installed a bed, and I'm using the table in front of a window for my ebay photographic activity. That, by the way, is going extraordinarily well, and I continue to laugh out loud whenever I am notified that someone has bought another bit of useless junk for £1.99. Two of my esteemed customers are even located so close that I have actually hand-delivered their purchases. Don't get me wrong, I'm glad they are buying because otherwise the hours I spend on photography and online listing would be a pointless waste of effort, but really, I feel sorry for their families. At some point they will have to do what I'm doing, unless they have the grim determination to build a bonfire.

I'm also starting to repopulate the loft. I don't want to fill it right up again, but it's nice to be able to store a few things in a moderately accessible way. The next task will be to get the spare room painted, and then convert it to half office, half bedroom. With just one exterior wall and two radiators it's a lot warmer than my bedroom which has three out of four exterior walls and only one small radiator, so I may decide to move in for the winter. I've spent a comfortable night in there as an experiment, but it will need curtains before it's any use in summer.

I haven't written about patients for a while. They continue to propose marriage - another one last week. Most aren't in the marrying mood and tend to be fairly recalcitrant when it comes to making dietary changes. I enjoy the teaching most, where people turn up knowing very little except what they've read in the press or heard from a doctor or nurse with no real knowledge of diet. They usually go away knowing a lot more, whether it has been a one-to-one consultation or a Type 1 or Type 2 group education session.

I would love to give a blow by blow description of some of the consultations that I'm involved with. I think I'm getting better at working with the usual range of 'reasons' people give for not doing what they have told me they intend to do. The one the continually irks me is when we embark upon the 'weight loss' conversation, and the first response is about not being able to exercise - arthritis, or fibromyalgia, or a bad back, or anything really. Exercise is hopeless for weight loss, but the resistance to weight loss by actually eating less is immense. I have a poster on the wall which says, for example, that 178 kcal or just three custard cream biscuits is the calorie equivalent of 37 minutes brisk walking. The calories in a single pint of lager are the equivalent of 53 minutes of brisk walking.

The DESMOND programme for people with Type 2 Diabetes has a nice script for introducing the weight loss session.

- What causes our weight to change? [food and activity]

- What happens to your weight if the amount of calories you get from food is the same as the number of calories that you burn off through activity? [it stays the same]

- If our weight starts to go up, what do you think has changed? [eating more and/or doing less activity]

- What would need to happen for someone to lose weight? [eat less and/or do more activity]

- What about people who are less mobile, and whose activity may be limited? What else can they do if they want to change their weight? [ha ha, got you there, you have no choice but to say 'eat less']

I know I shouldn't, but I get a small thrill if I manage to get someone to admit that losing weight is still possible even if they cannot run a marathon or play squash. Or walk to the car. I shouldn't feel that way because while we all know in our heart of hearts that eating less will allow us to lose weight, it's incredibly difficult to achieve. It's supposed to be my job to help, and I continue to try, but I do think that those who succeed tend to do it in spite of me rather than because of my input.

Anyway, back to the LTRP - I spent a happy day in Birmingham looking for household goods, and while I didn't buy anything spectacular I did make a few decisions on what might happen next, and I've since bought lampshades. The prospective builder and the airing cupboard carpenter have visited, and the people from the kitchen shop also got back to me with details of an alternative builder. I will have to address my naming conventions soon, as I am reaching the end of the vowel supply with only Ulf and Ylf to go. I may repurpose the name Elf, because I'm not planning to use the original man any more. I'm not going to ask Olf the Builder to quote for the kitchen build either. Ilf the Handyman, however, is a permanent fixture; I intend to keep him for as long as he can wield a screwdriver.

I also went to another Barn Dance with badminton friends who are very enthusiastic about Barn Dances. I feel satisfied that I have given it a good try, but I don't really like it. We had a discussion about the next badminton social event, and reached the conclusion that it needs to be indoors, not food-based, including physical activity but not so noisy that we can't hear each other speak. It was pointed out that what we were describing sounds a lot like badminton.

