A hypo in Berlin

For the first time I felt I wasn't prepared enough.
For the first time I felt diabetes was in control.
For the first time... I felt vulnerable.

It was after my wife and I had enjoyed a lovely meal at a restaurant in East Berlin, where the irony of a flashing neon sign above the entrance reading "Capitalism kills love" hadn't been lost on us. We decided to walk home rather than catch a bus as we'd just eaten a superb pudding - it seemed sensible. That was the second mistake.

The first mistake was clearly miscalculating the true carbohydrate content of my meal and the impact walking throughout the day would have on my numbers.

It should have been easy.

The only carbs in the three course meal were some chips and a lemon meringue tart.
I had the carbs and cals app on my phone to assist.
I knew the amount of walking (and climbing) I'd done during the afternoon.

Yet somehow I managed to get it wrong. Seriously wrong.

So, whilst walking "home" through the dimly lit streets of Berlin, I had a feeling. I whipped out my Freestyle Libre scanner and waved it over my right arm. Through my coat and t-shirt it scanned my blood glucose level and displayed it on the screen: 3.2 mmol/L and a slow decline arrow.

Getting into trouble...

Thoughts started tumbling through my head...

"Ok that's not good, but it's not disastrous."
"It always reads lower than my normal meter."
"But it's going down and my hypo senses are tingling."

We carry on walking and I ask my wife, "How far do you think we are from the hotel?". We both agreed it wasn't much further. We carry on walking.

I scan again: 2.3 mmol/L and an arrow going towards the floor.

Going nowhere!

Bother! I'm feeling hot and despite the Libre always reading lower than my usual meter this is now definitely hypo territory. I open up my "bag of life" and take out a tube of Glucotabs. Popping them in my mouth two at a time my wife asks "Shall we just stop at this bridge until you're feeling better?"

I look around.

There's a small group of young adults standing on the bridge, they're drinking bottles of wine; chatting; laughing; enjoying themselves. A few other solitary figures are walking, heads down, no doubt rushing to their destination hoping to be back in the warmth.

I'm boiling, physically sweating beneath my coat, hypo! All these people make me feel unsafe, yet none of them know about the condition I find myself in. I doubt any of them have even noticed me.

"No, we're nearly at the hotel. I'll be fine, I'm gluco-tabbed up." I hear myself reply.

We stumble on. No. I... stumble... on...

I scan again... LO.

This walking is getting harder!

My wife chirps up again, clearly concerned: "Why don't we just sit here at this table?"

We're near the hotel now, restaurants and bars had appeared on the street we were walking on. I looked at the ever decreasing amount of glucotabs in the tube and the people around me. Lots of people around me. It maybe a brighter and busier street... but all these people... I don't want them around me whilst I'm like this!

"No, the hotel is only a few metres away, let's carry on."

Each step felt harder than the last one but, finally we're outside the hotel.

Whenever we're away we scout out the nearby area for any suitable shops that might sell "approved" hypo treatments. It's an unspoken rule. We both do it, acknowledge it, but never openly say "there's an emergency hypo supply shop". The night before we'd both identified what seemed to be a large-ish late night newsagents with lots of drinks chillers.

My wife decided she would go and find some appropriate carbs whilst I went back to the room.

"What's our room number again?"
"4123."

I repeat this over and over in my head as I enter the hotel. Four - One - Two - Three - Four - One - Two - Three - Four - One - ...

I wipe my forehead with my hand as I approach the lift. It glistens in the light with its new coating of sweat.

I finally reach our room and enter.
Safety!

Shrugging off my coat my arms reveal that they too are glistening with sweat.

I scan again.
Still LO.

bgs in Berlin

A packet of crisps! I take them, lie on the bed and devour them.
What else? Poppets! There are poppets in my luggage bag... not anymore, demolished!

... and then? ...then I fall asleep, waking when my wife arrives with "goodies". The newsagent turned out to be selling alcohol! Instead she returned with a muffin from a nearby coffee shop. None of this is exactly fast acting carbs, but I ate that too! ...and then back to sleep.

I wake to her scanning the Freestyle Libre sensor on my arm, clearly worried. Thankfully it was a good number. I was just shattered from the whole experience.

So now I reflect. This is the first hypo were I've felt vulnerable. Why?

I think the answer is two-fold:

1. Previously all my hypos have either been when I've been on my own, in the company of my wife or at work (when usually no one notices and in any case I'm surrounded by people I know). This time I was in a public space.
   
   
2. Did I carry enough hypo treatment?
   
   What if I hadn't made it back to the "safety" of my hotel room?
   
   What if I'd eaten all the glucotabs in my bag of life, stayed on the street and my numbers hadn't come up? It wasn't like there was a shop or bar nearby that could have solved my problem. My wife would need to leave me on the street and go in search of carbs... and then what?

It's a rare event but it's left a lasting impression. Diabetes has made me vulnerable and I've seen first hand how that impacts those closest to me. It's a hard lesson to learn.

What I thought was a good enough safety net might not be... hypo treatments aren't "just in case" items, they are vital items and one tube of glucotabs might not always be enough.

Demons in your head?

I was in McDonalds recently.

