Blog - children and young peoples diabetes 

  • Congratulations to Professor Hindmarsh

    Congratulations to our very own Professor Hindmarsh, who won the Health Hero award for Britain’s most inspiring health worker last week. He was nominated by a number of his patients and their families and the award was presented by Theresa May at Downing Street. Read the full story is here

  • Ethan Saldanha's national diabetes day school talk

    Healthy eating food groups

    Hi, my name is Ethan and I am 9 years old. I’ve had type 1 diabetes for 6 years.

    My teacher suggested I do a special project for Diabetes week. My mum helped me make a presentation. I really wanted to include my pump in the presentation and the slides to have animation and noises. I really wanted to show them what it was like to have diabetes.

    On the 14th November 2017, I presented the powerpoint slides to my class. It went well. There were lots of questions for me. I found them easy to answer. The class clapped at the end and we were happy.

  • Diabetes in the under 7s

    Francesca Annan

    The International Society for Paediatric and Adolescent Diabetes (ISPAD) has just published a new guideline on managing Type 1 in younger children.

    Here are some of the recommendations they have made (a lot of the recommendations are about routine and mealtimes);

    • Always give meal/snack insulin before eating
      • If eating behaviour is difficult first check portion sizes – it’s better to offer smaller portions that will be eaten.
      • It usually takes 10 attempts to introduce a new food, so offer new foods repeatedly to encourage more variety in the diet.
      • Use a dual wave bolus on pump therapy to manage difficult eating behaviour
      • On injected insulin split doses into 1 before and 1 during eating if needed
    • Encourage a routine of regular meals with only small snacks between meals (less than 12g carbohydrate)
    • Meals should not last longer than 30minutes , avoid distractions and encourage family meals
    • Always leave a gap between meals and snacks
    • Don’t offer drinks just before eating and avoid giving milk/fruit juice to drink between meals
    • Don’t use food as a reward for good behaviour
    • Encourage active play through the day – active children become active adults
    • Use a matter of fact approach to diabetes management tasks e.g. finger pricks, injections, cannula changes etc. and involve children in diabetes management
    • Younger children usually need more insulin as bolus insulin (60-80%) and less basal insulin (20-30%) to get better blood glucose management
    • At least 7-10 finger pricks are needed a day
    • ISPAD recommends that pump therapy with CGM is used in under 7s to increase the amount of time spent in target

    We know that managing blood glucose levels is challenging and so we are here to support you.

    The Infant and Toddler Forum have some excellent resources to help you understand appropriate toddler portion sizes and managing fussy eating.

  • Vitamin D and Diabetes

    Peter Hindmarsh

    Studies that have looked at low amounts of vitamin D have shown associations with impaired glucose metabolism, insulin sensitivity and insulin secretion. These studies have been cross-sectional in nature and many have not accounted for altered handling of vitamin D binding protein by the kidney in diabetes. Two recent studies using a double-blind placebo controlled methodology have been completed where vitamin D was given to deficient patients with type 2 diabetes and the effects on glucose production and insulin secretion assessed. Despite more than adequate replacement with vitamin D in those receiving active vitamin D therapy insulin sensitivity, glucose production and glycaemic control did not differ between those receiving vitamin D and placebo. These data suggest that vitamin D dosing in type 2 diabetes to enhance pancreatic function is not required.

    Gulseth et al. Effects of vitamin D supplementation on insulin sensitivity and insulin secretion in subjects with type 2 diabetes and vitamin D deficiency: a randomised controlled trial. Diabetes Care 2017; 40: 872-8.

  • TRIALNET Study

    Peter Hindmarsh

    Hello everyone. We are now (finally!) up and running with the TRIALNET Study. This is an important research project aimed at family members WITHOUT type 1 diabetes (T1D). With a single blood test, the project would identify family members at high future risk of developing T1D. These people would be offered a targeted medication to see if the onset of diabetes can be delayed or prevented. 

    Any first or second degree family members can take part, providing they are aged between 3 and 42 years. We will be approaching you all by letters, emails, during clinic appointments and during dedicated research meetings. There is no pressure to take part but it would be important for you all to know about the study’s existence.

    In the meantime, please email our new research nurse, Kim, if you want to get on the list on kim.shrieves@uclh.nhs.uk.

    All the best.

  • Fast acting insulin - are we ready for this?

    Peter Hindmarsh

    Fast acting aspart insulin is an ultrafast form of insulin aspart (Novorapid®) to which is added niacinamide. This promotes more rapid absorption into the blood stream, a higher peak insulin concentration and greater insulin action within 30 minutes compared to standard aspart. Two publications in the July issue of Diabetes Care have assessed efficacy in randomised studies in type 1 and 2 diabetes. In both studies fast acting aspart was compared with standard aspart when incorporated in basal bolus treatment regimens. In the type 1 study fast acting aspart 2 hour post mealtime glucose was reduced by 0.7 mmol/l compared to standard aspart and a significant reduction was also noted at 1 hour. Over a 26-week period fast acting aspart led to a 0.1% greater reduction in HbA1c compared to standard aspart. However, the odds of achieving an HbA1c less than 7% was 1.47 higher with fast acting aspart compared to standard aspart.

    In the study of patients with type 2 diabetes who had slightly higher HbA1c than the type 1 patients there was no difference between the different insulins over the 26-week period despite significantly less glucose excursions 1 hour after meals but not after 2-4 hours. However, both types of insulin did reduce HbA1c by 1.5%. 

    In both studies there was no difference in hypoglycaemia rates.

    These studies suggest that fasting acting aspart would be useful to use as a bolus insulin 20 minutes before food intake with closer matching of insulin delivery to glucose excursion. Of interest is the greater number of patients attaining HBA1c below 7%. As HbA1c did not change much in these studies the question remains what the overall effect on long term problems might be. We also need to know how fast acting aspart will perform as part of pump therapy. Persuading commissioners and ultimately NICE that this new medication is of value will require firmer data on long term benefits.

    Russell-Jones D, Bode BW, De Block C et al. Fast-acting insulin aspart improves glycemic controlin basal-bolus treatment for Type 1 diabetes: Results of a 26 week multicentre, active-controlled, treat-to-target, randomised parallel group trial (Onset 1). Diabetes Care 2017; 40: 943-50

    Bowering K, Case C, Harvey J et al. Faster aspart versus insulin aspart as part of a basal-bolus regimen in inadequately controlled Type 2 diabetes: The Onset 2 trial. Diabetes Care 2017; 40: 951-7

  • New email changes coming into effect May 2017

    We have split into two teams to enable us to maintain a better/consistent relationship with patients and families and provide continuity of care.

    The old childrensdiabetesnurses@uclh.nhs.uk will no longer be in use from the beginning of May 2017.

    A formal letter is being sent out which will provide you with more detail regarding these changes.

    Please visit the 'contact us' page for further information.

  • How to banish diabetes burnout - tips for young people with diabetes and their families

    Peter Hindmarsh

    The Diabetes Research and Wellness Research Foundation (DRWF) have allowed us to share this article, written by Professor of Paediatric and Adolescent Psychology, Deborah Christie, with tips to help teenagers and their families avoid diabetes burnout.

    The DRWF Newsletters can be found here.

  • Diabetes, Exercise and ISPAD 2016

    This year the international paediatric diabetes conference took place in Valencia. On the first day of the meeting (Wednesday 26th October) a symposium was held on exercise and diabetes management.

    The sessions were presented by Professor Mike Riddell, Gavin Griffiths (aka DiaAthlete) and myself.

    You can view these presentations on the conference website, you will need to create an account and then you will be able to watch the presentations on the role of sports nutrition, the physiology of exercise and the experiences of a young person with Type 1 Diabetes who uses exercise to inspire others.

    http://medialibrary.ispad.cyim.com/

    If you would like to know more about managing diabetes during sport and exercise contact us childrensdiabetesdietitians@uclh.nhs.uk – we now have a regulaa Friday morning clinic for advice about exercise management. The appointments give you an hour to come along and discuss your sport and diabetes management.

    Francesca Annan

    Clinical Specialist Paediatric and Adolescent Diabetes Dietitian

  • Can You 'Hack' Type One Diabetes?

    Peter Hindmarsh

    They could (and did) apply for special considerations for my exams I had out of range blood sugars during. (This meant they took into account that my grade may be affected so they could give me extra marks to some extent). 

    Have you ever heard of a 'Life Hack' before? You know, the little tips and tricks that just make some small task easier?

    For instance, putting Bobby pins in your hair the curvy side down because it makes them stay there for a longer amount of time is a life hack. So is turning your toaster on its side to cheat at making cheese on toast. (However someone didn't think this one through because when a toaster is done it will pop the toast up, so surely this would send the cheese on toast flying across the room?)

    But, my point is, could there possibly be diabetes life hacks?

    Yes, I firmly believe there are.

    1. Tearing off the test strip pot lid. 

    Countless times I have left the house without various pieces of kit: my meter, a bottle of Lucozade, test strips or a set change. But often it is an honest mistake, when you've glanced over your kit and just missed something or because you didn't use any of the kit yesterday that must mean it is all definitely there. An issue I often had is that I would see a closed test strip pot and presume it was full when it wasn't.