Study Day

Part of Rugby School, May 2015. I really like the slanty windows

I have mentioned carbohydrates on here so many times - they are the mainstay of the British diet in the form of cereal, bread, potatoes, pasta, rice, pastry and flour as well as all the sweet and sugary food and drink, fruit, milk and yogurt. Carbohydrate is also the dietary component that raises blood glucose in people who have diabetes, which can cause poor health in the long term. For this reason, we are coming round to the idea that it makes no sense to encourage people with diabetes to eat lots of carbohydrates.

A reduction in consumption of sugary food and drink has always been advocated, and not just for people with diabetes. This is why the 'traffic light' labelling system on the front of some food packets includes the amount of sugar. But starchy carbohydrate and natural sugars in fruit and dairy products were not restricted in the past, despite the fact that they are also converted to blood glucose when they are digested. Glucose from starchy food, fruit, milk and yogurt enters the bloodstream a bit more slowly than glucose from sweet things, that's all. But if you don't have diabetes, you only really need to care about sugar.

So when people with diabetes come to see me, they always know that they're not supposed to have sugary foods, and they commonly mention that they have been told that brown, wholemeal or granary bread is good for you, as well as lots of fruit. Sometimes they say they can't have bananas or grapes. They have usually picked up this information from non-specialist Dietitians or nurses in their GP practice, or from friends and relations with diabetes.

It now seems to be accepted among Dietitians that limiting all types of dietary carbohydrate (not just sugars) is a valid and beneficial approach for people with diabetes, and very recently Diabetes UK seems to have accepted this idea and at last - at last! - the dietary advice on its website has changed. It used to recommend that carbohydrate foods should make up a third of your diet, or up to 14 portions of starchy carbohydrate a day. Now the same web page suggests you should 'try' to have some wholegrain carbohydrate every day, but acknowledges that you may be advised to reduce the amount of carbs that you eat.

Carbohydrate intake is only half the story; the other factor that leads to raised blood glucose in Type 2 diabetes is insulin resistance, which is often caused by excess weight around the waistline. Most people with Type 2 diabetes are overweight or obese, so I try to recommend that my patients replace the carbs with vegetables that are lower in calories than carbs, which should result in a calorie deficit and very welcome weight loss. Reducing carbohydrate intake reduces blood glucose levels on a day-to-day basis, and losing weight lowers blood glucose in the long term by reducing insulin resistance,

There are some who are not particularly overweight, and therefore cutting the calories from carbohydrates needs to be balanced by an increase in calories beyond what vegetables can provide. For these people we have up to now suggested protein and healthy unsaturated fats: monounsaturated (from olive and rapeseed), polyunsaturated (from sunflowers and corn) and omega 3 (from oily fish, nuts and seeds).

Diabetes Specialist Dietitians are generally a mild-mannered lot (as are most Dietitians). However, there is a militant faction of Dietitians who declare that not only is there no evidence of harm from saturated fats (derived from animal sources), but that these fats are positively beneficial. They promote a low carb high fat (LCHF) diet, and not just any fat, but saturated fats.

The difficulty is that these LCHF people are either deluded or they are visionaries, and we have no certain evidence to tell us which. On Friday I attended a study day where one of the highlights was a debate between a leading proponent of LCHF and a respected academic research Dietitian. Both argued their case admirably, although unfortunately the advocate of the LCHF diet was a little less articulate and let herself down with a couple of poor examples that weakened her case for me. In the end, the consensus is still that we believe saturated fat promotes cardiovascular disease, but there's a chance that it doesn't. Unfortunately it is impossible to conduct human trials that are sufficiently long-term, randomised or blinded to give us the evidence we need, especially as people eat food not nutrients.

The study day also included discussions about the pros and cons of weight reduction through surgery or extreme calorie restriction, the 5:2 fasting diet, a protocol for adjusting diabetes medication in a weight loss programme, and the AGM of the Diabetes Dietitians' Specialist Group.