To be honest I've been there quite a lot of late, usually around 11:00pm after completing some DIY at the house I've bought. I pass a 24hr McDonalds on my journey back to the rented accommodation I'm currently living in and just as my Levemir injection alarm goes off I'm usually tucking into a McFlurry treat!

The other night whilst eating a delightful Dairy Milk McFlurry, a song came on and I asked my phone to tell me what I was listening to... why? because I'd heard "the c word" in the lyrics.

For the avoidance of doubt, "the c word" is... carbohydrates!

...and it turned out the song was Vertigo by Rumer.



The song isn't the style of music I'd normally listen to, but ever since my diabetes diagnosis my ears have been able to tune into any conversation that mentions the c word with laser like precision. Although the song isn't about diabetes (far from it!), with a few tweaks here and there it certainly could be...
The concept of carbohydrates at 4am in the morning obviously has a slightly different meaning in my version of the song and I'll admit to playing it on repeat at the moment because (in my version) the lyrics are ALL about diabetes.

The challenge of diabetes isn't always obvious to those around us, sometimes there can be battles going on inside our heads and dealing with those "demons" can take its toll on our emotional, mental and physical well-being. Yet, bravely(?), we continue to tell those around us that we are fine. Trying to fool everyone (including ourselves) that everything is ok and that we are "managing" to deal with the condition.

Why do we do it? Are we too hung up with "not being a burden"? Do we decide help won't be available without really knowing and therefore decide not to ask? Maybe we feel ashamed of the need to ask?

There certainly isn't any shame in asking for assistance to overcome the "demons" and there should be no barriers in obtaining the help needed. So why do we lie to ourselves and others?

Imagine informing someone that they'd been signed up to a full time job which they cannot quit, that it came with no holidays for the rest of their lives, no weekends off, no opportunity to have a day off sick and indeed if they were unwell they would need to put in a double shift. It wouldn't take long before they were screaming for help. That's how cruel the employer Diabetes is - and in many ways it can be much, much worse!

So why not go into battle with the demons in your head (and help yourself and those around you) by sharing them with your HCP? After all, a problem shared might not be a problem halved... it might be a problem resolved.

Appropriate lyrics?

Pass me the bottle, pour me the wine.

I might be face down on the table, but I assure you I'm doing just fine.
Give me a cigarette, you heard what I said,
'cause I'm going into battle with the demons in my head.

'Cause I've seen trouble, I've seen more than my share.
I said I've seen trouble and I don't care any more.
No, I don't care any more.

You say I'm outspoken, that I'm loud, that I'm obtuse.

While I'm here all screwed up, baby, tell me what's your excuse?

Gimme carbohydrates, at four in the morning.

Gimme carbohydrates, 'cause I don't care any more.

No, I don't care any more.

Dear M&S...

You used to be a leader in sharing nutritional information with your customers. Back in 2005 you had a traffic light system on your food to help customers make informed choices. Tesco and Morrisons only agreed to do this at the end of 2012!

You were a leading light.

You used to provide information about the products you sold in Cafe Revive on your website enabling people, such as myself, the opportunity to plan how much insulin I would need to inject in order to eat at your establishment.

Unlike others (such as Costa, Starbucks, BB Coffee and Muffins, Caffe Nero etc), you took the retrograde step earlier this year to remove this information from your website. Eating in your cafe now has an element of risk to my (and others) health.

I don't have an explanation as to why you made this retrograde decision (even after spending 15 minutes on the phone to your customer care team). All I've been told is:

• The information is no longer provided on your website.
• You have no plans to provide this information on your website in the future.
• If I want to know the carbohydrate value of any product in your cafe I should request this information from your staff at the time of purchase.

Well last Saturday I did exactly that - in your Wellingborough store. I asked for the carbohydrate content of a piece of cake. The staff seemed quite put out with me asking and pointed to the plastic noteholder stating the product and calorie content. I was told very abruptly that everything I needed to know was there.

I pointed out this only provided me the calorie content of the cake and not the carbohydrate content. The member of staff stormed off to ask a colleague and after much discussion she came back and told me the amount of calories as though this was the carbohydrate content. If I hadn't done a mental check on this number I would have injected a dangerous amount of insulin that would have potentially ended my life.

I asked again for the carbohydrate content.

A rather large queue was starting to form and customers (quite rightly) where getting frustrated and annoyed that they weren't being served. I on the other hand felt like I was being a "problem" both for the other customers and the staff.

Eventually they found an A4 ringbinder which contained a printed sheet for each product. There didn't seem to be any logical order to how these sheets were stored and the staff flicked through each page in turn until they found the product I was interested in and provided me with the carbohydrate information. It seemed much larger than I was expecting (but nowhere near the calorie value!) but given the size of the queue that had formed I wasn't going to question it. I was embarassed enough!

I purchased my food and drink and took a seat.

At this point I did my calculations in order to determine the amount of insulin I required and then I had a panic. What if this number was wrong? It seemed too high for such a small slice of cake. Other cakes I had eaten in Costa (for example) were much smaller. Had they read the right value?

