Monday, 9 December 2013

'A Straight Talk' or 'A Straight Listen'?

A health professional at a recent workshop passionately exclaimed, ‘sometimes I have to give my patients a straight talk!’ By ‘straight talk’, the health professional meant telling the person exactly where they were going wrong with their diabetes management and what the consequences would be if they did not change their ways.

I do not doubt for a moment, the health professional’s motivation of concern for the health of those on the receiving end of the ‘straight talk’, nor the desire to help achieve the diabetes recommendations which are widely published and to which such health professionals, among others, are often held responsible.

Rather, what struck me about this encounter was the idea, in our evidence-based world, that such a strategy would work to improve the situation. In fact, evidence suggests exactly the opposite, that is that a telling off (for that is what was really meant by a ‘straight talk’ in this case – I knew it because the words were accompanied by a wagging finger) is likely to make people highly disinclined to make changes and distinctly unwilling to return to the clinic or a consultation with such a health professional.

What might be a more helpful and effective strategy is one I encourage any health professional in such a situation to consider, and that is a ‘straight listen’. This consists of asking a few interested open questions and actively listening to the answers, with the aim of experiencing the world through the eyes of the person with diabetes and to help address the challenges they face. ‘A straight listen’ has many advantages, among them:

It engages the person in talking honestly about their concerns about their diabetes and their thoughts and wishes about addressing them
It is more friendly and less stressful
It creates an equal contribution and participation in the consultation
It results in increased motivation to take action outside of the consultation
It takes less time and energy and gives much more satisfaction

Sometimes, listening is thought of as a ‘soft’ skill or ‘a bit touchy feely’ as described to me by another health professional recently. However, in survey after survey of people, especially those with long-term conditions, active listening and being non-judgemental are cited as missing, and strongly wished for from health providers. A recent example is a survey published in Diabetes Update. How can it be that something so apparently simple and so desired, is so comprehensively overlooked?

In my experience, there is no shortage of health professionals expressing a desire to be better communicators or listeners, but a common reason given for not investing in actually using these skills more, is a lack of time in consultations. This is interesting, since there is evidence that consultations can be shorter where there is more listening on the part of the health professional and this also brings increased satisfaction on the part of the person with diabetes. There must be something else. I find myself wondering if part of this ‘something else’ is that being a health professional is so intrinsically linked to being an ‘expert’ and an ‘advisor’, that ‘simply listening’ means to give up these roles with the perhaps consequent loss of status or even competence? Another reason may be that, among health professionals, the skills of listening are much less practised, hence less habitual, than those of talking or telling, and so their confidence in using them is less.

As I continue my musings as to the underlying causes are of the continuing need among health professionals to deliver a ‘straight talk’ against much good evidence of its ineffectiveness, I have a new offering to try and make ‘a straight listen’ more accessible and easier to learn and practice.

From today, SD’s latest download is ‘A Little Book of Listening’, a booklet with some inspiration, ideas and practical ways to use listening in consultations – and indeed in other areas of life, too. I hope that providing and spreading the word about this will go towards helping some poor souls avoid being on the receiving end of any more ‘straight talks’ next year!

Sincerely wishing you a listening 2014

Grant, P. (2013). What do Patients want from their Diabetologist?. Diabetes Update, Winter 2013

Successful Diabetes (2013). A Little Book of Listening

Tuesday, 3 September 2013

Diabetes Rules?

Self-monitoring for long term conditions like diabetes is all the rage in the new NHS. To be fair, it has long been advocated, but it is, happily, really centre stage at the moment. The idea that looking after your own health, taking responsibility and being personally involved in decisions about treatment, is central to the NHS reforms, summed up by the phrase ‘no decision about me, without me’.

It’s a welcome change from historical services for people with long term conditions, (which, incidentally, they have always managed themselves for the most part, so the idea is not new, just reality being acknowledged). The previous approach was based on following ‘doctor’s orders’ and woe betide you if you got it wrong as this would lead to a ‘telling off’ appointment with a penance of more rules to follow until the next time. For many, ‘getting it wrong’ was most of the time because doctor’s orders (often without explanation) is one thing, but having the tools to do the job, such as information, testing equipment and discussions with others, is quite another. There used to be way too much of the former ‘rules’ and not nearly enough of the latter ‘means’. Thankfully that has all changed now, or at least is in the process of changing, as we have discussed regularly on this blog.