The session about the 5:2 diet was presented by the Dietitian who invented it within the setting of breast cancer management, and she made the point that there are now three times as many books about the diet than there were participants in the trials that supported it. The diet she invented involved two consecutive days of very low calorie intake separated by five days of 'normal' eating, whereas the common version now in the public domain has separated these two fasting days. Evidence is scanty, trial participants were all women (breast cancer, remember), and the end message was that we have no long term evidence about either benefit or harm. It's pretty unlikely to do any damage (unless there is blood glucose lowering medication or insulin in the mix) so if it works and people lose weight then we're fine with that.

The other diet discussed was the 'Diabetes Reversal' diet pioneered in Newcastle, which involves restriction to 800 calories a day. The rationale for this was because people who have bariatric surgery for weight loss and who have Type 2 diabetes often experience sudden remission in their diabetes and normal blood glucose levels immediately post-surgery. The researchers wanted to investigate whether this outcome was due to extreme caloric restriction alone, or something else to do with the surgery.

Their original study put people on the diet for 8 weeks and required a portion of vegetables every day alongside meal replacement products, and it showed impressive results. They have followed this up with a bigger study - the biggest research grant ever awarded by Diabetes UK - which is for 12 weeks' restriction with meal replacements only. All the information about the original diet is in the public domain on their website, so anyone can try it, and a number of our patients have done so. We are now considering how to support our patients if they were to choose this option for weight loss.

The other sessions I attended at the study were interesting but not remarkable. Back at work, this blog comprises the main reflection I have carried out on the day's experiences. My colleagues are working on a way to offer people a choice of weight loss pathways and I'm planning to use their approach in my service, once they have ironed out the wrinkles.

Ten things

Greece, June 2014

This post is pretty close to a rant. It's true that I have been feeling a bit stressed and the four-day weekend for Easter was very welcome. Normal service should be resumed very soon with calm, considered blogs of an informational and entertaining nature. I hope so, anyway.

---

1. Sensational media reports based on a flawed interpretation of a journal article or on something made up by a journalist or a celebrity

"Did you see the TV programme last week about how eating saturated fat is good for you? I've switched back to butter."

"I read in a magazine about how you will lose weight if you eat nothing at all after 5 p.m."

"I cut this article out of the newspaper about kale smoothies reversing diabetes."

"This website says that chia seeds will melt fat."

"The Daily Mail says that eating blackberries brings your blood glucose down."

"It says there's a new cure for diabetes."

FACT: It's all rubbish, ignore it. If you are overweight and want to reduce your blood glucose and improve your diabetes control, then eat less carbohydrate and lose weight. If you want to lose weight, you need to eat less, and ideally move more. The dietitian's job is to help you find a successful way to do all this, not spend half a consultation explaining how journalists are perfectly free to MAKE STUFF UP and are paid handsomely for it.

2. I can't possibly eat any less

The patient declares that there's no way they can eat any less than they already do. "I don't have any appetite," they say. "I eat like a bird. My two-year old grandson eats more than I do." The account they give of their daily diet consists of a small bowl of cereal for breakfast, half a tin of soup for lunch, and one slice of toast and a tin of sardines for supper. Between meals: black tea and coffee with sweetener. "I can't understand it," they say.

FACT: You are eating more than this, and you know it. Or maybe you don't know it. Either way, you're eating more than this or you wouldn't weigh 20 stone.

3. Artificial sweeteners

"Aren't they as bad as sugar? I read they cause cancer. They're full of chemicals, really bad for you. I wouldn't touch them."

FACT: Artificial sweeteners are safe. They're calorie-free. They're carb-free. THEY ARE FINE, STOP BEING STUPID.

4. Exercise

"I would lose all this weight if I could exercise, but I can't."

"I'd love to go out for a walk, but my back/hip/knees are too painful."

"My dog died and I put on 10 pounds."

FACT: exercise is incredibly good for us - it brings down high blood glucose levels, makes us feel good, strengthens muscles and helps stabilise joints - but the amount of calories burned by ordinary people who increase their activity level is about equivalent to a sandwich. If you're a typical overweight person you won't lose weight by exercise alone, and you'll probably reward yourself with more calories than you used up. But go out for a walk anyway, because the other benefits of activity are so worth it. And then start eating less.