I couldn't inject without seeing this information for myself and so with a renewed resolve I went back to the counter and asked to see it. Once again I got stares from other customers as (I imagine) they were wondering "who is this person that has just jumped the queue?" and the staff didn't seem particularly happy with me interupting them again to ask the same question. Eventually they found the correct folder and flicked through each page (again) until they found the product and handed me the folder.

It turns out they had given me the correct number from the page. I thanked them and sat down. I decided I couldn't inject the amount it stated, it "seemed" wrong. I reduced the amount I injected by a couple of units on the basis it would be easier to correct with an additional shot of insulin later if the number was incorrect than to deal with a potential insulin overdose.

I don't know if the slice of cake I consumed on the day was smaller than the suggested size in the manual; or if the value on the page wasn't correct; or if diabetes just played one of those nasty tricks on me due to the stress of the situation, but I ended up hypo later that day and I had to eat some fast acting carbohydrates to get my blood glucose levels back in range. I suspect it was the stress, but with diabetes you can never be totally sure.

In the end, what should have been a nice "treat" at the weekend turned into a stressful, unhappy experience that ultimately ended up with me in a hypoglycemic state. Not an experience I wish to repeat and so until nutritional information is published on your website (like it used to be), unfortunately I will not be having a "treat" at any of your cafes again. I would much prefer to go somewhere that lets me be safe and in control of my health needs - as I have mentioned nearly all of the high street chains offer me this comfort.

Angry at what had happened, I raised this issue with you on Twitter and you told me to give you a call. I was hoping that when I rang you'd say "Sorry, we made a mistake, this information will be back on our website soon and when it is we will let you know" instead you made it very clear that there were no plans to give this information to customers on the website and despite me recounting my experience, the advice was still to ask in store - to put my life in the hands of poorly trained staff.

You said you'd contact the Wellingborough store to ensure they were aware of the issue, but you are a national chain... what if the same experience I had happens in other stores? What if your staff tells a customer the calorie content rather than the carbohydrate value and your customer accepts this without question? You are putting peoples lives at risk! If I hadn't had the sense to question the original answer I would have injected around ten times the amount of insulin required.

Given you send this nutritional information out to every store that has a Cafe Revive in it, surely it is not beyond the realms of your ability to share this information online with your customers? You used to, why did the policy change? Is this a lot to ask of a multi-national company? You already have the information so please share it for everyone's benefit.

Instead of being a laggard, I want you to become that leading light again. Show the UK how you care for your customers needs and how you understand the value customers place on nutritional information.

With a very heavy heart,
David

Help me to change the mind of M&S

If you agree with me that Marks and Spencer should start publishing on it's website (again) the nutritional information of the food it sells in Cafe Revive, please let them know.
It only takes a few minutes to make your voice heard.

You can:

• Contact them via their website
• Call their customer services line on 0333 014 8555 and select option 4
• Write to them at:
  
  Marks & Spencer
  Chester Business Park
  Wrexham Road
  Chester
  CH4 9GA
• and/or tweet them @marksandspencer (+M&S)
  

Please help Marks and Spencer become a leading light again and make it safer for customers to eat in Cafe Revive.

Thank you.

Diabetes Blog Week 2014 - Day 3 - What Brings Me Down

This week is Diabetes Blog Week.

Each day diabetes bloggers around the world will be writing a blog post on the same topic. You will be able to see who is taking part and what the daily topic is at Bitter Sweet Diabetes.

This is the first year that I have taken part and I've found it extremely challenging. They certainly aren't topics that I would normally choose to tackle, but sometimes it's good to be outside of your comfort zone!

Todays topic:What Brings Me Down

May is Mental Health Month so now seems like a great time to explore the emotional side of living with, or caring for someone with, diabetes. What things can make dealing with diabetes an emotional issue for you and / or your loved one, and how do you cope?

My response:

The dreaded buffet!

Many of my blog posts to date have covered some of the things that "get me down".

I've touched on the lack of spontaneity around food.

A recent example of this was when I attended a Christening and the obligatory buffet food that was served after the service.

Whilst everyone else went up to the table to fill their plate, I was sat trying to work out what my meal was going to be, how many carbohydrates it would equate to and what were the chances I'd go back for more.

By the time I had worked out the calculation and injected the appropriate dose of insulin, most people had already sat down and were engrossed in conversation... just as I left to fill my own plate. It can feel quite isolating (as well as stressful) when you are in social situations and have to work out carbohydrates for food you wouldn't normally eat.

Applications such as Carbs & Cals and MyFitnessPal help but it still takes time and energy. A growing number of coffee shops, fast food chains, restaurants and bars are now providing carbohydrate information too and I have tried to document them to help myself (and maybe others too) when out eating: Who helps you carb count when eating out?

The other main area that I find difficult is the lack of control, or perceived lack of control.
The repeated highs or lows, the hungry "hypo monster" and those "If I'm injecting, I may as well make it worthwhile" moments.

I won't dwell too much on these today as I'm sure you have all had these moments. They can all chip away at your positivity.