But have new rules replaced the old ones, bringing their own difficulties in applying them? For example, Diabetes UK have an admirable website, which includes a great deal of information for all ages and types of diabetes. On there is a page called ‘monitoring your health’, which sets out the need for ‘knowing your blood glucose, your blood pressure and blood fat levels, as well as the condition of your feet and getting your eyes screened for retinopathy’. While this may be accurate, it is a pretty tall order to hold in your mind every day whilst trying to juggle the usual demands of family, work and social life. It’s possible that someone could get it equally ‘wrong’ with knowledge as they may previously have done without it!

It was with these thoughts in mind that our latest ebook was born. Trying to address the question ‘how do I remember what’s important about managing my diabetes whilst getting on with my life?’, one answer has come in the form of ‘Diabetes ‘Forget-Me-Nots’, a bright and friendly little ebook with a mission to act as a spare diabetes memory! We hope it’s going to live on people’s ebook reader, tablet or computer so that when it comes to following the ‘rules’ of the moment, it can offer that extra bit of help and confidence to get it right - for a change.

Diabetes UK: Monitoring Your Health
Diabetes 'Forget-Me-Nots'

Sunday, 28 July 2013

Letter to the Home Secretary: On Developing Diabetes

Dear Mrs May

'What a b***y pain.' You may have said to yourself. 'Just when I am so busy helping to run the country, I have to get diabetes. And not the pill-taking kind, that some of my parliamentary colleagues seem to have, it's the serious sort that needs injections every day'.

You may equally, or also, have thought 'Phew. I was just beginning to wonder if all those symptoms were something really serious, like cancer. I've seen that happen to people, too. What a relief'.

If you did think either, or both of these things, you have a lot in common with the many thousands of other people with Type 1 diabetes. In my experience, everyone remembers their diagnosis and how they felt, whether it was annoyance or even anger at its unannounced and unwelcome arrival, just when they were busy doing something else much more important, or because it gave a more positive name to their worst fears.

Either way, you know it's here and here to stay. We wish you success in living with it and making use of the vast array of treatments, information and fantastic support that is available to you. It's not always easy. There will be some days - known to many as 'bad diabetes days' - when it simply doesn't behave whatever you do and even gets the better of you. You can't avoid this, however strong, clever and powerful you are - and there are many other such people, like you, out there.

Above all, take advantage of what your government offers to people with long term conditions: Rigorous medical care; The chance for personalised discussions about what care and treatment is right for you; Structured education to learn more about these, meet others (learning from many others, as well as the famous, like Steve, can be inspiring and practical) and get to know how to self manage it successfully. For example, it's unlikely that 2 injections will do the trick for you with your busy lifestyle. If it does, please tell everyone how so, as it would be welcome news for many.

Please allow yourself to feel the emotions that go with such a momentous diagnosis and life with diabetes - anger, relief, disappointment, even stigma and shame. Your feelings will affect how you deal with it practically and there is nothing wrong with acknowledging them. You won't want to tell the whole country (who would?), but do tell yourself and your loved ones, who live with it too and they will want to do their bit to help you.

There's a big society with diabetes in this country, Mrs May. People who've been there and know some 'tricks of the trade'. Please take advantage of what they offer and experience the benefits for yourself - for example, one thing people will be delighted to tell you is how you can still eat bread, cake and sticky toffee pudding!

It's unwelcome news to get diabetes, but you're very welcome here.

Yours Sincerely
Successful Diabetes

Here are just a few of the many online places you might like to visit

Successful Diabetes: Getting started: a short guide
Diabetes UK
Blog: Shoot Up or Put Up: The lighter side of insulin dependency
Carbs and Cals

Wednesday, 17 July 2013

Could Walking be the Great Cure-All?

It’s wonderful to hear about all the medical and technological developments in diabetes care. Recently for example, there has been the prospect of a once a day injection for type 1 diabetes and continuous blood glucose monitoring systems being made more widely available. In healthcare generally, more and more scientific developments are reported daily, which is fantastic news.