    After an incident last year involving my mum having to call a favour in whilst I was on a school trip in London which resulted in a Barrister running around the city with some spare test strips that had been found in the back of a hospital cupboard on his way to Kings College University, I decided I needed some way of deciphering used test strip pots from full spare ones. So, from then on, every time I finished a pot, I tore the lid off before throwing it back in my bag!

    It has honestly been a life saver, because although I do end up having piles of separated lids and empty pots appear when I turn my bag upside down, it's worth it. I've never made the mistake of taking an empty one with me since.

    2. The letters on the side of the Lucozade bottle.  

    I have quite a few diabetic friends that peel the label off their Lucozade, to meticulously measure 100mls, 200mls, 300mls and 380mls on the side of the bottle with a pen. Each hypo, they had to drink down to the next mark.

    Well, I was never that prepared and quite frankly, I was too lazy to do that for every single bottle!

    So, I cheated.

    Whoever designed the Lucozade label, was a genius because they made the word 'Lucozade' stretch down the entire side of the bottle! I just use the letters to measure my hypo treatments!

    My marks were the top of the D, bottom of the A and middle to top of the O. I still use those as a guidance to this day. 

    3. Theme parks 

    Need I say anymore? Anyone who has been in possession of a fast track pass knows exactly what I'm talking about. You simply can't refuse skipping queues, fitting in double or even triple the number of rides you normally could in a day and the glorious feeling of walking past hundreds of poor, unfortunate people waiting for hours in the blazing heat, the many soles of many feet almost on fire and you go to stand right at the front, in your own lane, ready to hop on the ride next. How could you possibly dislike this?!?!?!

    For some people this is obvious, but when you arrive at the theme park that morning grab yourself an exit/fast pass! They basically mean you go in the exit, or in the fast lane to go on rides meaning you bypass all queues! Type 1 diabetics are generally allowed to have them because of the waiting in queues messing up eating times, the heat and blood sugars etc. They're also helpful if you need to ask staff about magnets in the rides or somewhere to keep your kit safe temporarily!

    If you go to a theme park, at least ask. I wouldn't go to one without an exit pass. (You may need proof of disability but this can be a letter from your doctor, a letter from the DLA stating what you receive or a photocopy of a disabled badge or something.)

    4. Exam concessions 

    Everybody hates exams. Absolutely everybody. That's a fact. It's even worse with type 1 diabetes, right? 

    You have to eat the perfect breakfast to maintain your bloods, you can't go too high or too low before or during the exam, you stress about taking the test kit and hypo treatment into the hall, opening the noisy hypo treatment, not being able to focus on the paper because of out of range blood sugars....... The list goes on and on. It's a nightmare. 

    I dreaded my GCSEs because of all of this, until I heard about exam concessions. Oh my word, they are a godsend. 

    • I was entitled to my own room which was brilliant for my pump alarming, testing and treating hypos. 
    • I could stop the clock during the exam when my blood sugars were too high or low until I'd corrected them. 
    • I even started some of my papers 1/2 late due to high blood sugars. 
    • I could have extra time at the end for any missed time. 

    I could tell anyone in the concessions area my diabetes-related exam issues and it was sorted almost immediately! I didn't distract anybody else as it was my own room and everything was so relaxed because of the small numbers of people and environment. Even small things were incredible, like being able to shift in my seat comfortably and tapping my pen made such a big difference to my exam experience. 

    We spoke to the school over a year in advance and practised getting breakfasts right for months before hand, meaning my GCSEs went mostly smoothly and I received all the results I wanted! 

    It is definitely well worth asking your school about concessions and stopping the clock for exams. 

    And a handy tip I learnt, if you have problems with keeping your blood sugars all morning ready for an afternoon exam, with a levels apparently you can move your afternoon exams to the morning so long as you remain in isolation until everyone has completed the exam at the original time!

    5. Last but not least, don't be afraid to make it fun. 

    I know diabetes isn't a walk in the park, trust me. But that doesn't mean you have to keep it boring and clinical. 

    Jazz up your test kit. Buy a small makeup bag from accessorize to use as your case. Or grab a big one and just shove all of your medical kit into it! I pretty much buy a new one each year! 

    When I was 6 I would refuse to have my CGM inserted, so instead of forcing me, scaring me into it or giving up - my mum bought a little bag that she filled with goodies like hair clips and small toys and each time I had a good sensor insertion she would offer me this lucky dip, it was great!

    And one of my favourites, challenging a fellow diabetic to get the closest blood sugar to (for instance) 5.8. Or testing and asking your friends around you to guess your reading before you look at it. It just makes it so much more light hearted and fun!

    Maybe you can hack diabetes, maybe you can't. 

    But it's worth a try isn't it?

    Here is a link to my blog pancreasless.wordpress.com if you'd like to read some more!

  • Fat and protein - again!

    Peter Hindmarsh

    There has been considerable interest over the last few years on the role of fat and protein in determining insulin dosing for food. We are all comfortable with the idea of dosing for carbohydrate content so should we be doing something about fat and protein?

    Postprandial hyperglycaemia is a major factor in not being able to achieve target glycosylated haemoglobin values. Dietary fat and protein do lead to postprandial hyperglycemia in patients with type 1 diabetes. How to adjust for this remains unclear. This study in Diabetes Care assessed the impact of high-fat, high-protein (HFHP) or a low-fat, low-protein (LFLP) meal with identical carbohydrate content on postprandial hyperglycaemia and from this determined how insulin doses should be adjusted to cover a HFHP meal.

    This is a very specific study focussed on pizza!! Adults with type 1 diabetes ate LFLP (273 calories, 4 g of fat, 9 g of protein) and HFHP (764 calories, 44 g of fat, 36 g of protein) meals with an identical carbohydrate content of 50g covered with identical insulin doses. Interestingly their standard insulin bolus delivered by an insulin pump used a mixed or dual bolus set with a 50:50 ratio over 2 hours.

    With the same insulin dose, the HFHP increased postprandial blood glucose by almost double. To achieve target glucose control following the HFHP, 65% more insulin was required with a 30/70 split over 2.4 hours.

    So this is a start at least for pizzas!! The insulin needs varied between patients indicating that individualisation is required of the dosing schedule. For patients on injection therapy the combination bolus can be mimicked by a preprandial injection of regular rapid-acting analog insulin followed by an additional injection 60–90 min later. Now all we have to do is work out what is needed for all other meal fat, protein and carbohydrate combinations!! It is going to vary between people so this is the kind of information that we’d love to hear about what works for you - that way we can rapidly build up a library of meals!

    Diabetes Care 2016; 39: 1631-4

    By Professor Peter Hindmarsh

  • Better long term outcomes in type 1 diabetes -
    29 July 2016

    Peter Hindmarsh
    We are used to hearing that diabetes shortens life expectancy although sometimes it is difficult to separate Type 1 and Type 2 diabetes outcomes. Historically, mortality in type 1 diabetes has exceeded that in the general population. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study cohort was set up in the 1980s to compare intensive insulin therapies with conventional approaches. In the short term intensive insulin therapy reduced complications such as kidney disease. EDIC is the long term follow up of this study. In the August edition of Diabetes Care mortality in the intensive treated arm of DCCT was slightly but not significantly lower than that observed in the United States population. In the conventional group it was higher than expected. Mortality risk compared to the general population increased with increasing mean HbA1c with a significant step up over HbA1c of 9% especially amongst females.

    This tells us that not only is better control associated with a reduction in complications but we can now say that life expectancy with good control is no different to the general population. Good news for all with Type 1 Diabetes and especially our youngsters with the condition.

    Diabetes Care 2016; 39: 1378–1383

    By Professor Hindmarsh

  • Healthy (and tasty) eating on a budget: Part 2 -
    1 July 2016

    Healthy breakfast ideas:

    • Porridge – made with oats and semi-skimmed milk, add fruit (like berries, bananas or grated apples) or dried fruit (like raisins, sultanas or chopped dates) or a little honey for flavour. Avoid instant or flavoured porridges; they’re not as healthy and more expensive.
    • Choose other high fibre, wholegrain and low sugar cereals such as weetabix, shredded wheat or muesli. Supermarket own brands or value/basic brands will be just as healthy and cheaper.
    • Toast (go for granary or seedy breads), with nut butters or mashed bananas. Freeze bread and just toast what you need from frozen to avoid it going off – particularly useful if you’re living on your own or at Uni and cooking for yourself.
    • Avoid fruit juices and eat fresh fruit instead, fresh fruits have less sugar and more fibre.

    Packed lunch ideas:

    • Buying lunch out every day can really add up, so try making your own packed lunches.
    • Bread, rolls, wraps, pitta breads or bagels (again, go for wholegrain varieties and store in the freezer so you can just use what you need)
    • Fill with salad and a protein food like cheese, cheese spread, hummus, tuna, egg or mixed beans.
    • Use strong cheeses so you can use less and make it last longer.
    • Add a piece of fruit and low fat and sugar yoghurt to make up the other food groups.
    • Try making salads with left over pasta, rice or cous cous and use any of the fillings above. Tuna and canned chickpeas or beans make great options, add vegetables like grated carrots and cucumber or a handful of cooked frozen mixed vegetables, chopped tomatoes or olives.
    • Make homemade soups with leftover vegetables and beans or lentils. Just boil vegetables in low-salt stock cubes and blend for a smooth soup or leave chunky. Carrots, parsnips, sweet potatoes, squash, onions, celery and sweetcorn work well, but you can use any vegetables you like. Flavour with herbs and spices; curry powder works particularly well for some warmth.