When you have to sit and wait in the passenger seat of your car for 45 minutes whilst you become road legal (just so you can drive the 20 minute journey home after work) it can be difficult to see the positives in the experience... BUT the #doc is great therapy... they are there when you are low (in both senses of the word), they are there when you are high and most importantly they understand what you are going through... then it's not so bad and you see all the amazing people you have come into contact with because of your diagnosis.

...and now I am 1

In part two of my diagnosis story I'd been living my life as someone with type 2 diabetes and made big changes to my diet and exercise patterns. I'd lost a lot of weight and continued to do so. At my quarterly appointments I'd been encouraged by the progress I'd made, but the requirement for pills hadn't gone away. Slowly but surely it was getting harder and harder for me to keep control of my blood glucose levels and with my motivation based around working towards a no pill solution, it was upsetting to see myself failing and requiring more and more medication.

In an attempt to minimise the tablets (and ideally remove the need) I looked at the two things that really were in my control - exercise and food. I had already increased my exercise levels and I was regularly going on 10+ mile hikes at the weekends, at work I was using the stairs rather than the lift to get to the twelfth floor etc and so that left the only other variable - food.

This is how the gamification of my condition led to some "interesting" choices.

I understood that eating carbohydrates increased my blood glucose levels and that the medicine was getting less and less effective at bringing my levels back into range. Therefore, if I eliminated or reduced the carbohydrates from my diet then I'd minimise the blood glucose highs.

Foods started disappearing from my diet...

All fruit except berries (raspberry and strawberry) caused bg highs - REMOVED!
Pizza would cause bgs to run high for days - REMOVED!
Pasta - REMOVED!
Eventually it would be the same for rice - REMOVED!

... you get the idea, a lot of foods disappeared from my diet!

In the end I was eating three small meals a day with no snacks inbetween.

If I was really hungry in the evening I would sometimes relent and have something from my choice of three "cheat foods":

• Cheese and two crackers (4.5g of carbs per cracker)
• 50g salted peanuts (9.8g per 100g of peanuts)
• Options Hot Chocolate drink (5.4g of carbs per sachet)

In the morning I would weigh 30g of All Bran and 40g of semi-skimmed milk (17g carbs), I had a small ham salad sandwich for lunch (40g carbs) and then a small meal at night which had to be less than 70g of carbohydrates but ideally much less (c30g).

Towards the end of my time as "Type 2" I was eating less than 1,000 calories per day and less than 100g of carbohydrates, but I was getting lots of praise for how much weight I had lost.

At the end of March 2012 I knew something was very wrong but I didn't know what. I felt a complete and utter failure. My medication was being increased, my carbohydrate intake was being reduced and yet I still couldn't control my blood glucose levels.

The most disturbing thing was that I was started to feel tired and not wanting to do things - exactly the same feelings I had before being hospitalised in 2011, but this time I knew why I felt this way and that scared me. It felt like I was on a path back to hospital and no matter how many constraints I placed around my food, no matter how much exercise I did, diabetes was going to win.

I started to do my own research, to try and understand what was happening to me. I made slow progress because I didn't have the energy to do much after work.

Carb free eating in Iceland
Can you tell what it is?

Before going on holiday to Iceland I rang Helen (the nurse at the GP practice) to talk about my numbers going adrift and what I should do given I was out of the country for the next couple of weeks. I told her I thought the gliclazide wasn't providing any benefit and asked if should stop taking it, but it was suggested that maybe I was coming down with a cold or something and I should leave it a bit longer. If my numbers continued to drift up I should increase my gliclazide up to the maximum allowed, 160g in the morning and 160g at night. Unhappy at this prospect I went on holiday.

Needless to say, despite the increased physical activity, the walking in the mountains, the hiking up volcanic craters etc my numbers did continue to rise and so did my tablet taking.

On my return from Iceland the research continued and I read something that made me sit up.
I immediately went and dug out my discharge letter and read it again - there it was "urine +ve for ketones/glucose" - was I type one and presented in DKA back in 2011? I recalled the initial assessment of Type 1 on arrival at the hospital. I continued to read and came to the conclusion I needed to ask for a GAD and c-peptide test in order to settle it.

I went in to see Helen and she agreed to the GAD test but said they didn't do c-peptide tests. It was a start and might be enough. Easter was coming and I was warned it could take a bit of time for the results to come back. A HbA1c test was done at the same time and obviously that result came back much quicker. My HbA1c results since hospital were as follows:

HbA1c in 2011: March(diagnosed) 11.8%, June 6.4%, September 5.7%
HbA1c in 2012: January 5.8%, April 7.8%

About three weeks on and I still hadn't heard anything about the GAD results. I was told I should find out on the Monday 23rd...

Needless to say the 23rd came and went with no information.

One benefit of losing so much weight was that I believed my sleep apnoea was no longer a problem. I asked for an overnight test to be performed. On the 27th April I picked up a pulse oximeter machine and over the weekend stopped using the CPAP machine and instead recorded my oxygen and pulse levels with this...

A Pulse Oximeter unit for overnight tests

The blue thing in the bottom left of the picture goes on your finger and sends light through your fingernail to measure oxygen levels and sends the information to the machine in the top right of the picture which you wear on your wrist.

The waiting continued...

Waiting for the GAD result...

Waiting for the Pulse Oximeter result....
 