However, it takes time and specialist expertise, not to mention money, for these experiments and research to become everyday realities and while we wait, we have to do something to look after ourselves. It struck me, reading through recent health reports, that one of the main ways we can do this is cheap, extremely close to home and doesn’t require any technology or expertise at all – yes, I’m talking about the humble walk. Well, I say ‘humble’, but looking at all the benefits, I’m not sure that all of us who use it regularly shouldn’t qualify for something at least like a Nobel Prize!

For example, walking can help prevent type 2 diabetes altogether. It’s recommended as one of the main interventions in guidance from the National Institute for Health and Care Excellence (NICE) for preventing type 2 diabetes, both in the general population and among those at high risk. 30 minutes of walking of moderate intensity on 5 or more days a week is the minimum recommendation.

Most people living or working with diabetes know, through book learning or, sadly, bitter experience, that ‘diabetes rarely comes to the party alone, it brings all its friends’ as one lady with diabetes memorably described the risk or presence of diabetes related conditions such as high blood pressure and high cholesterol. Research shows that these too can be helped by walking regularly.

An increased risk when you have diabetes or other long term conditions, and sometimes even a precurser to having diabetes, is depression. Yes, there is evidence too of walking being beneficial in treating depression and even preventing it. Its mood-enhancing properties are frequently mentioned in research. In addition, when used as a social activity, walking can also be a way to combat loneliness after retirement, divorce or in older age.

Bringing together some scientific research and the benefits of activity is a recent report about the discovery of how genes can make a person biologically programmed to eat more. This is because a high risk version of a gene called FTO prevents a hunger hormone called ghrelin from falling after eating. One answer to this is to suppress ghrelin and tried and tested methods include eating protein rich meals and cycling. If cycling can work, why not walking? My guess is that it is only a matter of time for walking to be added to this list of weight gain preventive treatments in this group of people. Given that they will also be at risk of type 2 diabetes, through its link with obesity, it’s yet an other potential tick in the box of ‘benefits of walking’.

There are of course many people who for one reason or another cannot walk or walk well enough to take up even minimum guidelines. But even for you, there is good news. Walking is highly recommended as a form of activity, as we have seen, but it’s not the only one. Anything that makes you move more is helpful to health, says NICE, and the more times you move, in whatever way, is even better. So armchair movement including just your upper or lower body makes a difference. Passive or active, movement works.

So, we have the technology, in our very bodies, here and now, in any weather and at no cost, to make ourselves healthier both physically and mentally. It’s not often we can say that. Given that we should all be doing more of it, as our contribution towards this, we’ve recently added our booklet ‘SD Tips for a Lively 2013’ to our website download section, you’ll find the link to it just below. Help yourself to a copy and see if all this evidence works for you!

SD Tips for a Lively 2013! Quick, Easy and Fun Ways to Move About More.


BBC News. Fat boosting gene mystery ‘solved’. 15 July 2013

BBC News. Guide shows Borders walk benefits 25 June 2013

BBC News. Why retiring can be bad for your health. 16 May 2013

BBC News. Walking could be a useful took in treating depression. 14 April 2012

NICE. Preventing Type 2 diabetes – population and community interventions. May 2011

Friday, 31 May 2013

Help with Hurdling: Getting over the Barriers to Self Management

A recent review article in the journal 'Diabetic Medicine' described in detail the kind of barriers that get in the way of people with diabetes from being able to successfully self manage their condition, that is, taking the actions that are likely to promote and maintain health, such as measuring blood glucose, taking and adjusting medication, looking after feet, eating healthily being physically active and taking steps to prevent or deal promptly with hypoglycaemia and high blood glucose levels.

While a review article doesn’t aim to make recommendations for changes in practice, in describing the evidence for each of the barriers, it does reveal what is effective or less effective. This is helpful because, ideally, it gives the chance for diabetes services and health professionals to use the evidence base to implement effective strategies for promoting and supporting self management and ‘lose’ the less effective ones.

