Go Your Own Way

 

I developed Type One Diabetes just over 26 years ago, in December 1997. I have often said that it was a good moment to join that “club that nobody wants to join” in terms both of my own age and circumstances (I was aged 40, married with three children, settled in life and work) and in terms of diabetes management and treatment (beyond the days of glass syringes, primitive inaccurate blood tests etc.)

Yet even since 1997, things have got markedly better, with the past decade or so having brought two significant advances: The first a quantum leap forward in technological support for those living with the condition; the second the growth of diabetes peer support communities linked by social media networks.

The advances in diabetes technology were neatly highlighted by the nice coincidence that my most recent “diaversary” just before Christmas (19^th December, marking 26 years of the condition) coincided with the final announcement of NICE guidelines about the use of closed loop technology for those in the UK living with Type One, the culmination of a remarkably quick process which started with the arrival of the first mass market non-invasive glucose monitor - the FreeStyle Libre - ten years earlier. Those of us living with Type One under the care of the NHS are indeed blessed with a level of support for our condition which is the envy of the world. The leadership and accessibility of Partha Kar has been instrumental in making this happen, however much he protests that he is “just doing his job”

The growth of peer support fuelled by social media connectivity shows no sign of slowing down, and has achieved a good deal, albeit that the sheer numbers involved mean that it has lost its early intimacy and has inevitably led to a degree of empire building and thinly disguised rivalry between individuals and groups.

These two advances mean that nobody can deny that here in the UK, people living with Type One are well served by the healthcare system and by the community of people living with the condition who are keen to share experiences, expertise and friendship.

And yet…

There is increasingly a nagging feeling in my mind that I’m being left behind, a feeling complicated by the sense that I’m actually perfectly happy to be left behind. What’s going on? It doesn't quite make sense, so permit me to explain.

Forgive the self-analysis here, but in general terms, I like to believe that I am fairly adaptable to changing times. Although I grew up in the pre-digital age, I have embraced that revolution with appreciation rather than the resentment and bewilderment which I often see in others of my own age, let alone those older than me. I do not eulogise the “good old days”, but rather I positively enjoy and greatly appreciate the comfort and convenience of the world in which I am growing old. I spend way too much of my life glued to my phone, like the overgrown kid that I am. I am fully “digitised”

I therefore had no hesitation in taking up Abbott's groundbreaking FreeStyle Libre at the earliest opportunity, and in subsequently embracing its evolution into a de facto CGM using my smartphone rather than the reader. Moreover, I was among those singing the praises of this device from its earliest days thanks to my early adoption of the online diabetes community which coalesced from around 2012 onwards. It was the diabetes community that first alerted me to these advances in technology, and it remains a source of great pride to me that I played a small but significant part in the campaign to get this life-changing technology onto the NHS prescription tariff in 2017.

However, I now find myself being left behind as others embrace pumping for insulin delivery and closed loop systems to automate this process to a good extent. I feel a bit like the man who bought a top-of the range VHS video player in the late 1980s and refused to embrace DVDs, or the man who bought a stack of DVDs and CDs in the 1990s and now refuses to subscribe to Spotify or Netflix.

I am, by nature, a creature of habit with little taste for adventure and no thirst for the unknown. The facts about me speak for themselves: I’ve been married to the same woman for 40+ years; lived in the same town for 36 years; taught in the same school for 36 years; banked with the same bank since I left university; I’m now driving my 6^th successive Mitsubishi; I’ve been with 02 since it was BT Cellnet, firmly wedded to Android rather than Apple, and I feel guilty and disloyal whenever I am eventually persuaded to change energy supplier in search of a cheaper deal. I am inertia personified in some respects.

Small wonder, then, that I am perfectly happy with “just” my insulin pens: I know what I like and I like what I know could have been coined to describe me.

I have therefore watched with interest rather than envy as the Type One world has gone closed loop crazy. Social media timelines are filled with posts testifying to the life-changing effect of what some term an “artificial pancreas”, with screenshots of flat overnight blood sugar lines or of Strava maps telling the world that its author has been on a run freed from the need to fret about its effect on sugar levels. To be honest, these have started to become something of a bore.

And here I sit, armed only with my FreeStyle Libre and my ageing insulin pens, with a time in range of around 75%, an Hba1c of around 50 and no enduring sense that my life has been ruined by diabetes. Do I want an insulin pump? Do I want it to be linked to a CGM to take over the management of my diabetes?

The truthful answer is “I’m not at all sure I can be bothered”. I’ve got better things to do with my life than to learn the ins and outs, the tips and tricks of a pump when my own tried and tested “hit and hope” methodology continues to serve me well. Yes, I get hypos and hypers, but armed with a Libre I can and do correct with micro doses or snacks in a manner which works well for a largely home-based retired life. If I were still working, I’m pretty sure that I might think rather differently.

However I do often wonder why, if all this automation is supposed to be so liberating, it appears to occupy so much of peoples’ time and energy. I never see any posts by people - still the majority - using MDI, and I sense that’s at least in part because many of them, like me, prefer to just inject and get on with their lives. My strategy for living with diabetes has always been to keep it in the background where it belongs.

So am I opposed to the continued rollout of technology? Absolutely not. I firmly believe in “each to their own”, and I am well aware that there are many for whom a more automated approach is a godsend. And they are NOT all youngsters – I know many PWD of my age and older who swear by the life-changing benefits of looping.

Will I continue to resist the use of a pump and an HCL? I don’t know – ask me again every few years!

Do I think there are other issues, at least as urgent, arguably more, that perhaps should get the same level of effort, publicity and indeed funding that have driven the “rise of the machines”?

I most certainly do.

I’ll pick out three:

Firstly, I'd like to see the spread of non-invasive glucose monitoring on prescription to those living with Type Two diabetes. The phrase knowledge is power is often applied in a healthcare context, and despite the recent progress in linking CGM to insulin delivery, I still believe that knowing BG levels and their predicted direction of travel, and knowing what the effects of different foods and levels of exercise have on blood sugar levels provides for many the key to better understanding of, and hence better self-management of all types of diabetes.

Secondly, I'd like a reform and standardisation of the education given to people with diabetes at or soon after diagnosis. Another over-used cliché springs to mind - “education, education, education”, and I have a strong sense that there is huge variation on the availability, timing and delivery of education, and that the DAFNE and DESMOND models, with their somewhat rigid teachings, have been allowed to dominate to the exclusion of more streamlined models better suited to this age of busy lives and flexible working hours.