Whilst I waited, the blood glucose control got harder and harder as did the food control.

On May 7th I shared this post online:

Apologies for the length of this post. Not sure really why I'm posting, I know I just have to wait and see what happens and deal with whatever the result is. I guess I just need somewhere to vent a little and waiting isn't something I'm good at! lol.

Since diagnosis last year I thought I had this diabetes under control, but clearly not!

I have changed my diet and reduced my weight from 122.6Kg to 85Kg (6 stone) and still reducing.
My HbA1c results had been good, at just under 6% for the last few tests.
Until recently I was on just 80mg of Gliclazide and having regular lows at around 5pm, so I was about to discuss a reduction in medication, but then overnight something happened.

No longer were my results under control, despite no changes to my diet, drugs or exercise programme.
I waited a week to see if this was just a blip before ringing up to discuss. I was told to wait a little longer in case I was coming down with a cold or something, but that wasn't the case.
It was agreed to up my Gliclazide from 80mg in the evening to include a further 40g in the morning.
I tried that for about 10 days and then it was upped to 80g in the morning.

There was no positive impact on my numbers, in fact it was continuing to creep up, so it was upped to 240g of Gliclazide a day. Still no impact, so finally it was upped to the full 320g, 160g in the morning and 160g in the evening.

So my numbers now fluctuate between 14 and 18mmol/L each day and are pretty much stuck there. Whether I have 100g of carbs a day or 200g of carbs, my numbers just won't get any lower. I've had a couple of days of feeling really rough but my body seems more accepting now of running with high blood sugars... although I know I'm still not doing as much as I would normally, I have that "can't be bothered" feeling in me.

So the current thought is that I was mis-diagnosed and that maybe I am Type 1 after all. When I was first admitted to hospital they thought I was type 1, I had ketones in my urine and the sudden nature of it all pointed in this direction, but by the time I left they had settled on type 2 - no doubt due to my age and weight. So I went in for a HbA1c and a GAD antibody test.

The results of the HbA1c came back at 7.8% (no surprise given that my own readings each day had shown I was outside of the 4-7 mmol/L range) and I am still awaiting the result of a GAD antibody test - unfortunately it seems that for this test it takes several weeks for a result to come through.

It seems odd to be hoping for a positive result but I'm starting to worry about it coming back negative.
I (kind of) understand what will happen if it comes back positive and I can deal with that... at least I think I can

If it comes back negative though, I'm not really sure. They could try adding more drugs into my regime - although they haven't told me what other drug options are available or give up on oral drugs and switch over to insulin.
These options just seems shocking to me, one year into a T2 diagnosis having lost (and continuing) to lose weight, to be in a situation where I can't control it with diet and oral alone... that doesn't seem to bode well for the future.

I can see myself getting close to coming of the rails completely, thoughts like "have a biscuit, you're numbers are out of control anyway" are starting to creep in to my head and (I think as a result of the increased dose of Gliclazide) I'm feeling a lot more hungry between meals than before. So far (in the main) I have resisted, but there have been a couple of occasions already when I have given in and more worryingly although I might have had a short term spike with these "indulgences" they haven't really made much difference - by the time I get to my pre-meal reading there is no indication of a slip up - making it harder to stick to the regime.

I'm sure other people have been in this situation and I'm just looking for a little bit of advice on how others coped with being in this situation.

Many thanks (and sorry for the moan),
David

I rang up the following day to see if the results had come in, they hadn't but I was told to come in the following day and it would be sorted.

Waiting for the results...

That night I came home from work, shattered and hungry. I tested my bg level and saw it was in the 20s. I just sat in the kitchen staring at the meter reading until the screen switched off.

Do I eat now and possibly end up in hospital?
Do I not eat and go to bed hungry?
What if tomorrow they tell me I'm not type 1 and I really am type 2, because I can't live like this?

After sitting for what seemed like an eternity, on the verge of tears, I ate a piece of cheese and went to bed.

The following day I went to the surgery and, when I saw Helen, she told me that the results still hadn't arrived. She rang the lab whilst I was sat there. The GAD result was positive, I was type 1 after all!

finally!

I thought I was prepared for the news. It's was (bizarely) what I wanted to hear and yet it was still a shock to actually hear it.

Helen spent time teaching me how to inject, how I should tweak my background insulin doses, gave good advice on colour coding my pens, made sure I had a backup pen etc and that day, in the consulting room, I did my first background insulin injection in my leg.

I was so tired that I knew if I didn't write down some of these things I'd been told I would easily forget, so I recorded this:

A happy ending?

Well at this point things were looking up. I finally had a correct diagnosis. It meant new challenges ahead, but it also meant I could eat properly. With the weight loss it was confirmed that I no longer needed a CPAP machine for my sleep apnoea...

...the first set of tablets were removed...

...and I started to get better at injecting myself...

On the 14th I was introduced to one of the DSNs who could start me on my fast acting insulin (Apidra). The meeting didn't start well.... "Hi David, so you're type 2..." "Er, no!", but at least I had a full toolkit for living and things seemed to be going ok.

It was amazing how quickly my numbers came back into range.