    Evening meals:

    • Meats can often be the most expensive part of the meal, so try to have some meals with made with eggs, beans and pulses or fish instead. You could also try other options like tofu or Quorn, which is a cheaper alternative.
    • For meals where you might use mince, trying cooking with turkey instead of beef mince as it’s lower in fat and cheaper. You could also try swapping half of the mince with a can of beans or lentils. Lentils work really well in cottage pie, spaghetti bolognese or lasagne, beans work really in stews or chilli and chickpeas work really well in curries.
    • Make your own sauces and avoid buying ready-made jars. Use canned chopped tomatoes as a base and add herbs and garlic for a bolognese, chilli powder for a chilli or curry powder for a curry. You can ensure the sauces are low in sugar and salt and it’s much cheaper.
    • Make extra meals and freeze the leftover portions to have on busy days or use leftovers in your packed lunch.
    • Using frozen vegetables is a great idea, they’re often healthier as they’re frozen as soon as they picked and you won’t waste any, you can just use what you need.
    • You could also try buying fruit and vegetables from your local market, find out what’s in season as it’s often cheaper and it might encourage you to try new things. Try to eat a variety of different coloured fruits and vegetables as the different colours provide different nutrients.
    • Avoid prepped and prepared vegetables, fruit and salad as they’re usually more expensive.
    • Canned fruit can also be really handy to keep in the cupboard for a quick dessert, just make sure it’s canned in juice, not syrup.
    • Frozen berries are also a great idea to mix into porridge or cereal, add to yoghurt for a dessert or make a smoothie as a snack.
    • If you’ve got banana’s that are going off, try freezing chopped bananas, then blending them with a hand blender and eat immediately, it tastes just like banana ice-cream and it’s really healthy!

    Part three will be available next week with more healthy and low cost meal snack ideas!

  • Healthy (and tasty) eating on a budget: Part 1 -
    17 June 2016

    Laura Bull

    I was asked to run a session for a group of adolescents on healthy eating on a budget recently.

    I thought it may be useful to share some tips for those of you planning to move out of your family home or heading off to University soon.

    Eating healthily needn’t be time-consuming, expensive or dull; with a little preparation and planning you can eat well and still save the pennies.

    To ensure your diet is balanced, try to include a food from the four main food groups at each meal:

    Healthy eating food groups

    • Potatoes, bread, rice, pasta and other starchy carbohydrate
    • Beans, pulses, fish, eggs, meat and other protein foods
    • Fruits and vegetables
    • Dairy and alternatives (milk, yoghurt, cheese)

    To save money, it helps to cook from scratch, ready-prepared foods or convenience foods are often more expensive and less healthy. If you’re not a confident cook, ask a friend or relative to help support you with practicing some basic cooking skills.

    Stock up on a few basic store cupboard ingredients so you’re ready to prepare quick meals. You shouldn’t need fancy kitchen equipment either, just the basics.

    • Herbs and spices and garlic
    • Vegetable oil (check it’s 100% rapeseed oil, it’s just as healthy as olive oil and much cheaper)
    • Dried pasta (go for wholemeal) and rice (basmati or brown, if you have more time to prepare)
    • Frozen vegetables
    • Canned beans, lentils, chickpeas or other pulses
    • Canned chopped tomatoes
    • Canned fish (particularly oily fish like sardines, mackerel and salmon)
    • Porridge oats and other healthy cereals like weetabix or shredded wheat
    • Nut-butters (such as peanut butter or try other nuts like cashew butter or almond butter, these can be pricey but just use a little at a time and it will last along time)
    • Low-salt stock cubes
    • Then, you’ll just need to stock up on fresh meat, fish, dairy foods and fruits and vegetables when you need them. Try to only buy what you need to avoid waste.

      Make sure you understand food labelling, it’s important to follow ‘use-by’ dates as this is about food safety, but ‘best before’ dates are generally just about food quality.

      Top tips about shopping

    • Plan your meals for the week ahead and write a shopping list, avoid shopping when you’re hungry!
    • Don’t fall for buy one get free offers if you know you won’t eat it and it will be wasted
    • Look down at the supermarket – this is often where the cheaper, value brands are kept, as the expensive brands are kept at eye-level
    • Stay tuned for further healthy and low cost meal ideas in future blogs!

  • Healthy (and tasty) eating on a budget: Part 3 -
    8 July 2016

    Here’s some ideas for quick meals:

    • Jacket potato with baked beans and salad
    • Brown rice with a homemade vegetable and bean or mince and bean chilli. Vegetables that work well are butternut squash, mushrooms or aubergine, try canned red-kidney beans, chickpeas or black-eyed beans.
    • Wholemeal pasta with frozen peas and canned-tuna, stir in some low fast soft cheese, dried herbs, garlic and pepper for a creamy sauce.
    • Pasta bakes with wholemeal pasta, chopped tomatoes, herbs, a handful of mixed vegetables and can of beans, topped with some grated cheese.
    • Curries with vegetables, such as frozxen cauliflower, carrots, peas and chickpeas. Use chopped tomatoes as a base and flavour with curry powders or other combinations of spices that you like. Add some plain natural yoghurt if you like your curries creamier. Other vegetables that work well are mushrooms, peppers, squash, courgette, frozen spinach and okra.
    • Eggs are really versatile, try scrambled eggs on toast with some mushrooms and frozen spinach or make a frittata or omelette; fry any vegetables you like, such as courgette, peppers, mushrooms, onions and peas and add some chopped boiled potatoes, add some whisked eggs and bake in the oven until cooked through
    • Most of us tend to not eat enough fish, particularly oily fish like salmon, sardines or mackerel, which provide us with important essential fatty acids. Like meat, fish can be expensive. Sardines and mackerel tend to be cheaper or you could try frozen portions of fish, which are generally cheaper. Canned fish is also great, add canned salmon, sardines or mackerel to pasta and rice salads, or pasta bakes, or have fish in tomato sauce on toast for a quick lunch. Canned fish is great for making fish cakes too, mix with mashed potatoes and herbs and form into patties and fry or bake. You can coat in bread crumbs, but you don’t have to. If you’re not keen on fish; fish fingers, fish pies or fish cakes can be a great way to introduce it.
    • Stir fries with rice or noodles; use half the amount of chicken or salmon you normally would and bulk up with plenty of vegetables, or perhaps try tofu. Vegetables that work well are onions, beansprouts, carrots, cabbage, mushrooms and peppers. To avoid expensive sauces, you could invest in some garlic, ginger, soy sauce and sesame oil, which combined makes a great stir-fry flavour and will last for ages!
    • Make homemade pizzas with a pitta bread; spread with tomato puree and add any combination of chopped vegetables, fish and meat, like ham and mushroom or ham and pineapple, tuna and sweetcorn or chicken, onions and peppers. Sprinkle with some grated cheese and bake or grill until the cheese has melted. Serve with some salad

    There’s loads of great books, magazines or recipe ideas online for some inspiration, try the Change4Life website. It’s aimed at families and children, but it does have some great recipe ideas, particularly if you’re not a confident cook.

    It can be easy to plan healthy meals and then fall down when it comes to snacks so try to plan some healthy snack ideas when you shop as well. Carry some healthy snacks with you to ensure you’re not tempted to pick up expensive items when out.

    Try some of these healthy snack ideas:

    • A piece of fruit
    • A small-handful of dried fruits and nuts (these may seem expensive but just have a small amount and one bag will last a while, perhaps portion out small pots or bags in the morning to take with you to avoid the temptation of eating the whole bag!)
    • Small bags of popcorn (or for a more economical option buy the kernels and pop your own popcorn, which can be fun. It does need to be eaten straight away though – it won’t keep well)
    • Chopped vegetable sticks like carrot, pepper, cucumber and celery, with low-fat soft-cheese, guacamole (try making your own for a special treat) or salsa. Celery also works really well with peanut butter!
    • Oatcakes or rice cakes with a little low-fat soft cheese or peanut butter
    • A small pot of yoghurt
    • A slice of toast

    There is more information about healthy on the British Dietetic Association website, in the ‘Food Facts’ section

    For more information or to arrange an appointment with the Dietitian, contact Laura Bull on 02034479364 or laura.bull@uclh.nhs.uk

  • The Tree of Life Group by Sureya Ali (Assistant Psychologist) - 14 June 2016

    The Tree of Life project offers the opportunity for young people with Type 1 diabetes to meet with others their age for one day. The group allows people to talk in a unique way, learn from each other, and share tips and stories. People who have attended a Tree of Life day say:
     
    "Way to express your feelings, step back and look, make you realise diabetes is not everything."
     
    "They always make a big deal about diabetes but here it’s more chilled out."
     
    "More perspective, there was a lot more interesting things about everyone other than diabetes – without exception!"
     
    "Met more people with diabetes… like a family…we all understand each other."
     
    There is a 12-14 year old group coming up at the end of July and a 10-11 year old group at the beginning of September. If you’re interested in finding out more, please contact Sureya Ali by emailing sureya.ali@uclh.nhs.uk or calling 020 3447 9086.
     