Unfortunately this is not always what happens. Translating knowledge into action in relation to living with diabetes is in fact cited as one of the barriers. For example, the knowledge that persistent high blood glucose levels can lead to long term complications does not lead most people to keep their blood glucose levels within recommended ranges all the time. And it is exactly the same with health professionals – the knowledge that telling people what to do, advice giving and ‘warnings’ about complications is not effective in helping people manage their diabetes, does not stop them doing it regularly. There are other factors involved in effectively taking action and some of these are illuminated in this review article.

In keeping with previous blogs, I would like to suggest that in the evidence for effectiveness cited for each of the factors, there are as many messages for people working with diabetes as there are for those living with it, and reflecting and taking action on these could potentially help us all to feel more successful and satisfied in our efforts.

So, to make it easier than reading the whole paper in a lofty journal – who has time for that?! - here’s an SD 'key points' guide for both health professionals AND people with diabetes, along with some of the strategies that really work to promote and prize self management of diabetes, based on the evidence in this review. Think of it as your ‘hurdling guide’ - ideas for getting over the barriers when they arise!

‘Your SD Hurdling Guide’

Knowledge is important in self management. Unless someone knows what to do, why and when, they are unlikely to take useful action. However, Knowledge delivered once, or in a didactic or authoritarian way is not effective. Knowledge given in the context of an opportunity to use it, for example as part of an activity or as a result of someone's questions is much more helpful and likely to be remembered. Also, information given at diagnosis, is particularly likely to be forgotten, so must be revisited and checked. So, health professionals need to provide education and ask if it has been received, and for people learning about diabetes, they need to generate questions they need the answers to, and also check from time to time, to ensure their knowledge is accurate.

Motivation to take care of diabetes is influenced by how severe someone thinks their condition is, and how likely they believe themselves to be at risk of problems from it. Also, taking a particular action, for example starting insulin or taking up a new activity, will have benefits and barriers which will also determine whether it happens. So, health professionals need to explore with people what their perceptions are of severity, personal risk and benefits and barriers, rather than just dictate what actions they should take. For people with diabetes, being aware of the pros and cons for them of taking a particular action, and being prepared to discuss these in a consultation is very useful.

A higher level of confidence in self management makes it more likely that someone will do this effectively. Confidence can be measured on a simple 0-10 (high) scale, with discussion of the number given and working out what the barriers are if confidence is low. Discussions about confidence are vital, to shed light on what a person feels more or less able to achieve. For health professionals, this means giving people an opportunity to consider and assess their confidence and discuss it with them. For people with diabetes, it means being able to work out what they feel less confident about and why and what might improve their score in these areas.

Day to day problem solving is associated with better self management. Problem solving involves first acknowledging a problem, then working out what would improve the situation (a goal) and what action needs to be taken to achieve this. For health professionals, this means that consultations need to be based around what problems the person with diabetes is currently troubled by, then working together to set a goal and action plan. For the person with diabetes, reflection on their key problems and their preferred ways to solve them, and actively practising problem solving is helpful, to make it become an everyday habit.

Finally, social support, that is the availability of help from others, is an important factor in self managing diabetes. Support refers not only to practical, but emotional and informational help as well. People with more support seem to be more successful at taking care of their diabetes. This means that health professionals need to explore with people what kind of support they have and ways they could access more if they need it. For people with diabetes, the implication of this is to consider who and how they receive support and affirmation in managing their condition, and where there are gaps. Also, to recognise that they may need to ask for, or set up support rather than feeling like they have to 'soldier on' alone or ignore their condition for fear of what others may think.


Ahola, AJ., Groop, P-H. (2013). Barriers to self management of diabetes. Diabetic Medicine, 30, 413-420

Friday, 8 March 2013

'Doing Diabetes' - A Very Human Mission

One of the most interesting and lively discussions that often arise during personalised care planning workshops is about behaviour change and motivation. Health professionals often raise concerns about people with diabetes not meeting recommendations for their blood glucose or HbA1c levels, weight, exercise or taking medications as prescribed. They recognise it is hard for people to do these things but also express frustration that their efforts to advise and encourage seem to fall on deaf ears. As one health professional recently put it ‘they don’t seem to realise how important it is to look after themselves. I feel like I’m wasting my time’

Indeed they might be wasting their time and also that of the person with diabetes. For although the intention is excellent and the desire to help is paramount, there is a flaw in this way of thinking about helping people change. That is the underlying assumption that ‘they’ need to do something different because they have diabetes.