5. Honey

"I've cut out all sugar, I don't have any now. I put honey in my tea and on my porridge instead."

"Honey's natural so it must be better than sugar."

FACT: Sugar is processed from plants by people; honey is processed from plants by bees and then people. Honey will have the same effect on your blood glucose and your waistline as sugar. Sorry to disappoint you, but YOU ARE DELUDING YOURSELF.

6. Fruit and fruit juice

"Fruit juice is healthy, isn't it? It's natural."

"I buy the fruit juice labelled 'no added sugar.'"

"I've stopped snacking on biscuits, and I'm having lots and lots of fruit instead."

FACT: fruit juice has more sugar in it than lemonade, and nearly as much as Coke or Pepsi. Why would a manufacturer need to add more sugar to a product that's already 10% sugar? Yes, whole fruit is better, but you're not helping your blood glucose levels if you have more than a handful at a time. And the 'five-a-day' message? Well, it's perfectly OK to have five portions of vegetables and no fruit at all.

7. 'Full of sugar'

"I stopped having ketchup on my chips - it's full of sugar."

"Those pasta sauces are full of sugar."

"I don't eat grapes or bananas any more; the nurse told me they are full of sugar."

"I have muesli now - cornflakes are full of sugar."

FACT: There's far more 'sugar' in your chips than in your dollop of ketchup, more in your large bowl of pasta than in the couple of tablespoons of pasta sauce, and no less in your bowl of muesli than there was in your cornflakes. It's all about the carbs. Grapes and bananas are fine, but have a handful of grapes or a small banana, not the whole punnet or a banana the size of a baseball bat.

8. The Menu Plan

"Just tell me what to eat."

"Can you just give me a menu plan?"

The lifestyle magazines are always printing "a menu plan for a week". We love them. I love them. If only we could just follow the plan to the letter, it would be so easy and we'd reap the promised benefit. But then we look through them - one muffin? Half a grapefruit? 300g kale? What do we do with the five other muffins that came in the pack of six, or the other half grapefruit, and I'm not allowed grapefruit anyway, and kale comes in 500g packs, and I don't like kale, and it's too expensive to eat all that fish, and I don't like fish except tinned tuna. What do I do in week 2 - just repeat week 1? My wife does all the cooking and we eat curry and chapatti not sausages and potatoes...

FACT: Menu plans are useless, and I don't have one for you. You'll have to work it out for yourself. Sorry.

9. "You're telling me I can't have..."

Honey. Rice. Sugar puffs. Fruit juice. Potatoes.

NO, I'M NOT TELLING YOU WHAT YOU CAN AND CAN'T HAVE. What I'm telling you is the effect that it will have on your weight, or your blood glucose. You can have whatever you like, whenever you like, because it isn't me that will put on weight or need to inject insulin, it's you. If you want to start the day with a Pepsi, that's fine, but if I were you, I wouldn't do it, like I wouldn't walk into the road without looking, or swim in the sea when there's a red flag flying. But if you want to, you go ahead.

9a. 'Good' and 'Bad' food

There is no such thing as good or bad food - nothing is forbidden. It's good to eat a lot of some foods and a little of others, and hey! it's bad to eat a lot of some foods and a little of others. Eat what you like, it's your decision and you will have to live with the consequences. My job includes making sure you are aware of what those consequences might be.

10. Low blood sugar

"I had to have a sandwich because my blood sugar was low."

"I can't sleep unless I have a glass of milk and a biscuit before bedtime."

"I need a snack to keep me going."

FACT: if you 'need' a regular snack then your insulin needs adjusting down. If you're not on insulin (or gliclazide or another insulin-stimulating medication) then you don't 'need' a snack, you just want one - you will never have low blood sugar. Grow up, you're not a toddler any more.