    Tree of Life

Dr Peter Hindmarsh08 April 2016

Type 1 diabetes - It is different
Dr Peter Hindmarsh

 Just about everyone knows someone that has diabetes, but people often do not realise that there are different types of diabetes that have different causes.

In paediatric practice we see children and young people with Type 1 diabetes. This type of diabetes is caused by the body destroying the insulin producing cells in the pancreas. This is known as an autoimmune process. This type of diabetes is not caused by life-style or excess intake of sugar. The treatment is life-long insulin injections.

Type 2 diabetes is the one that most people will recognise as this is the condition that is looked after initially with diet and tablet therapy. It is often said that this is the form of diabetes that results from poor life-style choices. Certainly obesity contributes to the development of type 2 diabetes. Is it really true then that developing type 2 diabetes is the fault of the person? The answer is no not entirely. There is increasing evidence that insulin cell development is compromised in people destined to develop type 2 diabetes. It would appear that obesity simply accelerates this process causing the compromised insulin producing cells to sooner stop working as well.

In type 1 diabetes we work with children, young people and their families to ensure that all that needs to be done to care for diabetes fits within their family activities, rather than the other way round. Type 1 diabetes places huge demands on families with the requirements of blood glucose testing, carbohydrate counting and insulin injections. All of this is on a background of coping with school and day to day activities.

Recent developments with insulin pump therapy and continuous glucose monitoring have improved the way that people can look after their diabetes. Measures of how well people manage their diabetes are improving year on year in the UK and particularly at UCLH.  Exciting developments with the artificial pancreas means that we are getting closer and closer to a normal life expectancy for our young people and a life free of the complications of diabetes.

  

James - UCLH patient04 April 2016

Running a half marathon - by UCLH patient James (aged 8)

When James was first diagnosed with Type 1 diabetes aged four, one of the very well-meaning doctors said to me “It’s ok, he’ll still be able to do sport.”

At the time nothing could have been further from my mind, still struggling with the shock and the information overload. It is only now that I understand how important it is to be told you can do things, like sport, with a condition like diabetes.

Last week my son, now 8 yrs old, ran in a half marathon at Wembley. Well at least he ran the final mile there; he’d done the other miles at school, in lunch breaks. When we got the letter about the run I was a bit dubious, mainly because I was not sure if the school could manage; I really should not have doubted them as they have been brilliant from the moment he set foot in the place.

Firstly the teacher running the marathon (in both senses of the word) did not blink an eyelid when I said James was interested in joining in. He said he knew James was very keen on running and I just needed to tell him what to do and they would manage. Truthfully I was as much in the dark about how James would cope and what his blood sugar would do as the staff were.

We had two unknowns to contend with- the time he was running- just after lunch- and the distance he was running. He has managed runs in sports day events with no problem but this was considerably further. We did know any blood sugar readings taken straight after lunch may not be entirely helpful and we had no idea how much energy he would use doing the run so it was a bit of an experiment.

Whilst running the teacher carried the blood sugar meter and glucose and all was fine on that first run and every run afterwards; it was the aftermath that proved more tricky. James is incredibly fortunate in that the current Learning Support Assistant in his class is an extraordinarily competent and confident young woman. She has been trained but she shows such initiative it is amazing to see how she dealt with things. I taught her how to do a temporary rate on the insulin pump and after that she worked out the amount and duration herself, changing it each week as the pattern emerged. It took me so much longer to feel confident doing that- I have so much admiration for her. It turned out that James needed two hours at 50% less on his pump as well as a snack shortly after the run. It also appeared that certain foods for lunch worked much better than others- though we had very little control over that. The jacket potato week was the only week with no hypo that afternoon, but foods like cottage pie also seemed to work better than pasta. Of course it is impossible to pin down all the variables, but it seemed that the less insulin he had before the run, the better he was in the afternoon.

The day of the run in Wembley dozens of staff turned up to help, including a very nervous teacher to run with James. She was his teacher last year and so knew him and her nerves were nothing to do with diabetes, only the thought of having to keep up with James, who is known as Mo Farrah at school! The one contingency we had not talked about- being too high, of course occurred that morning as James was very excited. He was actually ok by the time the run started but we had to quickly go over what to do to bring him down if needed. We also discussed levels it was ok to run at and that James would have to be stopped if he was having a hypo, even though he would not have wanted to stop.

As it happened he was absolutely fine before, during and after the run and with a large snack afterwards he remained so for the rest of the day.

It was nerve-wracking as a parent but I have great faith in the school staff and also in James himself. I would not have wanted to stop him doing the run just because he had diabetes; in fact James himself wanted to do it because he wanted to show that having diabetes was no obstacle.  He also used it as an opportunity to fund raise for diabetes research and it made him feel very much in control- something I feel diabetes can rob young children from feeling.

His face, holding the medal made it all so worthwhile and that doctor was right- he can still do sport!

Jacqueline Harris

James says-

If you are running a marathon and you have diabetes, others might think you can’t do it, but there is no can’t. You just have to achieve your goals. Always believe that you can do it.

  

Icon image of three people (friends)21 March 2016

Type 1 diabetes explained using Adobe Voice - by UCLH patient Carl (aged 10)

Hello everyone.

My name is Carl and I'm 10 years old. I have had Type 1 Diabetes since I was six. I made this video with my mum to show to my class for World Diabetes day. Some of my friends helped me make it and we found it hard to finish it because we couldn't stop laughing. My class and teachers asked lots of questions after. I hope you enjoy it!

  

Dr Rakesh Amin26 January 2016

TRIALNET Study for London by Dr Rakesh Amin

Hello everyone.

UCLH is now recruiting people into the TRIALNET Study for London and the South East area. The TRIALNET Study is dedicated to the prevention and early treatment of type 1 diabetes. Relatives of people with type 1 diabetes have a 10-15 times greater risk for developing the disease. With a single blood test, we are offering screening of non-diabetic family members of children with type 1 diabetes to evaluate their risk of developing type 1 diabetes in the future. Those who are at high future risk would be offered a trial of a therapy aimed at preventing or delaying the onset of diabetes. Here are the details of the study;

The study in brief

We will recruit any non-diabetic person aged 3 to 45 with a brother, sister, child, or parent with type 1 diabetes.  The initial screening involves a single blood test looking for a genetic predisposition and autoantibodies associated with type 1 diabetes.  If autoantibodies are present, participants are offered the opportunity to have 6 monthly assessment of their glucose status and may be offered enrolment in a diabetes prevention study. The first of these is;

The TrialNet Oral Insulin Study

Relatives who have high levels of insulin autoantibodies (IAA), are positive for at least one other autoantibody and are not diabetic will be asked to take part in a further study testing a capsule containing insulin in a powdered form (“oral insulin”) which may delay or prevent type 1 diabetes. Participants will take one study capsule each day of either the active medication or a non-active version (i.e. active vs. placebo).

The Abatacept Study

Abatacept is a powerful immune-modulating drug which would be administered intravenously on 14 occasions on our research unit over the course of 12 months.  The aim is to dampen down the immune cells that have been implicated in the destruction of the insulin producing beta cells in the pancreas 


Recruitment

1. Email us on TRIALNET@uclh.nhs.uk with your contact details and we will get back to you.
2. Ask the UCLH diabetes team during a clinic appointment.
3. We will be holding regular evenings to discuss the study at UCLH outpatients and we will advertise these beforehand.

  

Laura Bull18 January 2016

The Tree of Life Group by Laura Bull

The Tree of Life project offers the opportunity for young people with Type 1 diabetes to meet with others their age for one day. The group allows people to talk in a unique way, learn from each other, and share tips and stories. People who have come to a Tree of Life day before say:

‘Way to express your feelings, step back and look, make you realise diabetes is not everything’

‘They always make a big deal about diabetes but here it’s more chilled out’

‘More perspective, there was a lot more interesting things about everyone other than diabetes – without exception!’

‘Met more people with diabetes… like a family…we all understand each other.’

There are Tree of Life groups coming up early this spring. If you’re interested in finding out more, please contact Sureya Ali by emailing sureya.ali@uclh.nhs.uk or calling 020 3447 9086.

Tree of Life

 

 

  

Mountain15 October 2015 

Life with diabetes by Hannah Baker (aged 9)

Hi my name is Hannah Baker, I am 9 years old and I've been diabetic for 22 months.

On October 3rd 2015, I climbed mount Snowdon, the highest mountain in Wales. It was very hard climbing up Snowdon but I made it to the top by thinking all along I was contributing to finding a cure.

Hannah Baker

My mum helped me create a donation page and many friends and relatives both from the UK and Colombia (I'm half Colombian) donated money to help me find a cure.

Life with diabetes is quite hard that's why I climbed Snowdon, to help find a cure for diabetes not just for children in the UK but also for children and adults all over the world with Type I diabetes.

Since I was diagnosed with diabetes, I feel I am stronger, healthier and braver so some good has come out of this.

I am raising money for JDRF (juvenile diabetes research foundation) and participate in lots of activities like the London bridges walk and discovery days. I highly appreciate how the technology is moving on from big glass injections to CGM's.

Hannah Baker

Hannah’s Mum, Pilar, also shared some tips about managing Hannah’s blood glucose levels during the climb...

On the day, we monitored Hannah's bloods very closely.

