Fat Club User Guide – Carbs & Cals

carbsandcalsI recently wrote about my experience working with the Kirklees Weight Management Programme to help achieve and maintain a healthy weight.

One of the tools suggested to me by the team behind the programme was a book that is generally recommended to Diabetics who monitor their carbohydrate intake and self dose insulin based on it.

Carbs & Cals: Count your Carbs & Calories with over 1,700 Food & Drink Photos!

I bought the book from Amazon for just under a tenner and then a few days later I bought the App from Google’s Play Store.

Both the book and the app are a really handy resource to check the calorific content of everyday foods.

The book is crammed full of pictures showing you nutritional information on a variety of foods in a variety of portion sizes.

The App takes this a step further by allowing you to scan barcodes to get nutritional information from a large online database of foods.

The App can be used as a Food Diary and even a Blood Glucose diary for insulin junkies like me.

Finally, both the book and the App are supported by online resources that can be found at the Carbs & Cals website.

 

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Church of Pfizer – Breaking the First Rule of Fat Club

Victoza-LiraglutideFor the last decade I have carried the clinical label of “Morbidly Obese“.

A decade ago I weighed in at over 20 stones; I had been piling on the pounds since the age of 25. A combination of living a lush lifestyle, holding down a sedentary office job and thriving on cortisol-inducing stress all culminated in the climactic crescendo of endocrine crash.

By October 2003 I had dropped 3 stone and suffered what were described later as “Osmotic Symptoms” – between you and me these were simply body-wide agonising muscle cramps caused by essential salts being flushed from my body as it tried to handle a fasting blood glucose level of 32 mmol/L (6 mmol/L is the norm).

I was rushed into hospital and diagnosed with Type 1 Diabetes (meaning that I rely on regular injections of insulin to survive).

For the last decade I have managed my condition as all diabetics must do – day to day and sometimes seeming to pull through by will alone.

It is by will alone I set my mind in motion. It is by the juice of Sapho that thoughts acquire speed, the lips acquire stains, the stains become a warning. It is by will alone I set my mind in motion.

Since then my weight has fluctuated between 17 and 20 stone, erring more towards the latter over the last year or so. Th weight dropping off as I exercise and then piling on when I stop.

Of course, medicine has played a large part in the management of my condition. As a Type 1 diabetic I have prayed at the alter of The Church of Pfizer for almost a full decade now. Insulin to make up for insulin I am not producing, Metformin (Glucophage) to help my body use the insulin and Pravastatin to deal with my high cholesterol.

Over the past couple of years I have endured an ongoing battle with my health care team over my condition. My health care team believe I am not a Type 1 diabetic at all but Type 2 (meaning I am producing some insulin but my body cannot use it). The only evidence given for this seeming to be my inability to maintain a healthy weight.

Victoza PenThe battle peaked towards the end of 2012 when my diabetic “specialist” decided to put her money where her mouth is and put me onto a trial course of GLP-1 (Glucagon-like-peptide).

Pitched as some kind of Panacea, GLP-1 is a weight loss medication with the surprising side effect of increasing insulin production in Type-2 diabetics. Type-1 diabetics may benefit from the weight loss side of the medication but would see no other benefits.

At the same time that I started the process of titrating up to a full dose of Victoza-Liraglutide (the trade name of this new sub-cutaneous Sacrament) I also signed up to the local Weight Loss Program – Kirklees Weight Management (lovingly referred to as Fat Club by my fellow losers).

I started the full course of Victoza 3 weeks ago and Fat Club 2 weeks ago and frustratingly enough the Victoza seems to be working – I must be Type-2, the priests were right all along.

I have reduced my insulin intake by more than 50% and appear to be losing over 2kg a week. The Victoza isn’t pleasant but I’m accustomed to the nausea and other gastric symptoms that arise from the daily injections.

So far the fat club appear to be offering sound advice but I have to admit that I am eating smaller portions mainly because the Victoza helps me feel satiated and slows my digestion down so that I am not hungry.

I haven’t felt this good since I tried the hypno-band the other year. Fat Club have given me a target of 6.2kg to lose over the 12 week period; 2 weeks in and I’ve lost 4.6kg.  I’m out walking more and seem to be energised towards losing more weight.