Thirdly, I would love to see a real and sustained investment in the understanding and treatment of the hitherto under-reported psychological aspects of living with such a burdensome and stigmatising condition. The recent publication of the parliamentary report into disordered eating among those living with Type One shone a light on this scandalously neglected issue. This one is close to my heart, as my best friend is among those affected and among those most engaged in the calls for better understanding and more integrated care, but it struck me very strongly how many other names and faces familiar to me from the online communities have been to some extent living with this debilitating and dangerous add-on to Type One.

So there we are: the outlook for people with Type One is vastly better today here in the UK than it was even 25 years ago, let alone a century ago when insulin therapy changed Type One from a death sentence to a manageable burden. Yet this situation brings its own challenges at a time of ever-increasing demands upon the limited resources of any healthcare system, the NHS more than any. I hope that we can continue to roll out pumps and loops to all who need or indeed want them, but at the same time, I hope that we in the UK will also count our blessings and make sure that other deserving, and in many cases more urgent, calls on scarce funds can be met.

I close by reiterating what is often said, but is so important: Your diabetes, your way. There’s enough factionalism out there, and this post is absolutely NOT intended to criticise those who have shown such drive and enthusiasm for the advance of technology, be they patient advocates or healthcare professionals. These people have been truly heroic and have achieved unimaginable progress in a remarkably short time.

But we must remember that, just as in everyday life where not everybody wants a smartphone, a smart TV, state-of-the art satnav and suchlike, not everyone wants their diabetes to be managed by technology. How many programmes on your washing machine do you actually use? How many apps on your smart TV do you completely ignore? And do you never get irritated by the constant bleeps and warnings, the sheer information overload, given by modern cars? Technology is wonderful, but can be too much of a good thing for some.

It's the same with diabetes technology: an insulin pump with closed loop is not much help if you live with diabulimia.

I am not extreme on this, but I do hope that other urgent needs of the diabetes community will not be overlooked or underfunded amidst the scramble for diabetes tech. Despite what the hashtag says, diabetes tech can wait - for some of us.

As the song (and my title of this post) says, Go Your own Way - and I’ll go mine.

Come Together: thoughts from the Diabetes UK Professional Conference 2023

I spent two busy but enjoyable days in Liverpool last week attending part of the Diabetes UK Professional Conference, having earlier this year been appointed as Chair of the charity's patient group, the Diabetes Lived Experience Advisory Committee.

I was there as one of three representatives of this group, free to attend any of the lectures and presentations, and to meet and mix with the hundreds of HCPs at all levels who attend this three day event. As its name suggests, the conference is organised first and foremost for healthcare professionals in the field of diabetes care, and over the years it has become very much THE get-together of diabetes HCPs, attended by not only the big names in the field, but also rank and file NHS staff, with places highly valued and sought after. In addition, like any such healthcare gathering, there is the accompanying “trade fair”, at which pharmaceutical and medical technology companies get a chance to display their wares to those whose job is to assess, prescribe, and administer them. It’s an impressive event, administratively and logistically challenging, not to say costly, but my over-riding sense is that it is a hugely worthwhile and successful exercise.

The conference has left two salient points in my mind, and when thoughts such as these get stuck in my mind, it always seems worth sharing them, to see to what extent others feel likewise.

The first is simply the fact that conferences like this are very, very valuable. Sadly, other commitments meant that I could only attend for two days, but my time at Liverpool was more than enough to remind me just how useful and important such events are.

Zoom, Teams and the like were a lifesaver during the pandemic but to experience this flagship conference, happening fully in person for the first time since 2019, was a forceful reminder of the value of face-to-face conferences.

Easily dismissed as "jollies", gatherings of professionals in any field are surely of inestimable value, even if that value is perhaps hard to quantify: As well as the formal content, it was a joy to witness and indeed to be part of the coffee break chats, the lunches, even the after-hours drinks. I always felt that way when I was fortunate enough to attend day or residential conferences and courses during my own working career as a schoolteacher, and I remain as convinced as ever. ”Comparing notes”, even in snatched conversations over a coffee is of immense benefit to anyone in any walk of life, often a precious and reassuring reminder that whatever challenges and difficulties we are facing, someone, somewhere else is also facing it. A problem shared is, indeed, a problem halved.

For me personally, to catch up with so many of the valued friends and acquaintances whom I have been lucky to make among HCPs, diabetes charities and diabetes tech companies was a pleasure.

This brings me neatly to my second point: to what extent should the likes of me, a “patient”, be at an event like this? What, if anything, is the value of lived experience in improving and developing diabetes care?

Over the years, and particularly over the past decade or so, it has become an increasingly accepted wisdom that the voice of lived experience should be front, left and centre at diabetes conferences. A popular hashtag in diabetes social media is #NothingAboutUsWithoutUs, a line borne of frustration from the days when people with diabetes were too often treated like naughty children, their condition described as “poorly controlled” and their attitude as “non-compliant”. In many ways, this goes hand-in-hand with the Language Matters movement, which has done so much to modify stigmatizing terminology used by HCPs and in so doing to also modify attitudes.

So in a sense, it’s the proverbial no-brainer: those living with a condition should indeed have a voice where those who treat it are gathered together. Over the past week, when diabetes social media here in the UK have been full of content about the week’s events in Liverpool, it has been easy to find calls for the lived experience voice to be present at every lecture, discussion or symposium.

Perhaps surprisingly, given my four years of membership of the Diabetes UK Patient group, and my recently adopted position as Chair, I find my enthusiasm for the idea of ubiquitous lived experience participation to be somewhat nuanced, and this worries me. Surely, a strong patient voice is unequivocally a good thing?

Well of course the lived experience voice is a good thing, but I do feel that there is a risk that we overplay the controversy, egged on, perhaps by angry advocates rather than the voice of the majority.

Firstly, because I think there is sometimes a place for humility, for acknowledging that the professionals actually do know best, and that they have a right to meet together and exchange views privately. The loudest voices calling for ubiquitous lived experience involvement are almost by definition those most engaged with and expert in their condition, but few if any have the breadth, depth and variety of experience of HCPs. In my profession - teaching - I was a consistent and sometimes lone voice in advocating student involvement in the teaching and learning process, in the formulation and execution of policies, and especially in assessing and measuring progress. However, to deny altogether that the teacher knows more than the learner is a betrayal of logic: sometimes, teacher does know best.