She and I walked along side and I held the dexcom (continuous blood glucose monitor) to make sure I was looking at what was going on all the time, at least once every 5 minutes. We made sure she had a good breakfast (cereal and toast with butter), bolused 20% less for breakfast and aimed to start the climb on a 7 or 8mmol/l. As she started climbing, I saw she was dropping into the 5's and I had a bag of gummy bears and fed her along the first phase of the climb. Even with carbs she was starting to go into the 4's so I set a temp basal of 50% for 3 hours and complemented this with more fast acting carbs (granola bars and haribos) without bolusing. 4 hours into the climb Hannah was getting fed up with sweets so I set a 4 hr 0% temp basal. For lunch, she bolused 20% less and throughout the following night (when hannah tends to hypo after strenuous exercise) she was on a 50% temp basal from 10pm to 6am.

And this did it for us !

So now, instead of fearing exercise we are looking for the next mountain to climb

We plan on climbing, climbing, climbing and climbing until a cure is found.

  

Laura16 September 2015 

School training days 2015 by Kirsty Dring

The diabetes team have had a busy week this week, we have trained over 150 members of school staff! We ran 2 study days, one on injections and one on insulin pumps and have had a great turn out and a great response to these! The study days covered subjects such as ‘what is diabetes?’, ‘ how to manage hypos and hypers’, ‘sports management’ and ‘legislation’. One of our Clinical Psychologists Hannah Duncan, talked about the impact of diabetes on cognition and learning and Laura Bull, our Dietitian led a carbohydrate counting group. We also ran a practical session on injections and the different pumps which was a logistical challenge but never the less very well reviewed! Some of the comments we had on our evaluation forms included “I think you are all doing an amazing job- very informative day”, “ it’s a good course thank you” and “Well done!- I feel more confident!”. The next study days are Jan 7th 2016 and September 12th 2016 – We can’t wait!

  

Laura09 September 2015 

Managing school days - medical plans and guides by Rebecca Thompson

You can download our school medical plans below:

Step 1: Complete the care plan for either pumps or injections:

Step 2: If your child uses a pump, add the appendix for their specific pump:

Step 3: If your child uses injections, add the ‘how to’ guide for injection technique:

Step 4: Select the appropriate ‘how to’ guide for the blood glucose meter your child uses:

Step 5: If your child uses continuous glucose monitoring (CGM), also complete the CGM plan:

Step 6: If your child uses CGM, add the ‘how to’ guide for their specific device:

Step 7: For all children and young people with type 1 diabetes, add the ‘how to’ guide for administration of glucagon:

Step 8: For all children and young people with type 1 diabetes, add the ‘how to’ guide for testing ketones using the Freestyle Optium Neo Meter:

  

10 August 2015  Annan

Managing sports, exercise and type 1 diabetes by Francesca Annan, Paediatric Diabetes Dietitian at Alder Hey Children’s Hospital

Managing exercise can be a challenge but it can be done and well managed diabetes is not a barrier to sports performance. There are many successful sports people at all levels with Type 1 Diabetes. So what is the secret to success? It is no secret really, it’s all about monitoring blood glucose (BG) levels and making adjustments to insulin and food (carbohydrate) intake.

Blood glucose monitoring and exercise

The best advice we can give is to check BG more when you are being active. We know it’s actually very easy to miss the signs of a low BG (hypo) during exercise. This is because the actual exercise can feel just like a low whatever your BG. Being distracted whilst you exercise also makes it harder to spot lows. If you can check twice in the hour before you start then you know if you have a stable, rising or falling BG. Check every 20-30minutes during the exercise, if you can, then you know what’s happening. Check again when you stop, 1-2hours after your activity, before bed and possibly overnight.

Being active may lower your BG during and after the activity. We know that exercise in the afternoon or evening often causes low blood glucose levels between midnight and 4am.

Aim to keep your blood glucose around 6-8mmol/L when you are active/exercising. Below 5.5mmol/L and you are more likely to have a hypo during the exercise and above 14mmol/L you may find your BG just goes up. Sports performance is better when the BG is between 6 and 8mmol/L.

Insulin adjustments

If you know when you are going to be active and you know what you will be doing you can plan changes to insulin doses. If activity is within 1-2hours of a bolus/injection of fast acting insulin you can decrease the dose to reduce the risk of lows. If you know you have a busy/active day ahead you can adjust background/basal insulin. On a pump you can start a temp basal rate about 60minutes before you begin an activity and on injected insulin you can lower your morning or night time dose of long acting insulin. Start by dropping the dose by about 20% and then check to see what happens.

Sometimes exercise puts your blood glucose levels up, you will learn through experience how you respond to different types of activity and what adjustments you need to make. Remember that every activity may be a bit different and there are lots of different solutions to managing your BG.

When any activity is planned then the monitoring and insulin adjustments can be planned, but life often isn’t like that so here are some tips for unplanned activity:

  • Check your BG and if you use an insulin pump/smart blood glucose meter check your ‘active insulin’ or insulin on board (IOB) as well
  • If you are going to do the types of activity that tend to drop blood glucose levels then here is what to do:

Blood glucose

Active insulin

Action for activity lasting longer than 45 -60minutes

Below 5.5mmol/L

No active insulin

 

 

Active insulin

Have a snack around 15-20g before you start being active to bring your BG up and prevent a low

You will need a bigger snack to prevent a low BG if you have active insulin

between 5.5mmol/L and 8mmol/L

No active insulin

 

Active insulin

Have a 10-15g snack before starting exercise

Have a 15 - 20g snack before exercise

between 8 and 10mmol/L

No active insulin

 

 

 

Active insulin

You can start exercise without any extra carbohydrate bur recheck your BG after 20-30minutes to see if you are stable or dropping

You will need a snack if you have more than 1unit of active insulin. About 10-15g - recheck BG after

Above 10mmol/L

No active insulin

 

 

 

 

 

 

Active insulin

No extra carbohydrate needed but you might need to think about whether you actually have enough insulin working to allow your muscles to use glucose.
If your BG>13.9mmol/L then check for blood ketones. If they are >1mmol/L you should not exercise until they are gone

No extra carbohydrate needed but you do need to check and make sure your BGLs fall just enough and don’t start to go too low or too high

  

Peter22 July 2015 

Blood glucose research by Peter Hindmarsh

Research has shown that the duration of infusion set correlates with blood glucose levels. Click on the link to read more:

https://t1dexchange.org/pages/t1d-exchange-evaluates-correlation-between-infusion-set-duration-and-fbg/

  

Peter27 June 2015 

HbA1c and a number of tests by Peter Hindmarsh

Just about every year we get a note from families that their GP is being bit stingy on blood glucose strips. This is partly because they look at Type 2 Diabetes where not much blood glucose testing takes place and then question why Type 1 diabetes might be different.

What we know is that blood testing is of paramount importance in the management of Type 1 Diabetes. Tests are required on a daily basis in order to determine dose adjustments for eating, correction of high blood glucose values and prevention or handling of hypoglycaemia. Research data show a clear relationship between the frequency of blood glucose control and diabetes control as measured by glycosylated haemoglobin.

Attached are the data for pump therapy showing that there is still benefit out there at 10-12 tests per day.

The minimum number of tests per day that resulted in improving control was 8 with an average of 10 per day. This would suggest that children and young people with type 1 diabetes require a regular prescription of a minimum of 300 test strips per month. Just out on interest this costs £150.

There is also a disturbing tendency for local Commissioners to advise certain meters and not others. This is particularly so with those systems that link to the pumps. This can be simply deflected on safety issue as the linking is important for schools where it avoids wrong glucose entry when requested into the pump.

  

Laura8 March 2015 

The Tree of Life project  by Lucy Cadagli

The Tree of Life project offers the opportunity for young people with Type 1 diabetes to meet with others their age for one day. The group allows people to talk in a unique way, learn from each other, and share tips and stories. People who have come to a Tree of Life day before say:

‘Ways to express your feelings, step back and look, make you realise diabetes is not everything’

‘People always make a big deal about diabetes but here it’s more chilled out’

‘More perspective, there was a lot more interesting things about everyone other than diabetes – without exception!’

‘Met more people with diabetes… like a family…we all understand each other.’

There are Tree of Life groups coming up early this summer. If you’re interested in finding out more, please contact Maddy Harris by emailing madeline.harris@uclh.nhs.uk or calling 020 3447 9086

  

Laura12 January 2015 

The D Word by Laura Bull

Patient Lizzie Milligan has created a very good short film  about people living with Type 1 Diabetes.

Lizzie said: "I made this video as part of my Media A level. The documentary was made to inform people about living with Type 1 Diabetes. It raises questions about what it is, the difference between Type 1 and Type 2 Diabetes, diagnosis, school life, emergency situations and living with diabetes."

 

 

Laura 9 December 2014

Carbohydrates at Christmas by Laura Bull

There’s no reason why children and young people with diabetes cannot enjoy festive foods and treats, just like anybody else. If your diet is healthy most of the time, treats at Christmas are fine, just try to make sure Christmas doesn’t last four weeks (and count your carbs)!

Carbohydrate counting at Christmas can be tricky, as foods may be unfamiliar. Eating out at restaurants or friends and relatives houses may be challenging, particularly if meals are home prepared, without food labels.

You might be surprised by some examples of the carbohydrate contents of these christmas foods. 