Very low carb diet

Low carb breakfast

As planned, I started my very low carbohydrate regime after the wedding. In brief, this involves: no sugar or starchy carbohydrates at all - no bread, pasta, cereals, rice, potatoes or flour, no cakes, biscuits, sweets or full sugar drinks. Fruit is limited to 100g per day (about a handful) of berries (strawberries, raspberries, blueberries, blackberries etc.), pulses are limited to 30g cooked per day (about 1 tbsp), nuts and seeds are limited to a small handful, and you can have 3 portions of dairy produce (to provide calcium) but not flavoured or sweetened yogurt. A multivitamin is required because of the exclusion of a whole food group. Lots of low carb vegetables are encouraged, ground almonds and coconut flour can substitute for wheat or cornflour (up to a point), and monounsaturated oils are recommended. Unprocessed forms of protein are deemed better than processed due to the potential for inclusion of carbohydrate fillers.

It has been easier than I thought it would be. I like protein and vegetables, so evening meals have been fairly straightforward: meat or fish and vegetables or salad. Lighter lunch meals have incorporated leftovers, or I've had vegetable sticks and dips like salsa or guacamole, or vegetable soup with a swirl of plain yogurt sprinkled with seeds. I thought breakfast would be the most challenging, especially on a work day when there isn't a lot of time, but it turns out that I like plain yogurt with berries and flaked nuts more than I thought I would. When there's time, breakfasts are egg-based - poached, fried, scrambled or an omelette with one or more of tomatoes, mushrooms, bacon, smoked salmon, cream cheese or herbs.

I thought I would miss pasta and rice, and when Mr A has cooked them for himself they smell lovely but I haven't been tempted. Luckily there has only been one cake at work, and it wasn't very attractive so not hard to resist. I've snacked on unsalted nuts or vegetable sticks, and a couple of squares of 85% cocoa chocolate are allowed, as well as 'Atkins bars' which I have felt obliged to try, but don't really like much. They're expensive, too.

The key to success has been planning, because I can't just grab a piece of toast or bowl of cereal if I'm in a hurry. So I have my week's meals scheduled, and at each meal time I consult the sheet of paper to find out what is on the menu. Tonight we're having mozzarella, some antipasti from a jar, a tomato and basil salad and grilled courgettes and peppers. Tomorrow it's haddock provençale from the BBC Food website. Mr A bulks out his meal with the carbohydrate of his choice.

Side effects can include headache, nausea, fatigue and constipation, but are usually mild and short-lived. I felt absolutely fine until about 10 days in, when I had a niggling headache for a couple of days - but it may be just a coincidence. I've lost a little bit of weight, only 1 kg, and I suspect it's because of not being able to tuck into the usual amount of work-based cakes and biscuits, and the odd slice of bread between meals, plus all the running that I'm doing. But I'm not the target candidate for this diet, which is squarely for the benefit of overweight people with Type 2 diabetes, in order to help them reduce their blood glucose and curb their appetite. I still haven't recruited any patients to actually start the very low carb diet for real, but I have produced a poster and some flyers that will be given to likely candidates during clinics, to see if I can rustle up some trade.

We had a Diabetes Dietitians' meeting this week, where we discussed exactly how much pulses to allow, and whether we should tell people about low carb bread, and what exactly is the recipe for ground almond pancakes. There are some recipes that the other Dietitians have tried, for linseed bread and low carb cake, but I'm not sure I can be bothered because I don't mind not having bread and I didn't bake cakes even when I was eating carbs. I did try to make the ground almond pancakes, but they just tasted like gritty omelettes, hence the discussion about the exact recipe. It was all very interesting - four out of five of us are on the diet, with one doing it seriously and the other three dabbling. I'm adhering to it strictly for these three weeks up to our holiday, but we'll see what happens when we're away, and when we come back.

Behaviour change

National Botanic Garden of Wales, May 2013

I was definitely going to do some homework this evening. I brought home the folder of notes which I had been accumulating during the taught sessions of my Masters module, and brought the computer down to the dining table to make it easier to type (my bedroom doesn't have space for a chair as well as a bed, table and chest of drawers). I did the washing up, some laundry, had supper, spoke to Mr A, and then prepared to do some work.

