Simvastatin

Just over a week ago I started on Simvastatin. My weight and cholesterol levels are pretty much perfect but after initially resisting the idea (I really don't want to take unnecessary medication) my GP convinced me that with a history of heart disease in my family, being on a statin would help reduce any likelihood of a future heart attack significantly.

I have noticed some side-effects. Within a fairly short time of taking the pill I feel general muscle aches making me weak and useless and so I only take it just before going to bed. I'm also getting mild constipation, as with my experience of mild stomach problems with Metformin, I'm hoping this will change over time. It could be a co-incidence with Christmas, but I am a bit more tired and grumpy than usual. Keeping a sense of humour is just a tad harder for diabetics at the best of times...

I'll go in for more tests in January so that will be a chance to review side-effects with my nurse.

On the food side, had a lovely bowl of trifle made by my aunt-in-law who's husband has recently been diagnosed with high blood sugar. She used sugar-free jelly and home made sponge and custard using a sweetener rather than sugar. It worked really well.

Home made diabetic cookies

As it's been months since I last found sugar free cookies for sale anywhere in London, I thought I'd try my own sugar free variation. The result was just under 30 of these diabetic friendly cookies, they go down a treat with a cup of coffee in the evening.

Recipe for low-sugar
porridge oat cinnamon cookies

• 1 cup of flour
• 1½ cups of porridge oats
• ½ tsp baking soda
• ½ cup sweetener*
  
• 1 tsp vanilla
• ½ cup sultanas (or raisins)
• 2 tsp cinnamon (or less to taste)
  
• ¼ tsp nutmeg
• 2 egg whites (lightly beaten)
• ½ cup skimmed milk
• 1/3 cup olive oil
• ½ cup walnuts (high in Omega3)
  

Sift the dry ingredients, add the oats and mix in the rest of the ingredients. Drop a generous teaspoon at a time onto greased paper and bake at 190C (375F) for 12 to 15 minutes.

* The sweetener should be suitable for baking and the amount used is equivalent to a half cup of granulated sugar.

The sultanas (or golden raisins) are just under 60% "natural" sugar. There are around 4½ cups of solid ingredients including the ½ cup of sultanas this makes the cookies a total of 13% sugar. You could make these with fewer sultanas (1/3 of a cup would make the total 9% sugar) and more nuts but they begin to taste a bit dry (I tried once with only nuts but they are not as nice). You could swap the walnuts for any other nuts (I added some Brazil nuts I had to use up) but walnuts are particularly good for Omega 3 fats (I'm still low on this sort of "good" cholesterol).

The original recipe called for a ½ tsp of cinnamon but as it is highly recommended for diabetics I quadrupled the levels making them smell nicely of cinnamon. If you are not such a fan of cinnamon you might try just 1 tsp.

I think the sugar levels are pretty acceptable (being on the same proportion as the sugar you would find in a fresh apple) so long as you don't immediately scoff the lot. If you are worried about the carbohydrate hit from the oats and flour, I suggest no more than 2 or 3 in a day, the oats make them pretty filling anyway.

High price of sugar free chocolate

After finding out that Chocology (I frequently walk past their stall at London Bridge Station) has put the price of 85g Cavalier bars of dark chocolate (only 1% sugar) up from £1.99 to £2.49, I decided to do some research on the internet. I quickly found that ordering from goodnessdirect.co.uk (it's okay to click the link, I don't get any commission) saved quite a bit as by buying enough for free delivery the bars came out as £1.42 each, a saving of £1.07!

It seems a little sad that shops like Chocology feel the need to add such a large mark-up on food that is so useful to diabetics.

Unhelpful GP

I managed to get my latest HbA1c results from my diabetic nurse, still good at 5.4.

My GP managed to be unencouraging. The surgery phoned me up and asked me to come in for a meeting with my GP, when I turned up he immediately apologised for calling me in as it was unnecessary and some sort of confusion on behalf of reception. Looking at my results he gave me the feedback that he thought I probably had the best results and control of all the surgery's diabetic patients and suggested that we reduce the number of times I come in for testing (currently 4 times a year). As I find the HbA1c results helpful and they refuse to fund self-testing I suggested we continue with every three months. The GP then launched into a bit of a diatribe saying that patients with much worse problems than mine can't get appointments (remember they called me in for an appointment unnecessarily) and if I wanted more regular tests he would give me the forms and I could go to hospital for blood tests.

I didn't argue with him but listened patiently. I suspect that despite his rant it will not make any difference to the arrangements with the diabetic nurse. I had 3 visits last year and as it's up to me to phone and make appointments I guess there's nothing to stop me keeping up the same level of monitoring.