Christmas Dinner

   
Roast Potato (90g portion) = 24g carbohydrate
Roast Parsnip (60g portion) = 12g carbohydrate
Yorkshire Pudding (1x ready made portion) = 7g carbohydrate Cranberry Sauce (1tbsp or 15g portion) = 6g carbohydrate

 

There is no or very little carbohydrates in turkey, brussel sprouts and other vegetables, so there’s no need to count these foods.

Check the labels of sausages, gravy and stuffing as some may contain carbohydrate, for example some stuffings may just contain meat whereas others may contain breadcrumbs or dried fruit, which contain carbohydrates.

If you make your own stuffing, yorkshire puddings, mince pies or christmas puddings, see below for help with carbohydrate counting for recipes

   
Mince Pie (1x ready made deep filled) = 40g
Christmas Pudding (1 individual pudding, approximately 100g) = 60g
 

* The plate used in the pictures is 19cm in diameter

If you’re eating out at restaurants or friends, ask them to keep the labels or write down the recipes or see if the restaurant has the nutritional information available. If not, you may need to estimate the carbohydrate content of the meal using your experience or resources such as the Carbs and Cals app or book. Just make sure to check your blood glucose levels two-three hours after eating and make any necessary corrections.

Christmas biscuits recipe

Christmas is a great time for having fun in the kitchen, there’s no need to miss out on Christmas baking and home prepared recipes. You can still enjoy baking and manage your diabetes. You can count the carbohydrates for recipes as well. There is an example showing you how to carbohydrate count the recipe for Christmas biscuits.

The Carbs and Cals App also has a useful tool for carbohydrate counting recipes and some useful Christmas resources, log in to their website to find out more.

If you need help with carbohydrate counting at any time of the year, contact the Children’s Diabetes Dietitian on 020 3447 9364 or laura.bull@uclh.nhs.uk

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Sammy 1 December 2014

JDRF (Juvenile Diabetes Research Foundation) special event - by Sammy Novick

Sammy Novick It only feels like yesterday when I wrote down in my JS book that I ‘really wanted to go to Buckingham Palace’. And as I write this: it was only yesterday when I actually went into Buckingham Palace!

I was honoured to be invited by the JDRF team to come along to this prestigious event where the Countess of Wessex would be unveiling a patchwork quilt which was made by the Girl Guides to raise money for JDRF: This special event offered me too meet up with some other diabetic people as well as visit Buckingham Palace, where I met and spoke to the Countess of Wessex. I was absolutely thrilled!

We initially all met at the Girl Guides’ head office near Buckingham Palace after a delightful lunch with my Dad. We were told to put on a JDRF t-shirt and a name badge. I was already wearing a suit so that I could look ‘as smart as I could.’

After a few photos, we had a quick conversation about how diabetes connects to us. Usually, I would have given a long speech about what it means to me, but I was surrounded by many people who, funnily enough, knew what diabetes was. Therefore, I excitingly and nervously said,  ‘I am a diabetic and I’ve been living with it for 8 years, since I was 5.’

We then headed off to a wonderful palace; Buckingham Palace.

As soon as I got through the main gates; I was gob-smacked. I was lost for words, although I apparently kept saying to my dad, ‘I’m so excited!!’

We walked through the first building and were lead via a marquee to a back building. Here, I was even more gob-smacked than before. In front of me was the most elegant and beautifully designed building I had ever seen, (& something which was not on the internet).

After a few minutes of preparation, we walked up the magnificent flight of stairs and we were led inside the ‘Blue Room.’

There was a huge table laid out with delicious goodies (including diabetic biscuits) and soft drinks and cups of tea. I couldn’t resist the lemon cake. I had to drink lots of water too as my mouth felt so dry (probably due to nerves!)

Once tea was finished and we visited the toilets (just to see if we could get a glimpse of the queen!), the Countess of Wessex appeared. We all lined up and each one of us spent time talking to her. She asked me why I had raised money for JDRF. I had prepared what I was going to say and explained to her something similar too (summary): ’ I wanted to raise money to find a cure as I don’t want people all around the world with diabetes to cope and worry about injecting themselves, before and after eating a meal, or even having to eat something when you’re low on sugar (even though it sounds appealing its really not at the time).’


Once the Countess of Wessex had finished speaking to everyone in the room and been presented with the quilt that had been made by the Girl Guides, we had the chance to take in more of the splendour of Buckingham Palace before being escorted back through the building to the main entrance.

After, an exquisite and an unforgettable day, it will be a prestigious and amazing memory of mine that I will always treasure.
Juvenile Diabetes Research Foundation.

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Laura 7 November 2014

What matters most to families/carers and young people? - by Laura Bull

The short survey has been devised by the National Diabetes Networks to find out what matters most to families/carers and young people. There are 6 questions. Please use the links below to complete the survey.
 
For parents and carers:
https://www.surveymonkey.com/s/3ZYZL2R
 
For young people:
https://www.surveymonkey.com/s/GCXBDN2

 

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Billy 6 November 2014

Travelling with diabetes - Sam's gap year - by Billy White

Are you thinking of going on a GAP year?

Sam Marcus has just come back from his GAP year and had a fantastic time. He’s written a really great article sharing his experiences and gives lots of sensible advice about going on a gap year with diabetes. 

We have written an advice sheet sharing other ideas from successful trips. One family just returned from Universal studios in Florida and didn’t have to stand in a single queue for the attractions. They went to “Guest Services” after they arrived at the park, told them about diabetes, and they were given a special access cards for all rides. We’d love to share your stories if you have other ideas.

You can read Sam's blog below:

Sam

Travelling the world is a serious undertaking for anyone. Those of us with diabetes have our own specific obstacles we must overcome. Over five months, stuff goes wrong. Sure, things may have been a little simpler for me if I hadn’t been ushered by non-English-speaking Vietnamese airport security into the ‘back room’ to launch mission: “Where does this suspicious (pump) wire lead?”; or if I hadn’t been forced into an emergency canula change atop a Fijian mountain after a long day’s hike. But “simpler” doesn’t always equal “better”; everybody loves adventure, and diabetes doesn’t have to be just an obstacle when you embark on your own.

Planning/packing

The planning stages are, of course, vital. Speak to doctors / nurses about how much kit to take with you (I took 50% more supplies than the ‘minimum’). The terms ‘overpacking’ and ‘overplanning’ shouldn’t exist. Think worst-case scenarios; the likes of ‘What if one of my frio bags stops working?’, and ‘What happens if a bag with my dextrose gets wet and they’re ruined?’. To negotiate most of these potential hiccoughs, spread your stuff out; putting all of your eggs in one basket, so to speak, wouldn’t be smart if the basket disappears.
I always split my supplies between two bags, making sure that in my “day sack” I carried with me at all times enough equipment to survive for at least two weeks in the event of my main bag being stolen from a hostel, not making it off a flight etc. This should usually be enough of a window to get hold of replacement equipment, either by sending it from home or buying it where you are. The ‘two bag rule’ slashes your odds of losing all your stuff in half, and worked well for me.
Specifics: I had one big backpack with two compartments. One compartment was for my clothes, the other had the bulk of my diabetes supplies and my loan (spare) pump. Then I carried a smaller ‘day sack’ / school rucksack type thing with the 2 weeks worth of equipment and insulin.

Airports

You’ve probably been through airport security before. It’s a simple drill travelling in western countries: have your letter from UCLH explaining that you have an insulin pump, don’t let anyone put it through a full body scanner and so on and so forth. It doesn’t always run so smoothly in less developed countries; many people won’t have ever seen or heard of a pump, and have a very limited understanding of what diabetes is. It’s a good idea to keep a document with a translation of what the pump is in the language of where you are, but as with most things travelling related, patience is the name of the game. Never lose your cool with people. For long haul flights or coach journeys, make sure you have enough food to hand - you don’t want to be stranded without.

Theft

Most travellers have something lost or stolen on a big trip, but iPhones/passports are a little less serious than BG meters/insulin. The obvious thing to say is be hugely vigilant. Your health is at stake, so behaviour bordering on the paranoid when it comes to bags is far more socially acceptable from you than someone else.

Insulin rates

The doctors can give you detailed advice about how your basal rate should be altered depending on what you’re doing, but cutting my rates in hot climates worked well for me, as well as if I was spending a day walking around in the heat and so on. Just make sure you test. I tested more travelling than I do at home. It really doesn’t take very long, and you’ll have a better time for doing so. It’s easy to get caught up in whatever you’re doing and forget about testing, but don’t!

Keeping cool

It goes without saying that you need to make sure your insulin is chilled all the time. Mine was fine in frio bags for the duration of my trip, so I wouldn’t have thought you need to go to the trouble of trusting people’s fridges along the way. Even if you’re staying in a private room with a fridge, be aware that in many countries, electricity in the room is cut off when you aren’t actually inside, so be careful about leaving your insulin in hotel room fridges. Make sure you soak the bags a lot if you’re in a hot climate, once a day is a good rule anywhere over 25 degrees. Also be aware that the insulin in your pump can be spoilt if you’re out in the heat all day. If you take your pump off to swim, don’t just leave it in the sun to bake. A separate frio bag for your pump is a good idea.