The reality is that, as we have mentioned before, having diabetes – or any other long term condition for that matter – does not make you automatically more motivated or successful in your efforts to make healthy changes than anyone else, or, crucially, to heed advice however well meant, from health professionals. Nor would health professionals be more successful at it, if they developed diabetes themselves tomorrow.

During such a discussion, I might ask health professionals how well they manage to adhere to ‘everyday’ health recommendations around taking exercise (150minutes/week), drinking alcohol (maximum 20 or 14 units/week for men and women respectively), calorie intake (3000/2000 a day for men and women) and eating oily fish (1 or more portions/week) Often, this produces a ripple of rueful laughter, as people realise that they don’t necessarily practice what they preach and this is nothing to do with having diabetes.

Further discussion reveals that the reasons they give for not being able to meet these recommendations – typically time for exercise, having a busy lifestyle, eating what’s available, family pressures around food preferences and not making themselves and their health a priority – are much the same as those with diabetes would give, with many more diabetes related activities to perform, for example blood testing, insulin dose adjustment, hypo prevention and foot checks, not to mention clinic appointments.

So what we establish is that motivation and behaviour change are influenced because of humanity, not the condition you live with. The key drivers are not what someone else advises you to do or recommends, but how important you think an action is, how many barriers to it are in your way, whether you believe your actions will result in benefits, whether you have confidence in your ability to take whatever action it is and also what past experience of success or failure you have had – to name but a few.

The consultation that simply gives information and advice is not going to be very helpful and might well be the waste of time and cauldron of frustration mentioned by that health professional earlier. Much more useful is one that explores the human side of behaviour – what makes you do something? What stops you? How important do you think it is to deal with your diabetes? How confident do you feel about doing what is recommended? These are all questions that could use the time much more effectively and even ones that someone could reflect on in advance.

Such an approach is truly a human collaboration and makes life much less frustrating for everyone ‘doing diabetes’ in their life or work. Thankfully it is an approach firmly ingrained in the new health policy rhetoric. The challenge now is to make it a reality.

Personalised Care Planning Workshops by Successful Diabetes

Wednesday, 20 February 2013

Diabetes Prevention by Horse Power?

It can’t have missed anyone’s attention in the last couple of weeks that the ready-meal industry among others has been hit by a massive scandal. While horsemeat in food is not harmful in itself, the reputational damage to these products and their providers is huge – being suspected of misleading your customers is not a great way to encourage them to shop with you.

The other recent headline-grabbing health issue has been the epidemic of obesity, with the ‘fattest town in Britain’ having about one-third of the population in the obese category of weight. ‘Something must be done’ screamed an alliance of doctors, a powerful voice describing the impending explosion of ill health and poor quality of life to come for a generation.

Am I the only one to think of a potential positive connection between these two issues? It goes something like this…

Ready meals and burgers especially the ‘value’ brands, have often been criticised for containing higher than desirable levels of sugar, salt and saturated fat. Eaten often by some because of their cheap source of calories, they contribute to weight gain and hypertension, 2 of the key ingredients in the recipe for Type 2 diabetes and heart disease. So would it not be a great move for a savvy supermarket to keep their previous ready-meal customers loyal by steering them in the direction of equally simple to prepare, but healthier alternatives at the same price and gradually ease out ALL the hidden risks from the shelves along with the horsemeat and other contents not mentioned on the labels.

What a victory that would be, in the race not only for the customer’s money pound, but also their fleshy one, by helping to hold back the tsunami of ill health destined in part by consumption of their current products. Come on food providers, it’s your chance to shine!

Tuesday, 29 January 2013

‘Difficult Patients’ – How to Manage

At a recent workshop for health professionals, a couple of the participants mentioned that some of their patients were ‘really difficult’. On exploring what they meant by this, they were frustrated by people who seemed not to contribute in consultations, or didn’t attend regularly, or when they did attend, they didn’t seem particularly interested in doing what they were asked to manage their diabetes. One also mentioned that such ‘difficult patients’ also often attended with their own agenda and questions that weren’t always relevant to the consultation.

