Tuesday, 12 September 2017

Flashdance - What a Feeling

Here is the text of an address I delivered to @APPG_Diabetes the all-party parliamentary committee for diabetes. I was asked to deliver this speech by Diabetes UK and Abbott, to help spread awareness of the benefits of the FreeStyleLibre Flash glucose monitoring device.

By a nice coincidence the following day saw the long-awaited announcement of the FreeStyleLibre being aproved for NHS funding. My address will, I hope, help to show those who are unfamiliar with this device how beneficial it can be.

My readers will know that I give all my posts a song title - so this one chose itself. Irene Cara's classic 80s feelgood song: FlashDance - What a Feeling!

"Developing Type 1 diabetes at the age of 40 could have seriously disrupted my life and career as a school teacher. Teaching is a mentally and physically active job, in which the tag “Sir” comes with an expectation that you be “in control”. A condition which makes you prone to hypoglycaemia, leaving you helpless and vulnerable, albeit temporarily, is not easily compatible with being in charge of a class of teenagers. 

At the time of my sudden diagnosis at the age of 40, I was just six years into a senior teaching post as Head of Sixth Form, responsible for the lives and careers of 160 young people, and was also a classroom teacher of French, a job which included organising and leading a residential trip to France for up to 70 teenagers every year. I didn’t stop either role, so diabetes had to fit in with that lot, as well as my family life with three children, all aged under 13 at the time of diagnosis.

Like many other Type Ones, I have always taken the view that diabetes has to fit around my life, rather than fitting my life around diabetes. That’s perfectly possible. Diabetes is a condition, not an illness. The problem with Type One is that the life-saving treatment - insulin - is also the biggest threat to one's day-to-day welfare. 

It’s truly a love-hate relationship, and to make a success of this unwanted relationship means being one step ahead of not only the condition but also the treatment. So how do I keep one step ahead? Well of course it’s not always possible, but if I can, I try to anticipate and stave off highs and lows rather than reacting to them. Day to day life with Type One is all about avoiding highs and lows.

Meals, snacks and exercise are all a challenge, leading to either an uncomfortable high or a disabling low if I get the dose wrong, but any impending low or high can be averted by a well-timed snack or a small correction insulin dose and I am in absolutely no doubt that my greatest ally in trying to stay one step ahead of diabetes is my FreeStyleLibre flash glucose monitor, which does so much more than just telling me what my blood sugar level is. 

Years ago, not long after my diagnosis, I remember my wife saying to me, as I was doing a finger prick blood test, that what I really needed was a device that could tell me if the level was rising or falling. So when years later flash glucose monitoring became available, this dream became a reality. 

There are numerous advantages to flash glucose monitoring over finger prick testing, not least the lack of sore fingers and the ability to test an unlimited number of times - tremendously useful at times when I am busy, active, or both. But above all else, it’s the trend arrow, telling me whether the level is rising or falling, which is invaluable: let me give a practical example: 

You are probably aware that the desirable target range for blood glucose is between 4 and 8 mmo/L. That’s the level of a non-diabetic person. So let’s suppose I do a finger prick blood test and the answer is 6.0mmo/L. Sounds ideal. Bang in the middle of the desirable range. No action required. Forget diabetes for a few hours? 

Well no! Take that same reading on a FreestyleLibre and it would show me a trend arrow, indicating recent change in the blood glucose level.

I would see either a downward arrow, which could mean I am just minutes away from a serious and disabling hypo, or else an upward arrow, which whilst not threatening in the immediate sense means that I'm on my way to a period of discomfort, thirst, fatigue and, if repeated, serious long-term damage to eyes, kidneys, feet - perhaps the whole body. 6.0 may or may not require action, and only additional information can help decide. This, incidentally, highlights the outdated folly of the DVLA’s position on flash glucose monitoring as unacceptable as proof of fitness to drive. Once NHS funding is in place, a logical next step by the DVLA is to recognise not only that flash monitoring is acceptable, but that it is indeed vastly better in this context.

The FreeStyleLibre gives a much fuller picture of blood glucose than a one off snapshot by finger prick can possibly give. I haven’t even mentioned its ability to produce detailed records, highlight trends, and calculate an estimated HbA1c. 

My own HbA1c was never bad, but in two and a half years of constant use of the FreeStyleLibre it has fallen from 8.4 to 6.4. It has self-evidently improved my short and long term health, but at a cost so far of around £2500 of my own money, money which the NHS has not been spending on test strips for me during that time. 

Technology, especially technology which is relatively cheap, has a key role to play in a condition like diabetes, for which self-management plays such a big part. It is a source of regret and guilt to me that many others less fortunate than I have not thus far had access to this technology, and as a prominent advocate of the FreeStyleLibre I look forward to sharing the good news of its availability to all."

My address was warmly received. Now that NHS funding has been secured, I sincerely hope that many more will soon start to enjoy the benefits which I have enjoyed these past two years.

Sunday, 3 September 2017

Going Back

I am writing this post as the wind and rain lashes at my windows. Only yesterday, I was barbecuing in the garden on a perfect summer evening, whilst just a week ago, I was picnicking in balmy sunshine at Lytham’s Fairhaven Lake.

But now it's a wet and windy Sunday afternoon at the start of September, and millions of households will be feeling a strong sense that summer has come to an end. School bags are being packed, pencil cases checked, name tapes sewn into clothing, clean white shirts and blouses taken out of wardrobes. Even in households with no children (or teachers) many will be contemplating a return to work after the summer break. It's time to resume our routines: Farewell, summer days.

In France, this sense is far stronger. It's a season: la Rentrée.  Magazines, newspapers and lifestyle websites in France are full of articles about how to cope with la Rentrée. People wish each other a “Bonne Rentrée”, meaning good wishes for a fresh start in life, work and everything.

For me, this will be the first time since 1962 that I have not started September by embarking on a new academic year. I have retired from my work as a schoolteacher, and so will not be going back to work this week. Yet I still feel, and always have felt, that September feels more like the New Year than the real New Year in January. I suppose this is because I am the son of a teacher, and although I am now retired, my wife and son are teachers, my younger daughter is a welfare assistant in a primary school and my older daughter is a university administrator. So my life is still shaped by the pattern of the academic year, and I have even bought myself a new academic year appointments diary, not least because my old one ran out on August 31st.

September has far more of a sense of change and new beginning than January. Days are noticeably shorter, nights are colder and as has happened today, the weather often turns cold, wet and windy. The sense of change is palpable, far more so than at the change from December to January. Going back to work, school, or university, or even starting a life of retirement as summer turns to autumn, brings with it a sense of renewal, fresh start and resolution. Even the football season is but young, and the sense of hope and optimism felt by every fan in the august sunshine has not yet been deflated by too many defeats.

May I wish all who read this a successful, fulfilling, and above all happy “Rentrée” and I hope that you are buoyed and not depressed by the prospect of cosy evenings by the fire and a new series of Strictly.

Here's a playlist to suit the season, including the one I chose as the title of this post: Going Back, by the incomparable Dusty Springfield:


Bonne Rentrée!