He offered to take me off Metformin, to which I suggested that I would try coming off Metformin if he could supply a self testing kit so I could see the effects of attempting to control my diabetes with diet alone. He wouldn't do this (a false economy in my view) and so I'm staying on 500mg/day of Metformin.

He then went on to discover that my blood cholesterol tests had not been processed, later on I received another phonecall from the surgery asking me to come in to give more blood as my cholesterol blood test had been lost; so my 1 visit for regular monitoring had now turned into 3 appointments!

My experience added to what I read on the diabetes newsgroups convinces me that the NICE guidelines encouraging the PCT to form a "team" with the patient are pointless as anytime I actually ask the surgery for support (self-testing or frequency of monitoring) they use funding as an excuse not to bother.

I eventually got my cholesterol results, my HDL is still low (0.6, should be greater than 1.5) with total cholesterol normal. So I might try moving to margarine with Omega3 added. If the GP had been a bit less of an arse I might have tried talking to him about it but I'll wait for my next appointment with the diabetic nurse in June.

Where can I buy low-sugar cereal bars?

Corny - German sugar free bars,
originally uploaded by Betacells.

This is my last "Corny", a cereal bar sold in Germany.

I bought two boxes of 10 when on holiday in Aachen before Christmas. I think they were less than €2.00 (only 15p a bar). These fairly plain yoghurt flavour cereal bars are 62% carbohydrates and 5% sugar (the hazelnut version is 1.3% sugar - for comparison note that skimmed milk is 5% sugar). They taste like you would expect sweet cereal bars to be and go really well with a tea or coffee. They were great to carry about as an emergency sugar-free snack when drinking in a cafe that only has sugary things to eat.

In the UK I can only seem to find low-fat, high-sugar cereal bars. I wish I'd bought 10 boxes while I was there.

How much sugar is in fruit?

This is a question I've been looking for an answer for since I was diagnosed.

For the first two months after diagnosis I was blithely adding a banana to my morning porridge, unaware of how much sugar this contained. Once I was advised by my GP's nutritionist that I should never touch fruit juices or smoothies and limit myself to a maximum of 2 portions of fruit a day; eating more vegetables to compensate. I am careful to avoid "hidden" fruit and sugar (in sauces, salads, added dried fruit etc.) and take care to account for any fruit I do choose to eat. As a rule if I am not sure how much sugar is in something I just buy something else.

Today I found that, for apples, according to the Food Standards Agency it varies with lower sugar apples being those with the strongest flavours (sugar to acid ratios being low). Their estimate is that an apple is around 10% carbohydrate (which I assume is almost all sugar).

The USDA National Nutrient Database has quite a nice food search engine showing tested sugars, carbs and fats. I've started a table on sugarfree.tiddlyspot.com which I will keep updated.

DESMOND course

I finally went on the DESMOND course (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) and can recommend it for those who are struggling to understand how best to manage their diabetes. Some of the people there just needed encouragement to see there were simple things they could change in their diet or lifestyle that would help improve their condition.

I thought that it was useful to be able to compare all those numbers from your GP (blood pressure, blood glucose, weight, cholesterol (LDL & HDL) etc.) against the recommended norm and those of other real diabetics as a way of setting goals for things to improve. It also worked well that we had two group sessions to ask questions and discuss issues with an expert and each other.

DESMOND poster, uploaded by Betacells
Click to see full size.

Though the course is designed for those in their first year after diagnosis, there was one woman there who was diagnosed 3½ years previously but had done little about it apart from cutting out Coca-Cola and hadn't been advised about what else to do!

I'm now 10 months after diagnosis and though I'd read a fair amount about diabetes it was useful to have the medical side explained simply (such as what beta cells do) and I think the course was worth the effort.

My numbers have gradually improved over the year (mainly due to losing weight) and today I found out that my Metformin dose has been halved (to 500mg/day). The only key number that I'm worrying about is my low HDL (though my total cholesterol is very good), I'll just have to try eating more fish...

Weight results for 2007

Excel weight spreadsheet for 2007

You can see that I have dropped 11 kilos this year (that's the same as 1¾ stones or 24 pounds), so I'm giving myself a pat on the back for making my diet stick and avoiding any "yoyo" dieting. The loss in weight has also meant losing 7 inches off my waist so none of my old clothes fit anymore!

I feel much better for losing the weight, here are the changes I've noticed:

• I tend to be less grumpy
• I feel 10 years younger and sexier
• I can buy clothes off the peg (I'm a 34 inch waist now)
• I don't wake up in the morning with a painful hip joint
• I can sleep lying face down
• I can shamelessly go topless on holiday

I guess my vanity wasn't a good enough motive to lose weight before becoming diabetic but it's a nice side-effect of having to get healthier.