This made me reflect on how often I hear this kind of point made and also on what a powerful, emotionally charged exclamation it is, to say that you have ‘difficult patients’. What is perhaps really being said is ‘I find it really hard to meet these peoples’ needs, so I am categorising them as difficult’.

I have heard of ‘difficult patients’ in all sorts of guises – someone with Type 2 diabetes who feels nothing the health professional suggests is worth trying, a teenager with Type 1 diabetes who sits surly and unresponsive throughout the consultation or what has been described by a fellow blogger Alison Finney as ‘a nightmare patient’ in her blog shoot up or put up , referring to someone who wants to know everything about everything and discuss the pros and cons of all advice given.

I venture the view that actually, there is no such thing as a ‘difficult patient’ but there are difficult encounters between people with diabetes and health professionals. These are characterised, in my view, by strong feelings on the part of each and yes, competing agendas, which are often only partly fulfilled.

It’s often about roles. Having diabetes certainly doesn’t make you keen to adopt or adopt unquestioningly, the behaviours recommended for keeping well. Neither does being a health professional make you all – knowing or even all-powerful. However, these are frequently the roles assigned, albeit unconsciously, in a typical consultation. Herein lies where agendas can clash.

There is also the question of expectations, if not judgements. Often, thoughts that precede the ‘difficult encounter’ will be “oh no, it’s the difficult/uncompliant/badly controlled/intense/obsessional person coming in next (health professional) or ‘I hate going to this consultation, I’m fed up of never getting anything right/not having my questions answered/not being able to get a word in edgeways/being told stuff I already know’ (person with diabetes). Hence the stage is set for a tricky, unfulfilling, and most sadly of all, ultimately pointless meeting.

I paint a dire picture, I know, but I’m guessing that it’s one you may recognise, at least in part, from your experiences of consultations. If you do recognise and would like to lessen the chances of being seen as or having a ‘difficult patient’, then I’d like to offer you a few ideas from research and experience – in no particular order of importance:

• Ask about feelings: sometimes anxiety manifests as anger and silence equals upset. Acknowledging that consultations are emotionally charged can remove a great deal of difficulty
• Plan for 1 thing – and 1 only – that you’d like to achieve from the consultation and share this with the other party, ideally before or at least at the start of the consultation
• Don’t expect your consultation to be 100% perfect or have 100% perfect outcomes. You are bound to be disappointed! Seeing this meeting as just one step on the journey of diabetes is fine
• Share your feelings – yes, both of you. Not in a ‘deep and meaningful’ way, but honestly: how about ‘I’m not sure we’re getting on so well: how can I best help you today?’ or ‘coming here always makes me feel a bit of a failure I’d like to talk about what I have been doing rather than what I’ve not done’
• Examine your motives for the consultation: are you expecting the health professional to solve or take over your diabetes? Do you want your patients to do what you tell them, unquestioningly? Either way, it’s unrealistic. Consider having a conversation about 1 thing that really matters to you both, instead
• Are you talking at cross purposes because you don’t both have the same facts at your fingertips, eg test results and their meaning? If so, would sharing test results in advance of the consultation help, so you can discuss them on equal footing?

It is certainly true that the more honesty and information sharing there is in consultations, the more worthwhile experience they seem to be. While writing this I’ve also been reminded of a comment made by a colleague, who once said ‘I see the HbA1c as an invitation to look at the person’s life with them’. Could this possibly be all that ‘difficult patient’ needs from their consultation?

Saturday, 19 January 2013

Legacy or Let Down? A Decade of the Diabetes National Service Framework

With great promise and excitement, the ambitious 10 year delivery strategy of the diabetes national service framework (NSF) was launched in January 2003. For the first time, a government was taking a long view of long term conditions care with these 10 year programmes, enacted from ‘the NHS Plan’ of 1997. Diabetes was just the third NSF to be published, showing what we thought was a brilliant commitment to this important and growing condition

At the time, 10 years seemed an age away with plenty of time to do everything the standards demanded. Yet here we are in 2013 with a whole new health policy world and with the next huge NHS reform upon us. So did the NSF achieve anything and will its legacy live on in the current incarnation of diabetes care - or were we let down on its promises?