One of the most absurd pieces of so-called wisdom that gained popularity in some quarters during the run-up to the Brexit vote in 2016 was Michael Gove's “I think the people in this country have had enough of experts”. An example of the damaging populism that drove the political process during that era, Gove's soundbite was both arrogant and delusional. Advanced human society is built upon expertise at every level: “to each according to their need, from each according to their ability” is how a civilised society ensures that we benefit collectively from the specialist skills of others, not least when it comes to healthcare. Far from having had enough of experts, I am deeply grateful for them, and in terms of my own diabetes, I am grateful not only for the pioneering expertise that brought us injectable insulin just over a century ago, but also for the technical expertise of those who have driven such spectacular advances in diabetes technology over the past decade or so. Listening to some of the content in lectures at DUKPC, I was left not so much with a burning desire to be represented, but rather a feeling of humble gratitude that there are people as clever as that working on better ways to treat and care for me.

Now of course there are areas when the patient voice is not just valuable, but crucial, and indeed still under-represented. The emerging area of diabetes psychology springs most readily to mind, where there is surely a vast amount to be learned by professionals listening to the voice of lived experience rather than trying to apply theory to practice. Walk a mile in our shoes before telling us how it feels to  walk in our shoes is surely how diabetes psychology should be applied, and I have heard alarming tales from a friend who lives with a diabetes-related eating disorder of the mis-application of theory in a manner which is counter-productive at best, harmful at worst. So yes, the voice of lived experience can be crucial in advancing the work of experts, but should always be offered and accepted collaboratively, rather than confrontationally.

Indeed I can’t help wondering whether here in the UK at least, we are actually pushing at an open door. In personal terms, what struck me most as I travelled home from Liverpool and reflected on my experience there was how a conference like this one is in fact a wonderful coming together of ALL stakeholders in the world of diabetes. When I had the chance to address the Diabetes UK HCP Council on the eve of the conference about the value of peer support, I was keen to make the point that in the UK, we are uniquely blessed with a diabetes community in which the overwhelming majority of HCPs are already respectful of and receptive to the expertise of their patients. Moreover, the very fact that it is a diabetes charity, not a professional association, which organises this event, is significant: we are exceptionally well served in the UK by our NHS and by our diabetes charities. Who needs angry advocates when we are blessed with the passionate, driven healthcare professionals who have brought about such spectacular advances in technology access for people living with Type One, or charities like Diabetes UK and JDRF who are driven by a passion for improving care and pursuing the elusive cure?

Together at conference: Partha Kar, Diabetes Lead for NHS England
with Karen Addington & Chris Askew,
CEOs of JDRF & Diabetes UK respectively. And me.

DUKPC is, above all else, a collaborative event, a chance for the community to Come Together (there's the customary song title if you click on the link, with a deliberate Beatles/Liverpool slant). A chance for the experts to do their thing, a chance for the companies to sell their wares, a chance for the professionals to hear from their patients where appropriate, and a chance for the charities and support groups to care and share.

Nothing about us without us? Of course the voice of lived experience should be at the centre of diabetes care, but I’m not actually sure that we need to sound quite so angry about it. Maybe, just maybe, diabetes care is an area in which we British are actually quite well served on a global scale, thanks in no small part to the voice of lived experience. The remarkable reach of Flash or CGM - 90% of people living with Type One - has been achieved by passion and determination on the part of HCPs (led by Partha Kar) informed, encouraged and supported by the patient community with which many HCPs have so willingly engaged over the past decade or so.

We in the UK have had much reason to feel rather ashamed and second rate over recent years, and the air of crisis which accompanies the NHS remains a severe and very real cause for concern. But this should not blind us to what has been achieved in the world of diabetes care, especially Type One care, and the fact that this has come about by such a collaborative effort. It was achieved not by shouting at each other and demanding better representation, but rather by a mutual realisation that collaboration and cooperation are almost always how progress is achieved.

The real challenge, and one in which I hope I can play a small part over the coming two years, is to spread this success into care for people living with all types of diabetes. 

"Walking on the Milky Way": some thoughts for Diabetes Awareness Week 2021

Some thoughts for Diabetes Awareness Week, to an extent recycling things which I have said before, but worth modifying and repeating, precisely in order to raise awareness. When talking about diabetes, I have always tried to strike the balance between melodramatic self-pity and “no big deal”. My talk at TAD back in 2017 attempted to put this across by portraying diabetes as “something and nothing” and four years on from that talk, and twenty three years on from diagnosis, that’s still my view. I genuinely find it hard to get annoyed by diabetes, or by others’ attitude to it; I am, however, very aware that for others this is not the case. I am sure that I would have found it far more of a burden if it had interfered with my carefree youth, or indeed if I hadn't had the benefit of the monitoring technology which we too easily take for granted. However, I am fortunate to be gifted with a temperament that doesn’t easily get annoyed, so for me diabetes remains a severe irritant rather than a burden. 

However, the one thing that consistently irks me in the perception of diabetes among those who don’t have experience of it is the widespread sense that Type One Diabetes is a condition that affects the young, which as I have written before, overlooks the fact that it can and does come on at any age, and that it stays with you for life.

I am resolutely anti-ageist: when I was young, I had many friends who were much older than me, and now that I am in my sixties, I have friends of all ages, including many in their twenties and thirties. I enjoy, but don’t crave, the company of others, and have always enjoyed most the company of people who are less than obviously like me. So I tend to find friends among those who have little in common with me, be it interests, occupation, tastes, gender or age. I believe that I am age and gender blind to a good extent, and I still feel no different mentally to the child, teenager or young adult that I once was.

However, in diabetes terms, I often feel compelled to draw attention to my age, given that persistent sense that the Type One Diabetes with which I live is often thought of as a young persons’ condition, whilst Type Two Diabetes is often associated with older age. Neither is true.

The theme for this year’s Diabetes Awareness Week is Diabetes Stories. Diabetes is a condition where there are as many stories as there are people living with it, but sharing stories is important, not least because others may read, recognise and draw comfort from similarities, and perhaps most importantly, because others may recognise symptoms and seek potentially life-saving help. My own story serves to remind others of the fact that Type One can strike at any age, and that once it does, it is there for life – a life which can and should be no shorter than anyone else’s. My story is a good illustration of the former, and I have every intention of ensuring that it proves to be a good illustration of the latter.

I was diagnosed at the end 1997, at the age of precisely 40. Until then, I had lived a life with minimal contact with the health service. I had the standard childhood illnesses, with the associated spells off school before the age of 10; I then managed an entire secondary school career without a single day's absence through illness. I fell off my bike at the age of 13 and suffered a straightforward arm fracture, which mended in the standard six-week time frame. And that was about it. Prior to my diagnosis with diabetes in 1997, I had worked for 17 years as a teacher with a total of about four days off sick (two lots of two). My doctor's surgery was a place unfamiliar to me.

Moreover, I was a slim, healthy and active person: as a child I had walked or cycled to school, played football as a recreation and spent holidays fell-walking with my family. As an adult I cycled to work, tended an extensive garden and walked from my home to the local shops rather than driving. And I still do.