The only thing missing was the actual case study - up to now I've been working on it at the hospital, and hadn't emailed myself a copy. Taking it back and forth on a memory stick is complicated due to NHS file security policies - they make it very difficult to take data out, so that we can't easily compromise patient confidentiality. So, no homework, and I'm blogging instead.

I didn't have a clinic today, so I went back to those carbohydrate reference tables again. It feels as though I have been working on this project forever, and in fact it has been an enormous amount of work. My colleagues came up with some suggestions and comments after I presented the first draft, and true to the adage, the last 20% has taken as much time and effort as the first 80%. It's nearly done now, and the time will soon come to compromise on perfection and go ahead with some flaws still present. For example, I would have to hold back for a few more months to get any decent carbohydrate figures for Christmas pudding.

I continue to have too few patients. I am starting to worry that unless I can fill my clinics, any extension to my contract will be at risk. Part of the problem seems to be that I keep discharging patients rather than offering them follow-up appointments. Having discussed a patient's lack of motivation to lose weight, for example, it serves no purpose to keep making them come to the hospital to have another discussion about how they haven't lost weight again. I may be repeating myself by saying that losing weight is one of the most difficult things in the world for most people to achieve, and you've got to want to do it to have any hope of succeeding.

There are a number of techniques that can be used in the complex world of behaviour change. Obviously active listening and open questioning are important to establish the topic to focus on - never assume that what's in the notes or the referrer's letter or even what you talked about last time will be what needs to be discussed this time. Circumstances change, things happen, and people move on. Last time the patient was 100% in favour of increasing the amount of exercise they wanted to do, this time they are worried about gallstones. Also important at this stage are empathy and taking care to withhold judgement.

Having established the topic, what does the patient want to do? What is the actual aim we are working towards? If it's a change towards 'healthy eating', how will we know when we have succeeded? What amount of weight loss in what period of time will bring about significant health benefit? It helps to describe the objective as fully as possible.

Then it's always worth exploring how realistic the aim is, often by questioning the importance it has to the patient, and their confidence in achieving it. At the most basic, you can use the Lickert scale, which is just a scale of 1 to 10. Anything less than 7 suggests ambivalence and is worth exploring further, and the whole thing can come apart when you really examine some of the practicalities of changing diet or lifestyle. Eating is really fundamental to who we are and how we fit into our families and wider society, and change isn't usually easy.

When it comes down to it, behaviour change is about breaking habits that aren't helpful, and developing and embedding more useful habits. Giving up smoking provides some obvious parallels - if someone always smokes with their afternoon cup of tea, then it will be important to discuss how to manage the feelings that will inevitably arise when having a cup of tea but denying oneself the cigarette. Replace 'cigarette' with 'biscuit' and there really is no difference. Setting a goal of cutting out biscuits while ignoring a lifetime of food-based habits is a recipe for failure.

We can ask questions about how a patient would feel if they achieved their objective, and what the first step will be towards that goal. What are the barriers that will interfere with success? How can they be anticipated, and overcome? Some of the barriers can be brought to light using an 'ambivalence grid', on which we record the positive and negative aspects of making a change, but also the positive and negative aspects of not making the change. It can be illuminating to examine how life would be worse if the patient lost weight (those of us who dislike shopping for clothes are well aware of one of the pitfalls). If the patient thinks that cutting out biscuits will lead to them taking up smoking again, then perhaps they should set a different goal.

These skills and techniques are among those used in Motivational Interviewing, Cognitive Behavioural Therapy, and addressing the Cycle of Change. The trouble is that I can't remember the theory or evidence base for any of these high-falutin' psychological theories, and I feel that for best practice I should know why I'm doing something as well as how best to do it. But for the moment I'm doing my best, and reflecting afterwards on whether I could have done things better, or differently, and that's how I hope to improve my practice. As well as doing my homework. Tomorrow.