As is our wont here at SD Comments, we’ll start by looking at some of the success stories that seem to be here to stay and have undoubtedly changed the face of diabetes care:

LEGACY: Eye screening for retinopathy is universally available and pretty much everyone with diabetes is invited to have their eyes photographed annually. As a result, blindness rates due to diabetes in the working population are getting lower every year, thanks to the early intervention on problems detected through retinal photography

LEGACY: Local diabetes networks bringing together people working within hospital, community and general practice services for diabetes have grown and persisted. Communication between health professionals working together has improved and faster referrals and decisions about acute situations such as foot ulcers can be made as a result. The latest recommendations about communication between services have just been published by NHS Diabetes, quite rightly highlighting their continuing importance in the ‘new’ NHS

LEGACY: Specific mention of children and young people as well as adults with diabetes. The NSF was very clear about the needs of children and young people as a specialty, a distinction that hadn’t always been so clearly made. Every one of the 12 NSF standards mentioned each age group and today, the focus on children and young people with diabetes is intense, with Diabetes UK’s most recent awareness campaign highlighting the need for prompt and early recognition of symptoms of Type 1 diabetes in children

Unfortunately, there are also some let downs when looking back at the NSF and these have to be examined too – so these important aspects don’t continue to be forgotten

LET DOWN: Diabetes structured education. Despite the NSF heralding the importance of supported self management and the provision of high quality information and education, there is still a massive lack of access to structured education and enormous variation throughout the country. Even more worrying (as detailed in this blog before) is the very low invitation to and uptake of diabetes education courses. In addition, education courses are often the first to be cut when economies in services have to be made, as in recent years in the NHS. This leads to people being unable to manage their condition for lack of the ‘tools to do the job’.

LET DOWN: Personalised care planning and participation in decision making. Despite a whole standard to do with empowering people to manage their condition themselves and being helped to make decisions based on their own goals and aspirations, there is still very little results sharing prior to consultations and consultations still often follow the traditional medical model of ‘health professional knows best’, despite the day to day management of diabetes actually being in the hands of the person living with it.

Happily, the current health policy is still promoting a personalised approach with the ideal of ‘no decision about me, without me’ and there is a strong focus on this for people with long term conditions in the Government’s recent instructions to the NHS, so maybe there is a glimmer of hope that this let down will become a legacy in the end

LET DOWN: User involvement in how services are planned and delivered. This aspect of the NSF started with great promise, with a number of initiatives and organisations, guidelines and recommendations dedicated to developing this approach. However, enthusiasm for it seems to have waned over the years, even among campaigning organisations. Proper, proactive involvement of people who use services is now extremely patchy. Apparantly, the new NHS will have a much stronger ‘patient’ voice, but this may be more to do with complaints and accountability than involvement and consultation in how services are actually run

So that’s our take on what is and what might have been. Ever optimistic, however, we will continue to bang the drum for person centred approaches, access to diabetes education and user involvement, and do all we can to ensure that the ‘brave new NHS’ will take note of these let downs as well as the legacies


Department of Health (2003). Diabetes National Service Framework: delivery strategy

Department of Health (2012). The Mandate. A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015

NHS Diabetes (2013). Implementing Local Diabetes Networks

Do you agree with what we’ve said? If so – and if not – your views and comments are welcome below!

Friday, 11 January 2013

Tops in 2012!

At the start of a new year, it’s traditional to look back on the highs and lows of the last one. In our case, we don’t really do ‘lows’ but prefer to concentrate on successes, as this has a much better track record when it comes to positive mental health. But enough of our philosophy, (which is covered in detail on our website if you’d like to know more) and here we go with some of the highlights from the last year, many of which we covered in this blog.

They get our votes because they really focussed on the people side of health and wellbeing and are consistent with all that we promote here at SD

So imagine a drum roll and let’s hear it for the following!