Victoza-para-Emagrecer-Funciona-3I’m sure this will level out at some point – at this rate I’d be looking at being back to 16/17 stone by the end of the 12 weeks, something my GP has advised against.  Not that the process stops there.  This isn’t some kind of Slimming World fad diet – it’s a total change to my way of life – again.

That being said, I do feel like I’m cheating somehow, there should be rules about the use of performance enhancing drugs at Fat Club.

Church of Pfizer – Crisis of Faith

Atorvastatin

I had my 6 monthly check-up with a diabetic specialist today.

I say a diabetic specialist because, once again, it was a completely different person altogether.

Since my diagnosis as a Type 1 (insulin dependent) diabetic, back in 2003, I have seen several different diabetic “specialists” – all no doubt very highly qualified and all possessing their own unique take on the treatment of my condition.

The lady I saw today was one of the more engaging specialists that I have seen; young, confident and powered with an eagerness to help me manage my condition.

There was just one problem… my notes.

All that any new specialist has to work with are the notes left by their predecessors.  Predecessors that cannot even agree on a diagnosis for my condition, let alone a treatment.

I take both subcutaneous injections of insulin and oral metphormin/glucophage tablets to manage my condition.  The latter is predominantly used for Type 2 diabetics, as I carry extra weight around my middle; my metabolism is so poor as to prevent my body using the insulin that I inject well enough without the pills… just like Type 2 diabetics.

This is further complicated by my body’s lack of insulin.  My pancreas packed in insulin production years ago… just like Type 1 diabetics.

So you can see where specialists get confused.  There isn’t a Type 1.5, Type 3 or even some funky Type X that they can label me with.

But that’s the real problem isn’t it?

How many diabetics do conform to the text book definitions? We’re all unique as human beings.

Every specialist I have seen has a completely different take on the situation.

I even remember the one that re-branded me as Type 2 – just like that!  His reasoning being that I am overweight and overweight people are Type 2 diabetics not Type 1.  Not only that, that’s unfair, apparently I am too old to be Type 1, this chap believed that Type 1 diabetics were all diagnosed early on in life and not at 28 as I was.

The very next check-up I had, I saw a new specialist who said:

No! You can’t be Type 2, you take insulin.

You can probably see, now, why I am so frustrated with the situation.

Eight years on and I’m struggling to keep myself healthy.

Don’t get me wrong, the support infrastructure is there for me… it just doesn’t work.

How can I be expected to know what to do when the specialists themselves can’t even agree with each other?

The fact of the matter is, I’ve lost my faith in the Church of Pfizer.  I was born and raised a scientist, albeit one with a firm belief in certain paranormal fields but a scientist none-the-less.

Church of Pfizer

Blind Obediance

Marketing Led Trust in Others

Healthcare Privatised

Even my GP and practice nurse disagree with the specialists – and I have far more faith in the doctor that I’ve seen for 10 years and the nurse I went to school with than the steady stream of people leaving medical school and progressing up the ladder.

I’ve asked time and time again to have my check-ups with the GP but the last I heard from him on the matter was a stern warning that my HbA1C had risen from 7.2 to 7.9 and that I should speak to my diabetic nurse immediately.

Well I spoke to my diabetic nurse today and she said 7.9 was fine.  Of course I should aim to get it as close to normal as possible but 7.9 was nothing to lose sleep over.

Contrary to this, the practice nurse at my GP’s surgery took my blood pressure last week and recorded it as normal.  We even talked about how this was never the case when I went for my hospital check-up.  She laughed and said not to worry, a lot of people have bad blood pressure readings at hospital.

Sure enough today, my blood pressure reading was high enough that the specialist wanted to start me taking more sacrament from the Chruch of Pfizer – not to mention resuming my daily consumption of Atorvostatin to keep my cholesterol down; despite the risk of liver failure that accompanies the drug.

The justification for all of this was the stark warning of early mortality due to heart disease.  A lengthy monologue on the dangerous combination of Diabetes, High Cholesterol, High Blood Pressure and a stressful working environment served to bully me into accepting medication that I have serious doubts over.

Atorvostatin

Sanguine Analysis

Cholesterol, Five Point Six

Bullied to Obey

Thankfully, she agreed to defer to my GP.  My blood pressure will prove to be normal at the GP’s surgery and so that’s one less sacrament to minister to myself.