My bg values before and after type one diagnosis

The relief was huge, but it wasn't quite a happy ending. To get the happy ending I was going to discharge myself from my consultants care - a story for another blog post!

Maybe this isn't the end of the story, maybe this is just the beginning!

It's all in my mind - a change in perspective

The past few days I've been trying to bury some feelings, to ignore them, but I suspect the best way to really deal with them is to acknowledge them and face them head on.

This is my attempt at doing just that.

So what are the thoughts that keep asserting themselves in my mind? The thoughts I've been trying to ignore? It's something very simple...

It's the feeling of loss

You see I'm recently diagnosed (by most people's standards). I managed to evade my type 1 diagnosis until I was in my 40s. I consider myself to be very lucky in this regard - don't get me wrong, adjusting to diagnosis later in life has its difficulties, but I'm well aware I've missed out on a lot of struggles others have had to deal with.

I've gone through life not having to think about food.

If I wanted to eat something, I just ate it.

If I walked past a Mr Whippy ice-cream van, I could decide to purchase a ice-cream without a second thought. Single cone? Double cone? Flake? Extras? It didn't matter.

If I changed my mind and decided not to eat it, so what? It was a waste, but that's all it was.

If I was at a buffet, I could have a second helping (or more!) and all I'd need to worry about is an ever expanding waistline.

What I'm trying to show is that I could be spontaneous with food - no thinking required.

Monkey see, monkey eat!

Now things are different.

Carbs are king!

King of my thoughts

Before every meal (and sometimes even when I want a drink) it requires a series of mathematical calculations to be executed.

An estimation of carbohydrates, consideration of the time of day to determine what ratio to apply, a bg test to see if any correction dose needs to be included.

I also need to log everything in my diary, do an insulin injection and then, finally, do the one thing I wanted to do in the first place - eat or drink.

Hardly spontaneous!

...and if I wanted that extra sandwich from the buffet, well that would require some more maths, some more logging and another injection...

...and if I've injected insulin for food or drink and then decide I don't want it - tough! Once that injection goes in, I'm committed - it doesn't matter if I'm feeling full or sick, the need to eat is set in motion.

So at the moment I'm grieving.

Grieving for the loss of spontaneity around food.

Eating and Drinking Out - Who helps you carb count?

Today I noticed a few people on Twitter discussing coffee shops that offer nutritional information about their offerings. Eating out can always be difficult so having the carbohydrate content provided by the retailer makes things so much easier. Over the past few months I've been collecting links to various companies nutritional information, so I thought I'd take the time to share them here in the hope others find it useful.

Please let me know if anything is missing or if any links are broken (companies are notorious for changing their websites!) and I'll continue to update it.

I hope you find it useful.

*Links last updated 18th November 2016.
Coffee shops/snack foods, fast food and pizza sections updated 14th July 2017

Coffee Shops/Snack foods

Company	Nutritional Information
BBs Coffee and Muffins	http://bbscoffeeandmuffins.com/ http://bbscoffeeandmuffins.com/Nutritional_Booklet.pdf (pdf download) Update: 17th November 2016 BBs no longer provide nutritional information on their website
Caffe Nero	https://caffenero.com/uk/en/menu/food/panini-sandwiches/ Updated: 14th July 2017
Costa	http://www.costa.co.uk/nutrition/ http://www.costa.co.uk/nutrition/Costa-ANI-data-July-2017.pdf (pdf download) Updated: 14 July 2017
Dunkin' Donuts	http://nutrition.dunkindonuts.co.uk/ Full product list No longer providing nutritional information. only allergens Added: 13/09/2015 Updated: 14th July 2017
Krispy Kreme	http://www.krispykreme.co.uk/mediadownload/media/nutritionals.pdf (pdf download) Added: 13/09/2015 Updated: 14th July 2017
M&S Cafe	http://health.marksandspencer.com/our-health-ranges/nutrition-information Cafe: https://health.marksandspencer.com/uploads/pdfs/MS-Cafe-Nutrition-Information.pdf (pdf download) Instore bakery: https://health.marksandspencer.com/uploads/pdfs/ISB%20Nutrition%20Information.pdf (pdf download) Deli bar and counter: https://health.marksandspencer.com/uploads/pdfs/Deli-Bar-and-Counter.pdf (pdf download) Updated: 14th July 2017 to add deli bar information
Millies Cookies	No carb information provided. Allergen information available: https://www.milliescookies.com/wp-content/uploads/Millies-Cookies-Allergen-information.pdf (pdf download) Updated: 17/11/2016
Patisserie Valerie	No carb information provided. http://www.patisserie-valerie.co.uk/faqs.aspx
Starbucks	https://www.starbucks.co.uk/menu Information on drinks (pdf download) Information on food (pdf download) Updated: 17/11/2016 Updated: 14th July 2017