Then, at the age of 40, I had a very bad case of 'flu - real ‘flu -  in the week running up to the Christmas break at school. A week's absence off work the first time ever, but no real cause for alarm: there was a big epidemic that winter (1997-98) and a number of colleagues were off at the same time. Then, on the day after I had started to feel better again, my condition took a nosedive, and I went to my GP, alarmed at this apparent recurrence of an illness from which I had just recovered. I felt tired, thirsty and run-down, but just thought it was a hangover from my first real illness in years. A routine urine test revealed very high blood sugar, and an alarmed GP informed me that she was pretty sure that it was diabetes, referring me to her colleague at the practice who was the specialist in diabetes. I was briefly thought to be Type Two, but with symptoms persisting and getting worse, it soon became clear that I was Type One, and my over-riding emotion was one of relief, not fear. I had found the cause of what, with hindsight, had been a malaise which had crept up on me through that autumn, with a battery of symptoms, all of which had been quite easy to explain away.

Foremost among these symptoms was the raging thirst. I had always been a thirsty individual, so the feeling of extreme thirst on hot days, after exercise, or after a meal was a familiar one. On a number of occasions that autumn, I therefore explained away extreme thirst by circumstances such as a salty snack, or a dash for a train on a warm afternoon. Moreover, it was in the late nineties that the sensible but now overstated and ubiquitous obsession with hydration really took hold. Not that many years ago, we didn’t all walk around clutching a bottle of water, and footballers played a full 90 minutes in the sunshine without taking hydration breaks. So if it doesn’t sound daft, thirst became fashionable in the late 90s, and I subconsciously bought into that fashion.

Another creeping symptom that autumn was extreme tiredness, but back in those days, my autumn working life was absurdly busy. As a Head of Sixth Form, it was the season of university applications which used to be submitted by an immoveable December 15^th deadline, and with 100 or so applications needing detailed references, no administrative support and little timetable remission I did most of that work in my spare time before school, after school and through very long evenings. It was exhausting, so any possibility of it being exacerbated by a medical condition didn’t cross my mind.

And then there was weight loss. I was never overweight, but had like most people gained a bit as middle age encroached. But then I started to notice a bit of looseness in trousers, requiring one notch tighter on the belt, or shirt collars feeling a bit loose. Fair enough, I thought. Losing a few pounds around the 40^th birthday was a welcome bonus, I thought, to being very busy and physically active, often with barely time for lunch or snacks.

Looking back, I was ignoring symptoms that should have rung alarm bells, but it took that dose of flu to bring it to a head. I assume that my diabetes came on gradually over those weeks, but that week’s illness gave it the boost that made it impossible to ignore. My HbA1c on the day of initial diagnosis was 22.1, and rose to 33.1 a couple of weeks later - just before I started on insulin. (I love that I can now look up those numbers on my NHS records)

The fateful numbers

Once the insulin started to have an effect (and that effect comes on almost instantly, as anyone with Type One will tell you), I was soon back to normal. By the Easter four months after diagnosis, I led my annual residential school trip to France with about forty pupils and five colleagues. I continued to do this every year whilst it remained part of my role at the school. By the June six months after diagnosis I was planning, setting up, organising and running the end-of-exams Ball for 200 Sixth Formers, a demanding job I undertook every year. In day-to-day terms over the remaining twenty years of my working life, I continued to take on all that life and work throw at me, with an unblemished attendance record in a very stressful job. I never missed a day due to illness through all that time.

But let's not pretend it's easy. Living with Type One Diabetes is a 24/7 challenge that we face on top of all as that we do in life, whatever that may be. You can never forget or overlook it for more than a few minutes. Every action, every piece of food or drink, every event needs to be thought through. Any departure from routine is potentially risky. Most infuriatingly, insulin - the treatment that you self-administer every day in order to preserve your life - is precisely what threatens to bring you down in day-to-day terms. I think is fair to say we have a love-hate relationship with it!

And please, if you're reading this and someone of any age whom  you know or love is showing diabetes symptoms - often now called the “Four T's” (thirst, tired, toilet, thinner) – do consider the possibility of Type One Diabetes. It is not at all related to lifestyle, diet or condition. It can strike at literally any age, not just in childhood and adolescence. And above all, it should hold no fears for the person diagnosed or their family. It will be a lifelong nuisance, which is fully controllable thanks to the wonders of insulin, increasing availability of sophisticated ways to administer it and very clever ways of monitoring blood sugar. And it won't stop you doing anything, eating anything or living a long, healthy and happy life.

If you are familiar with my blog, you will know that all my posts are given an appropriate song title, with a link to the appropriate song. My title is a song from my DiabetesPlaylist which I think is one of the most under-rated singles of the past few decades. OMD’s Walking on the Milky Way just about qualifies as a diabetes song in terms of referencing a chocolate treat which is NOT off limits for people with Type One, but for me it is a bitter-sweet recollection of lost youth tinged with dignified acceptance of the passing of time and creeping old age. It is melancholy yet triumphant, and this summer celebrates the 25^th anniversary of its release in the iconic summer of 1996. A brilliant introduction, a fabulous bridge, a soaring chorus and an outro that sounds like a recessional organ voluntary. If you're old enough, it'll take you back to the summer of '96. And if you're not, a chance to get to know a fine song that you missed.

The Only Way is Up: getting the Covid-19 Vaccination

Two days ago, on Monday, 8^th February, I received my first Covid-19 vaccination. I feel moved to post an account of how I came to get it, how it was and how it felt afterwards because I was blown away by the positive response of others on social media when I posted news of my good fortune. 

I was at first a little hesitant to do the “I've had my jab” thing on social media, fearful that it might look rather smug and “look at me”. I sought the opinion of a wise and trusted friend who often shares my views on such matters, and she assured me that to post about it would be welcomed by many. She was right. I am a very small voice, but if enough small voices say the same thing, they become a loud and influential voice. I am pleased and proud to learn that vaccine take-up is so high in the UK, but worried that it has been low in certain groups. I hope that anyone reading this will be reassured that it's the right thing to do, for themselves and for everyone. We all owe it to each other to talk up the good news of this rollout, not least given how much else has apparently gone wrong here in the UK.

I was aware that the UK’s vaccination programme was going remarkably well, and that as a man of my age living with Type One Diabetes, I could reasonably expect to be called sooner rather than later. However, I was thinking maybe sometime in March. I was more anxious for others in my household, three of whom work in schools and two of whom are required to be there in person; I am in the fortunate position of being able largely to control my own exposure to others, although I have throughout the pandemic resisted the urge to hide away and attempt to eliminate all risk.