• The Health Foundation – released a series of practical reports and reviews in relation to making a reality of person centred consultations, helping people make decisions, collaborative healthcare and supporting self care. Absolutely vital stuff to help the new, personalised NHS achieve its objectives

• Diabetes UK – kept up a relentless focus on the basic checks people with diabetes need to have, from blood pressure to foot examinations – and reminded the world at every opportunity how these were not universally offered or taken up, despite them being ‘must do’s

• The Irish Health Service – made rolling out pump therapy for the under 5s a priority in its health budget for 2013

• The National Diabetes Audit for England and Wales for including statistics about the poor offering and uptake of diabetes structured education and giving campaigners the opportunity to wave these statistics and press for change

• Diabetes Australia – for publishing a wonderful document about awareness of language in relation to diabetes. Just creeping in from December 2011, but we’re guessing it was 2012 before anyone read it and it remains one of our favourites!

• Last but not least – anyone living or working with diabetes who has reflected on their approach, made changes or generally tried to make their diabetes or the environment in which they work a better experience during the year. As we never tire of quoting, from a dear friend with diabetes “diabetes is a marathon not a sprint; I need help to stay in the race”. Every bit of help along the way matters equally every year.

Hoping to see much more great work like this in 2013 and wishing all our readers a very happy and healthy – and Successful - new year!


Wednesday, 2 January 2013

To eat or not to eat?…A question many with diabetes would love to ask

Will Self’s recent ‘point of view’ certainly gave me food for thought.

He argues that we have become obsessed with food, which dominates our high streets and our television programmes and we could do well to remember that eating is really a way of satisfying hunger rather than being a creative occupation. He also reminds us that there are plenty of people going hungry in our own localities, with food banks opening up with depressing frequency, even as we make the agonising choice of which ready meal to purchase from the heaving supermarket shelves. He suggests that we tend to take the easy option of an eating culture instead of attending to more challenging cultural developments in arts or science. He begs us to resolve to purge ourselves of our food obsession in 2013.

He has a point. There’s a lot to digest in his column (pun intended!), including the observation that when hungry, it doesn’t matter to our bodies whether the food we consume is cooked in a celebrity kitchen or a billy can over a single gas ring. This particular point made me reflect on how, actually, we know these days that food does matter to our bodies and that maybe all the attention on food in recent years has been a force for good - for example we know our bodies react differently to unsaturated and saturated fat, complex or simple carbohydrate, animal and vegetable protein and soluble and insoluble fibre. The outcomes of eating different proportions of these can literally be the difference between life and death, so for all of us these developments are in fact, vital.

That’s not to say there’s a direct relationship between ‘media cooking’ and health, quite the opposite sometimes, if recent reports on the unhealthiness of celebrity endorsed recipes, are to be believed, with many found to be way over the recommendations for fat, sugar and salt. However, another way of looking at this is that such research can actually serve to offer a new way of bringing healthy eating recommendations to the attention of the masses consuming food related news – perhaps another benefit of our food-orientated culture?

My main reflection generated by this column was the thought that for the couple of million people with diabetes in this country, eating or not eating is not a simple option, although many would dearly like it to be. I have heard many times from people with diabetes that just to choose to skip a meal would be a luxury and the liberation felt by those who have experienced this, perhaps through starting pump therapy, reversing the early signs of type 2 diabetes, or for the lucky few, an islet cell transplant, is immense.

For the rest, eating is often a daily grinding juggling act, a way of getting through the day without experiencing hypos or high blood glucose symptoms, catching a hypo in time to prevent embarrassment, and simply being able to fit food in with their social or work schedule. Many say that an obsession with food ‘comes with the diagnosis’ and that looking at food in an enjoyable way can become a rare thing. Someone with Type 1 diabetes I met recently explained it like this ‘you see a lovely roast dinner and prepare to enjoy it….I see a maths equation - ‘how many carbs + insulin will equal a normal blood glucose level?’. Such mathematical calculations are part and parcel of everyday life with diabetes.

We’ve written in this column before about our wish for more and better access to technologies such as insulin pumps, and more flexible medication regimens that do so much to expand the options around eating for people with diabetes. Whilst we do our bit to make eating and cooking calculations easier with diabetes, for example with our carb-counted recipe book, it's also our regular new year hope that even more people with diabetes will get the chance to ask the question ‘to eat or not to eat?’ and answer it in any way they like.

The Never-ending Culinary Merry Go-Round

'Carb-Counted Recipes for Diabetes’