Social stuff

Always tell people you’re travelling with that you have diabetes; in an emergency, you’d be thankful that people know. This doesn’t mean walk around with a huge “diabetic” brand on your forehead or anything like that: there are way more casual ways of letting people know; being around fellow travellers 24/7, they’ll see you testing and will probably ask you why you’re still using a “pager” in 2014. That would be a good time to let them know you have diabetes and what they could do in the unlikely event of you being ill. Be careful about how much you drink; there’s usually a lot of alcohol in hostels and the like, but you won’t be the only person who isn’t going crazy if you choose not to indulge. If you do, drink less than you would normally at home and make sure you have food to eat when you get in from the night out.

So there you have the various obstacles I faced travelling with diabetes. They aren’t too difficult to overcome; it just takes more planning and vigilance than most people need, but that doesn’t have to be a bad thing. If you can plan your activities and route with as much competence as your diabetes planning, you’ll be doing well. People will always want to ask you about your pump and how you cope with diabetes, so don’t feel awkward about telling people about it – it can be a great conversation starter in hostel environments, if nothing else! Good luck.

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Peter 04 November 2014

Low dose glucagon for hypoglycaemia – by Professor Peter Hindmarsh

There has been a lot on interest in this topic recently and a recent paper in Diabetes Care this month has opened up the topic for a broader discussion.

When blood glucose starts to fall a series of responses start to operate.  At a blood glucose of about 3.6-3.8 mmol/l insulin secretion by the beta cells switches off.  This switch off in insulin leads to an increase in glucagon release from the alpha cells in the pancreas and the increase in glucagon tells the liver to break down glycogen (the liver stores glucose as glycogen) and release glucose into the blood stream.  If the blood glucose falls down to about 3.2 mmol/l then other hormones are released such as adrenaline, cortisol and growth hormone which will all act to increase blood glucose.  Cortisol and growth hormone take some time to act which is why you often get a rebound high after a hypoglycaemic episode.

In Type 1 diabetes the usual reason for going hypo is that there is a bit too much insulin around for the situation eg. Doing exercise after lunch when you have bolused normal amount for the food.  As there are no beta cells working insulin cannot be switched off and because insulin cannot be switched off that natural rise in glucagon cannot take place. 

Normally we get round this by taking rapidly available glucose and going through the “15 rule.”  Occasionally this does not work and a glucagon injection might be needed.  The dose recommended is 0.5mg for those under 12 years of age and 1.0mg for those above 12 years of age. 

More recent thinking has questioned this and raised the idea of low dosing with glucagon.  This has been in part stimulated by the use of insulin and glucagon in a pump delivery system as part of the artificial pancreas project.  We mentioned this in an earlier article about the closed loop.

The Diabetes Care study looked at how much glucose was produced (mg/kg) when different doses of glucagon were given on the background of different insulin infusion rates.  The results are summarised in the graph.

Chart

So for a child weighing 20kg the insulin infusion rates would be 0.3 units/hr (blue line), 0.6 units/hr (red line) and 1.0 units/hr (black line). 

These doses are a fraction of the standard suggested dose.  What is important to note is that if the insulin infusion rate is high (black line) then the mini-doses are likely to be less effective in raising the blood glucose and higher more conventional doses may be needed.

What this means is that if the basal insulin infusion rate is less than 0.05 units/kg body weight/hour then mini-doses would seem to be good way of getting the blood glucose up without overshooting but if rates are higher than this then they may be less effective.

If you want to read the article which is quite technical then have a look at:
Diabetes Care 2014; 37: 3054-60.

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Lucy 12 September 2014

The TRIALNET Study - by Rakesh Amin

It’s been a long time coming but the necessary paperwork is nearly completed and from October 2014, we will be recruiting people into the TRIALNET Study. Relatives of people with type 1 diabetes have a 10-15 times greater risk for developing the disease. The TRIALNET Study is dedicated to the prevention and early treatment of type 1 diabetes in these people. We are offering screening of family members of children with type 1 diabetes and in those who are at high future risk of developing type 1 diabetes, recruit them into suitable studies. Here are the details of the study;

Eligibility criteria

  • Any non-diabetic person aged 3 to 45 with a brother, sister, child, or parent with type 1 diabetes.
  • Any non-diabetic person aged 3 to 20 with a cousin, aunt, uncle, niece, nephew, half sibling, or grandparent with type 1 diabetes.

Screening phase

The initial screening involves a single blood test looking for autoantibodies associated with type 1 diabetes. About 4% of family members of people with type 1 diabetes will have autoantibodies in their blood.

Monitoring phase

If autoantibodies are present, participants are offered the opportunity to have 6 monthly assessment of their glucose status and may be offered enrolment in a diabetes prevention study. The first of these is;

The TrialNet Oral Insulin Study

Relatives who have high levels of insulin autoantibodies (IAA), are positive for at least one other autoantibody and are not diabetic will be asked to take part in a further study testing a capsule containing insulin in a powdered form (“oral insulin”) which may delay or prevent type 1 diabetes. Participants will take one study capsule each day of either the active medication or a non-active version (i.e. active vs. placebo).

If you are interested please inform your diabetes team at your next clinic visit or email Dr Rakesh Amin (rakesh.amin@ucl.ac.uk).

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Peter 11 September 2014

CLOSED LOOP SYSTEMS – Getting better all the time by Professor Peter Hindmarsh

Insulin pump therapy has become well established as a way to improving blood glucose control in type 1 diabetes. Now researchers are seeking to improve this with closed loop systems that monitor and automatically adjust the insulin infusion rate depending on the tissue glucose recorded.

In the medical journals over the last three months here have been a series of reports from several research groups on mainly overnight glucose control using the closed loop system.

Essentially the closed loop uses a glucose sensor to track tissue glucose levels. These values are fed into a lap-top computer that determines from the glucose level and a series of other parameters the amount of insulin the pump needs to deliver to maintain a normal glucose level.

The closed loop system certainly can achieve overnight normal blood glucose values at least in the hospital setting. In all the studies to date only insulin has been given. What is novel about the New England Journal of Medicine article is that insulin is administered as usual using the senor and pump. The difference is that at a preset glucose level glucagon is also pumped in as insulin is switched off to avoid hypoglycaemia.

You will remember that normally in the pancreas if our blood glucose falls insulin is switched off and the fall in insulin levels in the pancreas triggers the release of glucagon from the alpha cells in the pancreas and this raises the blood glucose.

So this pump mimics this process. Not only were 24 hour glucose levels better 7.7 mmol/l on the “bionic” pump there were less hypoglycaemic episodes.

As always the limitations of the closed loop are how good the sensor system is. This was evident in this study. Reliable sensors remain the goal if this technology approach is to be of value to patients with type 1 diabetes. Things are looking good for this kind of technology in the coming 2-3 years.

Check out the paper:

Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes
New England Journal of Medicine 2014; 371:313-325

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1 May 2014

School teacher training for insulin pumps and injections

As we start to prepare for the autumn school term, we would like to encourage children, young people and their families to ensure they have two teachers at school who have been trained to support them in caring for their diabetes.

We will be running training days for Injections on the 4th September and for Pumps on the 8th September 2014.
 
We will be giving out details of how to book tickets for these sessions in clinic over the coming months or you can ask the nursing team.

Who is this training aimed at?

This training is aimed at teachers/ teaching assistants / first aiders and school nurses who are supporting children with Type 1 Diabetes in schools and early years settings.

What will be included in the programme?

There will be sessions covering an overview of diabetes; the cognitive impact of diabetes; managing hypoglycaemia, hyperglycaemia and exercise and relevant legislation. The morning will cover the care of children using insulin pumps, with a combination of both theoretical and practical sessions.

Is there a charge?

There is no charge to attend. We offer a maximum of 2 places per school.

Can anybody attend?

In order to be able to attend, the child must be under the care of the diabetes service at UCLH.

Do I need to bring anything?

Please bring a copy of your ticket and the brand of pump which the child uses so we can ensure you have appropriate training.

If you are changing schools, don’t forget to download a school care plan from our website to agree with the school before we sign it off.

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Lucy 21 February 2014

The Tree of Life project by Lucy Casdagli - Clinical Psychologist

The Tree of Life project offers opportunities to meet other young people with diabetes  to:

  •   Talk with other young people in a unique, chilled way
  •   Learn and share tips with others
  •   Swap stories of what works in a creative way
  •   Identify and build on your strengths
  •   Explore and share your hopes and dreams with others
  •   Gain a different perspective on yourself and others

Young people who have participated in the Tree of Life day say:

  • “It lets you talk about serious stuff in a fun way”
  • “You realize what you do to keep going. You tend to do it without realizing.”
  • “Sharing views with other people”
  • “I’ve never spoken to anyone else with diabetes or heard other people talk about diabetes – quite wow!”

For more information or to apply for the next Tree of Life project day contact:

Lucy Casdagli or Isabella Girling
Psychology department
020 3447 9086

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Billy 21 February 2014

Out of hours care - give us your feedback by Billy White

What sort of support do you want when the diabetes nurses aren’t around (weekends, evenings and nights)?

We are working with other diabetes units across the South-East of England to develop improved out of hours care.

Click here to complete our quick survey.