Then last Friday, my younger daughter, who has mild learning difficulties, received a call from our GP inviting her to come for a vaccination on the following Monday, at the end of the working day. We had not been aware that she was in Priority Group 4, but they explained that all with a registered learning difficulty are classified as such for vaccination purposes.

Great news, we thought, not least as her work as a welfare assistant in a primary school exposes her daily to risk.

Then on the day of her appointment, we got another call from the GP practice: they had more doses than anticipated, enough that if I and my wife were able to come along too, we could all three have our vaccinations. We are both in our early sixties, and of course I have an added background risk through diabetes.

The whole process, from notification to injection, exemplified all that is good about how the UK’s programme is working. It felt personal and local, and strengthened my sense that the vaccine rollout will prove to be UK Primary Care’s finest hour. Ours is a relatively large practice in a small town - Ash Tree House in Kirkham, Lancashire; we have been patients there since moving to the area in 1986. Over the years, the practice has been there through all our medical needs of those 35 years, and many of the staff, clinical and non-clinical, have been known to us through personal or other professional and personal connections. We have had many occasions on which to feel grateful for their work.

In the case of this vaccination, communication was by phone, and was cheery, concise and personal. Our appointment was at the clinic in Kirkham, a place familiar to us from when the children were little. Not an ideal venue for a mass vaccination programme, but the most suitable NHS building in the town.

On arrival, we were greeted by a man and a woman marshalling the Car Park in hi-vis jackets, wrapped up against the bitter cold and wearing masks; only when we got near did we and they realise that we were old and good friends, former neighbours with whom we remain in touch and with whom we still socialise - well we used to! Another great thing - volunteers doing their bit: they are both retired police officers.

They, and everyone whom we saw throughout the process, were friendly, upbeat and welcoming. A young woman from our practice (a member of the admin staff) was at the door, letting people in one by one from the queue shivering outside the building. She herself was clearly freezing, and had to repeat the same words to everyone, but did so with a cheery smile, an apology for the wait, and an apologetic tone that suggested she was well aware that her questions checking our status were almost certainly superfluous.

The Practice Manager who checked us in and showed us to the waiting area recognised me and greeted me by name - such is life in a small town community. Her manner, at the end of a long and busy day, when she and everyone had clearly been on their feet all day, was positive, welcoming and reassuring. There was, throughout the building, a palpable sense of togetherness and teamwork in a less than ideal setting.

After a short wait in a room carefully adapted with temporary screens for distancing purposes, we were called through to be vaccinated. My wife and daughter received their jabs from one of the GPs, I from a practice nurse. It was quick and painless.

Side effects? Yes, entirely as predicted, and no reason whatsoever for alarm or hesitancy. We all had some degree of flu-like symptoms: shivery, achy, and lethargic. But very much just the next day, and by now (the second day) I am fine, as are they.

And which vaccine? Ours was the Oxford AstraZeneca - very much the dominant and default vaccine in the UK at present, for well-documented reasons. I have to say I wanted it to be that one, for the very silly reason that I am genuinely proud to be a graduate of a university whose scientists have done so much to develop and bring this vaccine to us at such astounding speed. Not long ago, the pernicious spirit of Trump and Brexit was claiming that we had all “had enough of experts”. I always thought this was dangerous nonsense, and if there’s one thing the Coronavirus pandemic has taught us, it’s that we sure need our experts. And Oxford University, so often criticised as élite and out of touch, has done us all a favour by reminding us that we need expertise and excellence, we need élite places of learning, we need places that select the best, and it’s not entirely their fault if those who prove to be the best do not come from the broadest of social backgrounds – that is an issue for society to address, and I wrote about it here

So there you are: a positive story in a year of gloom. It is my fervent hope that I shall soon see loads of posts on social media of people I know having had their jab. I shall get the same pleasure seeing that as others appeared to get from mine, and it will reinforce the sense that we are, despite all the caveats and warnings, heading to a better place as the days start to get longer and warmer. And just as we so joyfully did at that Olympic Opening Ceremony back in 2012, let us celebrate and be proud of our NHS, and all who work in it. 

Thank you, NHS, Thank you, scientists. Thank you, experts.

I need an optimistic and upbeat song as a title – how about The Only Way is Up?

Join Together: Why GBDoc is alive and well....and matters

This coming week, Saturday, March 7th to be precise, marks the 5th anniversary of the first significant #GBDoc social gathering of people with diabetes, held at the old headquarters of Boots the Chemist in Nottingham. The second one happened a year later, on Saturday February 27th 2016.

The Group photo from Day Two of #PWDC16

Organised by the then lead organiser of GBDoc, (the online community of people living with diabetes in the UK) this so-called “Un-Conference” was truly an iconic event for many people, myself included.

A session at #PWDC16 on diabetes and sport, led by Paul Swann

The 5th anniversary brings into sharp focus how much has changed over those five years. With so many of the current users of GBDoc being much newer to the group, and the majority of those who pioneered it back in the early days now seldom taking an active part, it is now harder to characterise such a large and diverse group of people as a “community”. The idea of gathering them all in one place for a meet-up is now fanciful, yet the demand for TAD tickets proves that there is a real appetite among people with diabetes to meet each other. 

Add to that the inevitable fragmentation that occurs in any group as it expands, the differences of motivation, the clashes of style and personality, and it is no surprise that some now consider the idea of an online-based community to have outlived its usefulness. This is, I think, mistaken, very unfair on those who are trying to keep its sense of entity (especially Paul Sandells and Julie Barcroft and their team who work so hard to promote and organise the weekly tweetchats), and very unfortunate for those who have yet to be diagnosed with diabetes, or to discover the benefits of associating with others living with the condition. More of that later.

First of all, a little history, which may be of interest to those who have discovered the hashtag #GBDoc or the tweetchats more recently:

Diabetes communities, and online diabetes chat are older than many might think: Local support groups have been around for years, and people with diabetes, and parents of children with diabetes, had been talking to each other online, sharing experiences and providing mutual support since the early days of social media. Closed Facebook groups existed, and forums (remember the term chatroom???) gave people a chance to ask and answer questions. 

However, GBDoc as a named and identifiable community was formed in 2012 by a gentleman diagnosed with Type One in middle age who was an enthusiast of social media and was seeking ideas and support for living well with diabetes. He chose Twitter because of its open access and simplicity and launched a weekly tweetchat on Wednesdays at 9pm, which quickly grew in popularity as more and more discovered it. It had a website, and its own Twitter account, which is still there, but dormant - @theGBDOC, and this community grew rapidly and was soon imitated in other countries. 