I know I’ll never be rid of diabetes; it is a life-long condition – it will kill me one day – the trick is keeping that day as far in the future as possible and balancing it with a reasonable quality of life.

All I want is to get settled back into a routine where my diabetes is in control so that I can concentrate on other areas of my life.

I’ve been at this for a month now, with a different appointment every week, each one resulting in more and more confusion and often in further appointments.  There is light at the end of the tunnel but it is growing harder and harder to get by without blowing up at the confusion, stress and anxiety caused by it all.

Of Nurses and Naming Conventions

HRI 1I had my regular check up at the Diabetic clinic this week.  It is always a time of mixed emotions, no matter how well controlled my emotions can be there is always a level of anxiety in the run up to the check up.

Even when my diabetes was perfectly controlled*, I would still need to make quite an effort to ensure I was calm and relaxed whilst waiting to see the specialist.

This is predominantly down to the completely emotionless manner in which medical professionals handle us as patients.  Don’t get me wrong, I respect what these people do but they have to deal with hundreds of patients a week, many of which (I imagine) have bad news rather than good – these people can’t afford to let emotion creep into their working life.

I wouldn’t say that this emotional detachment scares me, it is more that I know the specialist could just as easily declare me riddled with cancer, as declare me fit and well (for an insulin dependent Diabetic).

For me, a trip to the Diabetic Specialist is like a trip to see Hannibal Lector.  I feel like a young (male) Clarice Starling brought by necessity to an appointment with a cad carrying psychopath.  Except in my case the sociopathic doctor could kill me with words**, rather than slice slivers from a work colleague’s brain and serve them up as Hors d’Ouevre.

HRI 2This recent trip was somewhat harder than previous visits.  I don’t want to become maudlin and go into the reasons why, they’re transient and will soon pass.  The point is, this week’s hospital visit was not as eagerly anticipated as previous ones.

My battle against anxiety was not helped by the change in procedures that Huddersfield Royal Infirmary’s diabetic clinic had recently implemented.  This should not have been a surprise, the process changes slightly every time.  This was a big change however.

The usual process is a permutation of:

  • Turn Up
  • Check In
  • Apologise for lack of urine sample/provide pre-prepared sample/provide fresh sample
  • Get Weighed
  • Have blood test
  • Wait 20 minutes to an hour to see the Specialist.

This time was different insofar as, I checked in and then had to wait 20 minutes or so to be weighed, hand over urine etc.

This meant that I had more time to dwell on all the possible outcomes of the visit.  Like a diabetic kwisatz haderach, I sit there mapping out all my potential futures.

And then the nurses call me in and we get to the crux of this post.

I was called into a consulting room, where four nurses were ready to pass me through the new process.

Firstly, I was reprimanded for not bringing a sample and invited to provide a fresh one after processing.

Next I am sat on weighing scales whilst my blood pressure is taken.

As I am being seated, the nurse who is logging all this and in a colloquial mix of West Indian and Yorkshire (that you only really get in Huddersfield***) says,

You don’t look like a Benjamin.

Then to the other nurses,

He doesn’t look like a Benjamin.

I’m left bemused by this, what should I say in response? I’ve never really considered what kind of name I look like.  To me I am the epitome of Benjamin, so as the other nurses agree move onto the usual Emmerdale/Sugden references I reply:

You know, I always fancied myself an Andrew…

and then,

… not in that way of course

This last followed with my best attempt at a cheeky grin – instantly regretting the fact that they must now think I’m some kind of gay-bashing homophobe.

The nurse is laughing anyway, and refered to me as Andrew whenever I saw her that day, so it couldn’t have been that bad.

HRI 3The point is, I could have really put any name there, and almost did!  Peter, Graham, Benedict all of which could have been put forward, because the truth of the matter is that I don’t know what particular name I look like, if I don’t look like a Benjamin.

Anyway, with that thought provoked for the day, I was rushed off to provide a sample and then sent onto the next step of the process.  The question of what I should be called or what name I look like was sufficient a distraction that I managed to coast through the rest of the appointment anxiety free.

I suppose nurses are the counterbalance to specialist consultants in that they have to show (and share) emotion; nurses deal with patients for far longer than doctors, they are often the ones who deal with the aftermath of a negative consultation.

So hopefully, this lady will be there when I return for my next check-up in six months time.