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5 February 2014

Calshot Activity Centre

Our UCLH children and young people’s diabetes team work closely with colleagues at Great Ormond Street Hospital. Today’s blog comes from Rebecca  Margetts, dietitian at Great Ormond Street Hospital:

My name is Rebecca and I am a dietitian. I work with children and young people who have diabetes at Great Ormond Street Hospital.  Last summer I was very lucky to be able to go on a Diabetes UK children’s holiday to Calshot Activity Centre in Hampshire.  I spent 7 days with a great group of children and other volunteers.  It’s was a very action packed week.  The children (and adults) have the opportunity to take part in a wide range of activities including archery, indoor skiing and sailing, all led by experienced instructors. Diabetes UK volunteers are on hand to support and help the children manage their diabetes in various scenarios.

This was my forth visit to Calshot and every year I learn something new.  Some of the children have insulin injections and some are on insulin pumps. I’m always so impressed by how everyone helps and supports each other.  At camp, there are doctors, nurses, dietitians and other volunteers who have diabetes so there are plenty of opportunities for the children to ask questions and learn about diabetes. Not only do the children build on their knowledge, they also gain confidence and often go home taking more responsibility for their diabetes.  The children learn in an informal way, having discussions about carbohydrate counting at mealtimes, learning how to adjust their insulin for exercise and also trying new injection/cannula sites or improving their injection technique.  They really benefit from spending time with other children their own age who also have diabetes.

If you think your child would enjoy meeting other children who have diabetes and benefit from a Diabetes UK holiday then for more information on where and when these holidays take place visit the Diabetes UK website.

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Laura 17 December 2013

Carbohydrates at Christmas by Laura Bull

There’s no reason why children and young people with diabetes cannot enjoy festive foods and treats, just like anybody else. If your diet is healthy most of the time, treats at Christmas are fine, just try to make sure Christmas doesn’t last four weeks (and count your carbs)!

Carbohydrate counting at Christmas can be tricky, as foods may be unfamiliar. Eating out at restaurants or friends and relatives houses may be challenging, particularly if meals are home prepared, without food labels.

You might be surprised by some examples of the carbohydrate contents of these christmas foods. 

Christmas Dinner

   
Roast Potato (90g portion) = 24g carbohydrate
Roast Parsnip (60g portion) = 12g carbohydrate
Yorkshire Pudding (1x ready made portion) = 7g carbohydrate Cranberry Sauce (1tbsp or 15g portion) = 6g carbohydrate

 

There is no or very little carbohydrates in turkey, brussel sprouts and other vegetables, so there’s no need to count these foods.

Check the labels of sausages, gravy and stuffing as some may contain carbohydrate, for example some stuffings may just contain meat whereas others may contain breadcrumbs or dried fruit, which contain carbohydrates.

If you make your own stuffing, yorkshire puddings, mince pies or christmas puddings, see below for help with carbohydrate counting for recipes

   
Mince Pie (1x ready made deep filled) = 40g
Christmas Pudding (1 individual pudding, approximately 100g) = 60g
 

* The plate used in the pictures is 19cm in diameter

If you’re eating out at restaurants or friends, ask them to keep the labels or write down the recipes or see if the restaurant has the nutritional information available. If not, you may need to estimate the carbohydrate content of the meal using your experience or resources such as the Carbs and Cals app or book. Just make sure to check your blood glucose levels two-three hours after eating and make any necessary corrections.

Christmas biscuits recipe

Christmas is a great time for having fun in the kitchen, there’s no need to miss out on Christmas baking and home prepared recipes. You can still enjoy baking and manage your diabetes. You can count the carbohydrates for recipes as well. There is an example showing you how to carbohydrate count the recipe for Christmas biscuits.

The Carbs and Cals App also has a useful tool for carbohydrate counting recipes and some useful Christmas resources, log in to their website to find out more.

If you need help with carbohydrate counting at any time of the year, contact the Children’s Diabetes Dietitian on 020 3447 9364 or laura.bull@uclh.nhs.uk

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Lucy 21 October 2013

Managing diabetes on Halloween by Laura Bull

Having diabetes doesn’t mean that you have to miss out on enjoying events like Halloween.

Whether you have diabetes or not, if you eat healthily most of the time, you can allow some exceptions on special occasions. Its fine to have some sweets occasionally and there’s no need to have diabetic sweets, just make sure you have extra insulin for them. (See the factsheets on healthy eating for diabetes and carbohydrate counting)

Although, it can be daunting managing your child’s diabetes in these situations, increased activity levels, excitement and different foods may all affect blood glucose levels. You may find you need to check their blood glucose levels more often so you know what is going on. (See the fact sheets on managing high blood glucose levels, low blood glucose levels and exercise.)

Tips to manage Trick or Treating

  • Try not to eat the sweets while out and about as it can be difficult to keep an eye on how much has been eaten
  • Arrange to have one treat when returning and save the rest for other days. Explain this is to keep everyone healthy and is the same for everyone in the family, not because of diabetes
  • Try to have a proper meal with starchy carbohydrate before the sweets and increase the insulin dose for the extra carbohydrate
  • Celebrate Halloween in other ways, so it’s not all about the sweets! Stay at home, dress up and play games.
  • Try preparing a scary autumnal feast. Try worm spaghetti with eyeball meatballs, mini toads in the hole, pumpkin pasta bake, witches brew green vegetable soup with bread. Be creative – there’s loads of ideas on the internet or try recipe books in the library! Get your child involved in planning and preparing it too, this is particularly helpful if your child can be fussy or isn’t keen on trying new foods. Let us know what ideas you come up with and if you need help carbohydrate counting for home prepared recipes we can help!
  • Show your children that fruits and vegetables can be healthy and fun – try apple bobbing and carving the pumpkin. Use the carved pumpkin in recipes such as pumpkin soup, roasts, risottos, stews or pies.  
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Lucy 23 September 2013

School staff diabetes training by Kirsty Dring

UCLH has seen a flurry of activity this September with The Diabetes Team training over 230 members of school staff from 126 schools across the country. The team ran two half day sessions on managing diabetes on pumps and one session on injections in schools. The sessions were attended by school teachers, school nurses and teaching assistants and included talks on 'What is Diabetes?' ,'Managing high and low blood glucose levels', 'Diabetes and cognitive function' and 'Documentation, legislation and training needs'. School staff with a duty of care to look after young people with diabetes felt the day gave them a better idea of what was expected of them legally and also practically. We had very positive feedback for both the pump and injection sessions with most people increasing their knowledge over the day. For those staff who have been coming every year they reported it being a useful reminder and update.

Here is some of the feedback we have had:

"Thank you it was a very interesting course and I feel more confident about diabetes and the effects of it."

"Very good demo on insulin pump and settings"

"Excellent training- so helpful thank you!"

Due to high demand the team are considering running another course in January to train more staff and those who couldn't make it in September- watch this space! Also please remember we are not able to visit individual schools (apart from at diagnosis) so please take this opportunity to come and get training on Diabetes management. Care plans can now be downloaded from the website and emailed to the nurses for signing off, once filled in by school staff and parents. Please email completed care plans to childrensdiabetesnurses@uclh.nhs.uk.

You can download our diabetes school medical plans below:

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Lucy 16 July 2013

Hay Festival by Dr Deborah Christie

If you asked me what I like the most about my job as a psychologist I’d say working with adolescents and their families and hearing about the ways they refuse to let diabetes stop them getting on with their lives. I hate the way that diabetes can just arrive in someone’s life one day and then do it’s best to get in the way of things. The second thing I love about my job is the chance to travel and talk to people about how our team works with children, young people and their families knocked off track by diabetes.

Having a chance to edit a book about how diabetes affects families and the different ways to support them was a great opportunity. The book was called ‘Psychosocial aspects of diabetes, Children, Young people and families’.  I spoke to people that are the best in their field from all over the world and got them to write about the most up to date research. The book had three sections. The first section was the facts about diabetes, what caused it and shat effects it has. The second section was about how to manage the effects. The final section was a kind of tool kit with resources and suggestions about how to put good practice into practice! I was really pleased it the finished article – it’s not just for professionals but parents too. It has been very exciting to be able to go to the Amazon website and look up the book to check out if anyone has reviewed it as well as see if it is selling. My first review was from a  parent who bought it. 

In May this year I was invited to come to be interviewed about the book and about diabetes in children and young people by the Hay book festival which is held every year in Hay-on-Wye. I’ve never been to Hay before. It is a really pretty little town on the edge of the Brecon beacons (on the English side of the border. The whole town gets taken over by thousands and thousands of people who arrive for a 10 day party all about literature and the arts. There are events from 9 in the morning going on till late at night. Every where you look you see people ‘off the telly’ who are either there to interview someone about a book or to talk about their own book or career. There is something for everyone from kids story telling events to late night stand up and lots of high brow stuff in between.

To my surprise people bought tickets for my event which was advertised as a ‘conversation with a clinical psychologist about diabetes and it’s effects on the family’. I was being interviewed by Rosie Boycott (off the telly!) . On the day I was really nervous and wondered if anyone would turn up but there was a pretty good audience including some young people with diabetes. I was asked about the differences between Type 1 and type 2 and about why it is that sometimes it can be hard to keep diabetes under control, especially for teenagers. There was time for questions from the audience and then I got bundled off to a book signing – where I sold out all the books on the table.( I don’t get very big royalties by the way – I think it’s a penny a book so I haven’t made it to JK Rowling status yet!)

The Hay festival is definitely worth a trip – I’m hoping to go there again as a punter next year and just enjoy the great things available to see and do – but it also inspired me to think about my next book and reminded me how lucky I am to do the job I do. 

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