The gentleman concerned conducted the chats himself, became known to many and organised the two meet-ups, but unfortunately conflict and controversy arose between him and some members of the community over time. Without ever announcing it, he stepped aside from the de facto leadership of the community in July 2017 and has remained absent from social media ever since.

Nevertheless, the two real-life meet-ups that he organised, in March 2015 and February 2016, were outstandingly successful and life-changing for many - including me. I am far from alone in having made some very close and enduring friendships from those two events and the sense of togetherness from being in a room full of fellow diabetics for the first time was remarkable and unprecedented. 

Five years on, we should not just dismiss the old GBDoc like an ill-advised dalliance. It was wonderful for a while and many of us owe something of a “thank you” to the founder of GBDoc for the fact that we know each other.

The #GBDoc label was “rescued” in July 2017 by a small group of people who had been alerted to discontent and misgivings surrounding the founder. These people were trying to save the idea of an identifiable community yet without running it, and as the individual who offered publicly to reveal plans to save the tweetchat and the hashtag, I and the others were accused of trying to “take over”. It was a very uncomfortable time, and I was grateful for the many words of support that eventually came from well-wishers, especially when others involved revealed who they were. We set up the @GBDoctchost account as a result, and it is still used to this day.

So how is #GBDoc now? Why is it that many people - myself included - have drifted away from the tweetchats over time?

Well firstly and most simply, it’s that people move on. Stuff happens: relationships, babies, jobs - life! Moreover, many of us who live with diabetes spend more than enough time thinking about it without wanting to add a sometimes contrived and at times repetitive conversation at an artificially chosen time and place. I myself am often otherwise occupied on a Wednesday evening.

However, we MUST remember that this feeling is a product of time, and that there will always be people new to diabetes who might relish the chance to “chat” with others in a safe, supportive and accessible place, with no need to ask to “join” a group. So we mustn’t knock it just because we don’t have time or have become become bored with it.

Secondly and more contentiously, I think that some conflict and discontent is inevitable over time, often stemming from that most basic and universal of human instincts: jealousy. People don’t like leaders and some resent those who style themselves as advocates. They build them up, then knock them down. Yet a “community” cannot exist without a measure of leadership. A tweetchat needs an organiser, and just because somebody organises doesn’t necessarily mean that he or she is “taking over”. Unfortunately, that is how it is perceived.

Thirdly, there’s the question of sheer size. For my own part, I always start to feel ill at ease in any group that becomes too large and/or too noisy. So I find myself estranged from the idea of a “community”. I don’t actually like the word, because I resist being categorised and labelled. This is why what was rescued in July 2017 was just a hashtag, and it is when people start to regard it as something more than a hashtag that problems start. If an individual or group of individuals become too associated with a community, it assumes too much of their identity, and accusations of cliques inevitably follow. Twitter often looks like a clique, given the way that it can quickly become a private conversation between a few conducted in a public place. It often feels like you’re in a room on your own watching a group of others having fun and laughing loudly. Not their fault but that’s the way it can appear.

A growing community also inevitably becomes fragmented, and dominated by those who say most. Individual differences are inevitable, so it behoves everyone to ensure that they don't regard themselves as guardians of the truth or the “right” way to do anything. Unfortunately, Twitter gives a perfect platform for people to “speak” without thinking. Things that in the past would have been just a matter of self-contained annoyance or private amusement become a public proclamation, with an air of authority and permanence that comes from the strange hybrid of communication that it is - writing as if speaking.

What have I learned from GBDoc? Above all, I have been strongly reminded about difference. Same condition, 100s of ways of handling it:

There will be some who want to hang out with others on social media, but 1000s more who don’t.

There will be some who want to meet up socially with others living with diabetes, but 1000s more who don’t.

There will be some who welcome in the community all types of diabetes, some who don't. 

There will be some who want to be all “woe is me” about the burden of life with diabetes, and others who want to be all “no big deal” about it. 

There will be some who want to be humorous and witty about it, and others will not find it funny. 

There will be some who care passionately about language and terminology, and some who don't give a hoot. 

There will be some who want to embrace technology and push the boundaries of innovation, and others who want to keep it simple.

There will be some who welcome the presence of HCPs in the community, and some who want it as a safe place for patients only. 

I could go on.

I guess the thing about a diabetes community is that the very randomness of the condition means that as a group it is more diverse than other groups to which we might be attracted. Groups consisting of people with a common interest, hobby or profession will inevitably attract a certain “type”, whereas there is nothing that unifies those with diabetes except diabetes.

And as I am fond of saying, this is a major strength, but strengths are very often also weaknesses. A diverse community with 1000s of personalities, tastes, experiences and opinions is unusual and precious, yet also a potential tinderbox for conflict.

For that very reason, I shall continue to cherish #GBDoc, but avoid over-involvement in every discussion, avoid the temptation to opine about everything, and hope that others will do likewise.

Oh, and in keeping with my tradition (which some probably find really annoying) I need a song title for this post. How about Join Together, one of the Who’s later and lesser known songs, from 1972? Some pertinent words in there:

Do you really think I care

What you eat or what you wear?

Won't you join together with the band

There's a million ways to laugh

Ev'ry one's a path

Come on and join together with the band

You don't have to play

You can follow or lead the way

Oh won't you join together with the band

We don't know where we're going

But the season's right for knowing

Oh won't you join together with the band

It's the singer not the song

That makes the music move along

Oh won't you join together with the band

This is the biggest band you'll find

It's as deep as it is wide

Come on and join together with the band

A collage of Day One at #PWDC16 - courtesy of Nichola Davis

I’ve Gotta get a Message to You: mixed messages in raising awareness of diabetes.

It’s Diabetes Awareness Month, built around World Diabetes Day, November 14th - the birthday of Sir Frederick Banting, inventor of the insulin injection therapy to which those of us living with Type One Diabetes owe our lives and well-being.

Every November in this, the social media age, screens turn blue and people with diabetes spring into action with posts, blogs and images intended to “promote awareness” of diabetes. Amongst this torrent of awareness-raising material, there’s always good stuff, some entertaining, some serious. Eloquence, insight, seriousness and humour in plentiful supply; quite a mixed message, you might say. Read on...

“Awareness raising” is very much a thing these days: there’s scarcely a day goes by that isn’t a *insert condition here* awareness day, and as a result I’m pretty sure that we are all better informed about a range of medical conditions with which some, often many, people are living, and for which someone somewhere is campaigning, researching, supporting and often fundraising in an attempt to improve matters. 

But what does “awareness raising” mean? Is it necessary, and does it work? 

This presents two big questions: whose awareness are we trying to raise? And what do we want them to be aware of?