Footnotes

* All diabetics go through a “Honeymoon” period, during which their control is perfect; eventually the body becomes accustomed to/polluted by the manufactured insulin and other medicines, and leaves you to manage your blood sugar levels on your own.  For the past year or so, I’ve been on a spiraling decline with regards my HbA1c readings.

What were once 6.3 to 6.7 had got up to 11.3 and climbing.  My specialist showed me the chart this week; he seemed alarmed as my readings have dropped back to the 7.6 mark.

I’ve put this down to my decision to completely ignore the faff and kerfuffle at the Hospital.  My specialist can’t even decide on what type of Diabetes I have, let alone the correct treatment for me.  Anyway, more on that another time.

** I believe quite strongly in the power of the mind to overcome biological and medical hardship.  I strongly believe that a lot of people who die from terminal diseases sooner rather than later, because they are told that they will.  They’re given a fixed period of time and then shuffle off; I believe some of them (the more negatively focused ones) could go on for much longer if they were unaware of their life expectancy or even their disease.

*** My Father once told me about a wonderful lady he worked with at a local asylum in the seventies; in this same, jolly, colloquial accent she would remark,

I got ‘im by dem stones David!

As she grabbed someone between their legs and lifted them from the ground.

Haiku – HbA1c

HbA1c

Hum of centrifuge
Eyes avert to floorfull
Blood woman beckons…

Church of Pfizer – Origins

I heard a radio advert for yet another “Stop Smoking or the Bunny Gets It!” advert this morning; like most adverts it finished with some hastily-spoken-at-low-volume audio fine print:

Brought to you by Pfizer

Well that’s what it sounded like anyway, it could have been anything considering the speed of the sound-byte. Either way it reminded me of a flame war conversation that was held on the British Horror Film Forum a couple of years back, during which I coined the term “the Church of Pfizer” as a catch all way of referring to the New Inquisition – or more clearly stated, the dogma and beliefs of devout followers of Science (with a capital S).

The term appeared in reference to the medication I take on a daily basis to manage my Diabetes and associated complications;

I am a type 1 diabetic. I self-administer 2 subcutaneous injections of a mixed human analog insulin a day to “live”. I lived for years beforehand without my twice daily prayer rituals to the Church of Pfizer and have only the word of a venerable “specialist” to state that I need it.

I appreciate that out of the context of the original discussion, this sounds a little facetious. The original discussion had started when I supposed that the 20th century could be seen to have evolved into a Science/Religion paradigm and that Scientists were the new priesthood (an idea put forward far more eloquently by the dearly missed St. Bob).

The point really comes from a discussion that I had with my GP shortly after being diagnosed as a Type 1 Diabetic. To keep my cholesterol levels down, I am prescribed 10mg of Atorvastatin (Pfizer) to be taken orally every night. When my GP saw that I had been prescribed that particular “brand” of statin he exclaimed surprise. I probably shouldn’t have picked up on it but I did. Asking for an explanation, my GP kindly offered me one.

He explained that he would have prescribed an alternate statin; when asked why, he explained that his favoured brand had been tested on a demographic of around 10,000 men of all ages in the North of England from the 1960’s onward and that the results showed that the statin had a positive preventative effect on the complications of high cholesterol (such as Heart Disease).

My GP went on to explain that the statin I had been prescribed had been tested for a short period in the 1990’s, on a demographic of around 1,000 middle aged men and women on an island in the Mediterranean. The studies showed that the statin was highly effective at rapidly reducing blood cholesterol counts but there was not yet any evidence as to whether it was as efficacious as other statins with regards long term complications.

(I should add the caveat that the exact details of the conversation are lost to the mists of time, this is just the crux – facts and figures may be out but the point is the proportional difference between studies)

We discussed this at length and both agreed to keep the prescription as was, the Hospital presumably having its own reasons for the prescription.

I’m a scientist at heart, I studied Molecular Biology at University and work in computing (which, granted, can have its arcane moments); I also maintain an open mind to new ideas and have recently found myself sympathetic to zeteticism. That being said, the rising fundamentalism within the Church of Pfizer does worry me. We the public take everything for granted; in my case I assume that my doctors are right and the pills and needles are essential to a healthy life (despite the fact that they can no longer agree on a correct diagnosis of my condition). There are other concerns, that should become apparent when I resurrect the discussion from the BHF. I may actually edit it (to protect the innocent) and post it here for posterity.