Fast Food

Company	Nutritional Information
Burger King	http://www.burgerking.co.uk/menu http://bk-uk-prod-2.s3.amazonaws.com/sites/burgerking.co.uk/files/documents/Nutrition_Feb.pdf (pdf download) Full product pdf no longer available Allergen information (pdf download) Updated: 14th July 2017
EAT	http://www.eat.co.uk/food Updated: 17/11/2016
Greggs	https://www.greggs.co.uk/nutrition https://admin.greggs.co.uk/assets/Uploads/Nutritional-leaflet.pdf (pdf download) Regional nutritional information Updated: 14th July 2017
KFC	https://www.kfc.co.uk/nutrition https://www.kfc.co.uk/nutrition.pdf (pdf download) Updated: 14th July 2017
Little Chef	No carb information provided. Nutritional/Allergy information. http://www.littlechef.co.uk/menu Updated: 13/09/2015
Mcdonalds	http://www.mcdonalds.co.uk/content/ukhome/meal_builder.html Also note that nutritional information is provided on the reverse of the tray sheet.
Pret A Manger	http://www.pret.com/menu/ Allergen guide Updated: 14th July 2017
Subway	http://www.subway.com/en-gb/menunutrition/menu http://www.subway.com/~/media/united_kingdom/nutritionals/nutritional-table-dec-2016-master.pdf (pdf download) Allergen guide Updated: 14th July 2017
Upper Crust	No carb information provided http://www.uppercrust-baguettes.com/menu/ Updated: 13/09/2015
West Cornwall Pasty Company	No carb information provided http://westcornwallpasty.co.uk/our-menu
Wimpy	https://www.wimpy.uk.com/images/downloads/Menu/2017/NutritionalBooklet.pdf (pdf download) Updated: 14th July 2017
Yo! Sushi	Only provides sugar content, not carb information http://yosushi.mysaffronportal.com/Menus Updated: 13/09/2015

Pizza Outlets

Company	Nutritional Information
Ask	https://www.askitalian.co.uk/media/2148/170612-nutritionalmenu.pdf (pdf download) https://www.askitalian.co.uk/menu/ Updated: 14th July 2017
Bella Italia	No carb information provided. Allergen information provided. http://www.bellaitalia.co.uk/menu/main-menu/ Updated: 14th July 2017
Dominos	http://corporate.dominos.co.uk/nutritional-information Information only available in pdf format. Allergen information available. Pizzas: http://corporate.dominos.co.uk/Media/Default/CSR/Food/UKNutritionalsRegularMozzarella.pdf  (pdf download) Sides and desserts: http://corporate.dominos.co.uk/Media/Default/CSR/Food/SidesDessertsNutritionals.pdf (pdf download) Updated: 14th July 2017
Pizza Express	http://www.pizzaexpress.com/our-food/our-restaurant-menu/ Carb information only available as a pdf download. https://www.pizzaexpress.com/~/media/files/pdfs/nutritionals/pex_our-food-calories-and-nutritions.ashx (pdf download) Allergen information available for food dishes Allergen information available for drinks Pizza Express have not provided the carbohydrate information of their winter specials online, however you can find them on my website here: Nutritional info for winter specials (pdf) Updated: 14th July 2017
Pizza Hut	https://www.pizzahut.co.uk/nutrition Allergen information available. Updated: 14th July 2017
Zizzi	http://www.zizzi.co.uk/food Carb information only available in pdf format. Allergen information available. https://www.zizzi.co.uk/data/menus/static_menus/6/pdf/Spring17NutritionalMenu.pdf (pdf download) Updated: 14th July 2017

Pub/Diner Food

Company	Nutritional Information
Beafeater	http://www.beefeater.co.uk/steak-restaurant-menu Allergen and carbohydrate information (pdf download) Updated: 14th July 2017
Brewers Fayre	http://www.brewersfayre.co.uk/pub-restaurant-menus Allergen and carbohydrate information available (pdf download) Updated: 14th July 2017
Ed's Easy Diner	http://www.edseasydiner.com/nutritional-values/ Allergen information available. Carbohydrate information IS NO LONGER available. Main Menu (pdf) Breakfast Menu (pdf) Drinks & Desserts (pdf) Juniors Menu (pdf) Updated: 14th July 2017
Fayre and Square	http://www.fayre-square.com/ Allergen information available. Currently the website doesn't have nutritional information but an old version can be found here: https://www.fayre-square.com/Media/Documents/allergen-nutritional/fs-core-menu-nutritional-info.pdf (pdf download) Updated: 14th July 2017
Flaming Grill	http://www.flaminggrillpubs.com/nutrition-allergen-information/ Allergen information available. Carbohydrate information in pdf format only: http://www.flaminggrillpubs.com/Media/pdf/SS17-flaming-grill-nutritional-information.pdf (pdf download) Updated: 14th July 2017
Harvester	http://www.harvester.co.uk/ourmenus/ Allergen information available. Nutritional information (pdf download) Updated: 14th July 2017
Hungry Horse	http://www.hungryhorse.co.uk/food-menu Allergen information available. Nutritional information for the breakfast menu (pdf download) Nutritional information for English restaurants (pdf download) Nutritional information for the golden years menu (pdf download) Nutritional information for Scottish restaurants (pdf download) http://www.hungryhorse.co.uk/sites/default/files/hh-aw15-main_menu_allergen_sheet.pdf (pdf download) Added: 18/11/2016
JD Wetherspoon	https://www.jdwetherspoon.com/food Allergen information is available. Nutritional information for UK outlets (pdf download) Nutritional information for ROI outlets (pdf download) Updated: 18/11/2016
Slug and Lettuce	http://www.slugandlettuce.co.uk/food/ Allergen and nutritional information available, click on the apple symbol to the right of a dish to see the carbohydrate value. Updated: 18/11/2016
Table Table	http://www.tabletable.co.uk/pub-restaurant-menus Nutritional and allergen information (including carbohydrates) (pdf download) Updated: 18/11/2016
Toby Carvery	http://www.tobycarvery.co.uk/nutrition/ Allergen information available (pdf download) Nutritional information available (pdf download) Updated: 18/11/2016