The answer to that first question is fairly obvious: It’s those who don’t have, or don’t know well anyone who has, the condition to whom we should be directing our efforts to raise awareness. Awareness and knowledge of diabetes, which is so common, remain worryingly low, and I for one am reluctant to get angry about this. I knew very little about diabetes until I developed it, and I am sure there are many serious and common conditions of which my knowledge is very limited because of lack of experience. So there is a continuing need for those living with diabetes of any kind to remind the world that this invisible condition is there, and that every single human being is at risk of developing it.

But what of that second question: what do we want those unfamiliar with diabetes to be more aware of? 

Well, I recently spent an evening catching up with a longstanding friend of my own age, whom I hadn’t seen in many years, and whom I knew well in the days before I had diabetes. Naturally, our conversation turned to the topic of my diabetes, and he watched with a mixture of incredulity and interest as I tested and injected ahead of our meal together. He was vaguely aware that diabetes involved injections, but had no real awareness of the two main variants of the condition, of what the healthy pancreas does in a person without diabetes and how those with the condition have to replicate its job, partially or fully. Above all, like many people, he had never really been made aware of the central paradox of Type One in particular: that an effective and life-preserving medication - insulin -  presents an ever-present and unpredictable threat to our day-to-day well-being which must be monitored, anticipated and reacted to, not by professional experts, but by patients themselves.

So all those posts reminding those who don't know diabetes just how difficult, time-consuming and draining it can be are clearly necessary, and the awareness-raising message is well worthwhile.

But what about that message? Is that really all we want others to hear? Do we just want to make sure that others feel sorry for us, make allowances and help raise funds to finance better ways of preventing, living with or even curing diabetes? I really don't think so. Self pity is not always a good message coming from those living with a serious yet perfectly survivable condition. Harsh, but true: what we actually need is a mixed message. 

Now in all other areas of life, “giving off mixed messages” is not a good thing. We crave and admire clarity, honesty and consistency. Yet time and again, from both my own experiences and those I read and hear about from others, I realise that if we are successfully to “raise awareness” of the complex and mercurial nature of diabetes, we need to give a message which is indeed mixed.

As I said in my TAD Talk back in 2017, diabetes is an enigma: on the one hand quite something, yet on the other hand nothing at all. It's something that demands our attention, sometimes fully, often partially, every single day of our lives, and means that even the most ordinary of activities - eating, exercising, driving, having fun - can only be done and enjoyed with at least half an eye on our diabetes. Yet it's also nothing in that it needn't stop us doing anything and enjoying it to the full, throughout a long and active life. 

So the message is mixed, and that message with all its inherent ambivalence needs to be understood. Which is why I acknowledge and value the voices of all those who advocate on behalf of those living with diabetes during this and every month. Some choose to accentuate the negatives, wanting to be sure that the rest of the world understands better the burden of diabetes; others choose to accentuate the positives, wanting to be sure that the rest of the world understands that diabetes is not a barrier to doing anything. We all react differently, so a variety of apparently contradictory voices and responses is both necessary and desirable.

I've just gotta get a message to you, as the Brother Gibb sang, long before the white suits, falsetto and fever. 

But that message is, quite rightly and inevitably, a mixed message.

We Can Work it out

I freely admit to being conflict-averse. Some would say annoyingly so. There seems to me to be so much discord, conflict, and argument, so many angry words and deeds in this world, that I see no possible benefit to me or to anyone else in picking fights, metaphorical or literal, with anyone, unless absolutely necessary.

Easily said and arguably complacent, I know: I am well aware that I am fortunate in having been born and raised in a stable family, and I enjoyed the benefits of a good education, leading to an enjoyable and safe career. I have also enjoyed the stability of a 38 years-and-counting marriage, blessed with three lovely and loving adult children. I am lucky enough to still live with two of them, and a fab daughter-in-law. I am also blessed with friends of all ages drawn from a life surrounded by good people. 

I therefore perhaps have rather less to be angry about than many in this far-from-perfect world.

However, it seems to me that there is a lot of anger around at the moment, both in a wider world which has become significantly more polarised and tribal in recent years, and also in the social media bubble in which I have chosen to spend some of my time in recent years - the one inhabited by (a very small proportion of the total of) people who live with diabetes.

I spent four days this week largely absent from Twitter and Facebook, having taken a short holiday staying with some old friends who live in deepest Norfolk in a house with unreliable Wi-Fi and intermittent 4G. I didn’t try to take a “digital detox”, but found myself confined to just an occasional look at social media (usually provoked by a notification when out and about), without the means easily to reply or get involved in any prolonged exchanges.

It turns out I inadvertently chose a good few days to take this unplanned break: returning home to a catch-up on my accounts, I saw much hostility, notably the justified but arguably excessive and misdirected anger about Paul Hollywood’s ill-advised “diabetes on a plate” quip from Tuesday’s Great British Bake-Off; a simmering row involving many about the nature and extent of the problem surrounding healthcare professionals’ use of language in talking to and about the people in their care; and finally a poorly-judged advertising campaign by Diabetes UK seeking to draw attention to the dangers posed by some of the potential complications of diabetes.

In all these cases, there is usually some merit in what is said on all sides, some justification for the anger, and some justification for the anger about the anger. What saddens me is the way in which the immediacy of our hyper-connected world causes such rapid, and therefore almost by definition, unreflective responses. And in that sense, I am grateful that my own unplanned absence from social media gave me the chance to sit back, watch and reflect, rather than piling in with my own, probably imperfect, words.

Social media, especially Twitter, is in many ways a megaphone in which those who say most, and say it loudest, can very easily be mistaken for the majority. It gives us all the means to chip in with comments which are potentially “heard” by 1000s, and it’s the easiest thing in the world to join in when you agree with something, even if in a pre-social media world you might have simply noticed, commented to those sitting with you, and moved on with your life. There are clearly many on Twitter who find it very difficult to say nothing, when often to say nothing is the most effective and powerful of all comments.

Then there’s also the pressure to make a post snappy and eye-catching, which inevitably leads to ever more extreme language. I am NOT defending Paul Hollywood, but was what he said really “vile”? Foolish, ill-advised, ignorant, yes, but not maliciously intended to hurt others. Not “vile” or “disgusting” as many chose to say. We all make mistakes and upset people, we all use words carelessly and cause hurt which we then regret: it's part of being human.

The megaphone of Twitter made sure that criticism of Mr Hollywood’s ill-informed quip made it into mainstream media, and quite rightly so, but the real villain of the piece was, as some rightly pointed out, the programme makers. I am sure that there is much left on the cutting room floor after an edition of GBBO or any similar programme is made, and it wouldn’t have taken a PR genius to spot the potential backlash to a diabetes joke.