Restaurants

Company	Nutritional Information
Aagrah	No carb information provided. Gluten/Nut information provided on menus. http://www.aagrah.com/the-menu/
Cafe Rouge	No carb information provided. Allergen information provided on menus. http://www.caferouge.co.uk/faqs
Carluccios	No carb information provided, just sugar for certain items sold in the shop. Allergen information provided. http://carluccios.mysaffronportal.com/Search?terms=&trigger=searchbutton http://www.carluccios.com/getattachment/Menus/Menu-Partial/Allergen/Allergen_and_Nutritional_Info_8_4_15.pdf.aspx?ext=.pdf (pdf download)
Chiquito	http://www.chiquito.co.uk/menus No carb information provided. Allergen information provided.
Coal Bar and Grill	http://www.coalgrillandbar.co.uk/eat No carb or allergen information provided online.
Frankie and Bennys	http://www.frankieandbennys.com/menu/breakfast No carb information provided. Allergen information provided.
Giraffe	http://www.giraffe.net/menus/main-menu No carb information provided. Allergen information provided. Updated: 18/11/2016
Handmade Burger Company	http://handmadeburger.co.uk/get-in-touch/faq/ No carb information provided. Allergen information provided (pdf download).
Jamie's Italian	Click on each dish to see carbs and allergen information listed in pop up. http://www.jamieoliver.com/italian/menu Updated: 15 March 2015
La Tasca	No carb information provided. Allergy information provided (Excel spreadsheet). Updated: 18/11/2016
Nandos	https://www.nandos.co.uk/eat/menu Click on the "i" for carb and allergen information Updated: 18/11/2016
Prezzo	http://www.prezzorestaurants.co.uk/menu/ No carb information provided. Allergen information provided.
Restaurant Bar and Grill	http://www.individualrestaurants.com No carb or allergen information provided.
Wagamama	http://www.wagamama.com/our-menu Select dish and click on nutrition + allergy dropdown

London Chains

Company	Nutritional Information
Itsu	http://www.itsu.com/nutrition/calorie_counter_and_allergens.htm Allergen information provided. (pdf download) Nutritional information provided. (pdf download) Updated: 18/11/2016
Ping Pong	http://www.pingpongdimsum.com/menu Click on nutrition fact for carbohydrate information.

Schools

Company	Nutritional Information
Gwent School Meals	Gwent Children's Diabetes - School Menus
Pasta King	Nutritional (and allergen) information Primary: http://pastaking.co.uk/wp-content/uploads/2015/07/Primary-Meals-Range-Meal-Nutritionals-New-Range-2015.pdf (pdf download) Secondary: http://pastaking.co.uk/wp-content/uploads/2015/07/S4-Pasta-King-Core-Range-Meal-Nutritionals-2015.pdf (pdf download) Updated: 13/09/2015

Cinemas and other venues

Company	Nutritional Information
Alton Towers	No carb information provided by any of the food outlets in the theme park. Allergen information provided on site not online. http://www.altontowers.com/info-help/places-to-eat/theme-park#restaurants
Cineworld	https://www.cineworld.co.uk/xmedia-cw/repo/nutritionalinformation_june2015_3.pdf (pdf) Added: 17/11/2016
Odeon	http://www.odeon.co.uk/food-concessions/nutritional-info/ http://m2.odeon.co.uk/_uploads/cached/sites/odeon_co_uk/uploads/documents/nutritional_info/Complete_Version_-_2016_Coke_Nutritional_Info_PDF_version_UK_V.2.pdf (pdf) Added: 17/11/2016
Vue Cinema	https://www.myvue.com/legal/nutritional-information Food (pdf) Drinks (pdf) Sweets (pdf) Icecream (pdf) Added: 17/11/2016

Hotels

Company	Nutritional Information
Premier Inn	http://www.premierinn.com/gb/en/why/food.html Allergen and carbohydrate information provided.

Change Log

1st July 2014: Flaming Grill Pub and Eds Easy Diner added.
1st October 2014: Full refresh of all links.
12th October 2014: Added Schools section.
13th September 2015: Dunkin' Donuts and Krispy Kreme added. Links to allergen information added.
22nd September 2015: Millies Cookies added.
13th December 2015: Added Hungry Horse. Updated Ask with older menu that includes carb info. Added new category of hotels.
3rd February 2016: Added Pizza Express winter specials
17th February 2016: Added ASK carb values
17th November 2016: Added Cinemas to venue section