Then what of the #LanguageMatters debate? I fully recognise that there is a continuing need for care and sensitivity to be used by HCPs in what they say to and about people with diabetes, but in my own experience of living with diabetes, I have never experienced anything beyond amused irritation at what people have said, and to be honest I have got better things to do than spend time calling out every single inappropriate word or expression used about me or others with my condition. In all areas of my life, I mind rather more about peoples’ manner and attitude, rather than what they say. The right words can be said, but the speaker may say them in a manner which betrays dutiful adherence rather than genuine empathy and concern. Just as when someone in a shop wishes me to “have a nice day” I am only impressed if their manner suggests they care about me as an individual.

I wonder how many people with diabetes or other conditions have genuinely been demoralised and demotivated by things said by HCPs? It’s very easy to adopt a reaction, having seen someone else’s, and join in the hue and cry.

It appears that “being nice” is not good enough according to some. But it’s not a bad way to live your life, and personally I think I’ll just try to be nice and hope others do likewise to me, knowing that I can’t please all the people all the time, but at least I tried. And if I’m angry, I’ll say so myself. But don’t hold your breath waiting.

“Life is very short, and there’s no time for fussing and fighting my friend” Lennon and McCartney often said some pretty profound things, so I'll call this post We Can work it Out

"Do the Right Thing" - Getting insulin injection technique right

Well, January is nearly gone, and this is my first new blog post of 2019. It’s been a busy time for me, and it promises to be a busy year, not least in the world of diabetes which has become such a big part of my life in retirement.

One of the things that has occupied some of my time and attention this month has been starting my role with the newly re-constituted @FIT4Diabetes Board, a group of healthcare professionals who work under that banner, supported by Medical Technology Company Becton Dickinson, to promote best practice in technique and safety for those receiving and administering insulin injections.

FIT Board Members

I was pleased, but frankly somewhat surprised and flattered, when I was asked late in 2018 to join the FIT Board as a patient representative. I am aware that I am one of the longstanding members of the online diabetes patient community, known directly or online to many fellow people living with the condition; I am also aware that I have been something of a minority voice in that community as one of those happily managing their condition by multiple daily injections rather than an insulin pump. The very nature and demographic of the online world gives a false impression of the ubiquity of pump and diabetes technology use.

Moreover, I am also very aware that I am no expert in diabetes, despite my 21 years of living well with it. Indeed, I have often said that I’m not really very interested in diabetes, nor do I have any great enthusiasm for clever technological solutions. I am very interested in people, and in doing my bit to support and contribute to the greater good, and so my participation in #GBDoc is based very much on an interest in the people with diabetes, rather than the condition per se.

However, having attended the first meeting of the FIT Board, I have realised that I do have something to contribute to this group and their work. At our meeting, we started with an illustrated presentation about best practice in injection technique: not the most comfortable viewing when sitting there as the only patient accompanied by three DSNs, two pharmacists and a GP! I watched with a mixture of amusement and embarrassment as one by one, my occasional or permanent bad habits in diabetes management were exposed:

Wash hands? X.

Change needle every time? X.

Rotate injection sites? X.

Prime the pen? X.

Wait ten seconds before withdrawing needle? X.

Dispose of used needle immediately in a sharps container? X.

OK, so some of these I am better with than others, but I doubt if many longstanding PWD could in all honesty tick every single one, every single time. My excuse? Well, it’s that life gets in the way! We’re often told that diabetes shouldn’t stop you leading a full and normal life, and I have certainly lived as full and as normal a life since diagnosis as before it.

However, “normal life” is often very busy: I think back to my hectic working days as a teacher, often in work from 7:30am until 6pm, with literally no break. Lunch was often snatched on the go, and dressed in a suit, with formal shirt and tie, eating in a crowded school canteen or grabbing a sandwich during a lunchtime meeting is not conducive to good injection technique. It’s hardly easy carefully to choose the right site, prime the pen, leave it in for 10 seconds etc. More likely grab the pen - untuck shirt under table - jab - pen back in pocket with top on over needle. And all that was until very recently (with the arrival of FreeStyle Libre) preceded by a messy finger prick test!

I am also very aware that discreet and hurried injecting is, rightly or wrongly, rather easier for a man than a woman: a dress and tights, still commonly a staple of formal dress for women in the workplace, gives no opportunity for easy, dignified exposure of a suitable injection site, and it is small wonder that many women with diabetes inject through tights – far from ideal, but a pragmatic compromise.

But does it matter?

Well, since my watching that awkward presentation at the FIT meeting, I have to say yes. Confession time: I have become very aware that the flabby bits above my waistline are not just a touch of middle-aged spread, but actually a textbook example of Lipohypertrophy, lumps under the skin caused by accumulation of fat cells at the site of insulin injections. Not life-threatening, far from the worst of the secondary issues which can arise from living with diabetes, but nevertheless  a very real and creeping threat to living well on insulin injections.

I wonder whose tum that is?? !!

Lipos develop because of poor site rotation over the years, and injecting into them significantly reduces the effectiveness of insulin, caused by irregular and incomplete absorption rates. Since that meeting two weeks ago, I have been carefully avoiding those over-used sites, and guess what? My insulin requirement has fallen, quite significantly!

I genuinely think that Lipohypertrophy is the Cinderella of diabetes issues. We PWD are all so bothered about avoiding hypos, dealing with the uncomfortable highs, pursuing elusive “flat lines”, over-reacting to the TMI that many of us now get from our Libres and CGMs, that we overlook the insidious damage that we are doing to our too-easy-to-reach tummies.

And judging by the responses to a quick Twitter poll that we did after the meeting, checking our injection sites and advising on injection technique are a frequently missing part of our consultations with HCPs in clinic.

Perhaps it’s time we all started to think rather more about injection technique, site rotation, size of needles etc. I spent the first 20 of my 21 years with diabetes using the 8mm needles that were the norm back in 1998, blissfully unaware that current thinking among experts is that 4mm are best for everyone, regardless of their BMI. And whilst my eyes are screened annually, my feet jabbed at every visit, questions asked about my “control”, my highs and lows, my erectile functioning, etc., nobody has ever asked about, let alone examined, my (frankly rather unattractive) midriff.

So please look out for tweets and posts from my wonderful colleagues on @FIT4Diabetes. They have been brilliant in not making me feel guilty about my own shortcomings in technique, but I have to say that, thanks to them, I’m going to try very hard to Do the Right Thing.

There you go, a title for this post  - from a song, as always: a classic from the heyday of Mick Hucknall’s Simply Red. Click on the title and enjoy a bit of 90s nostalgia, then sing it to yourself while you inject.