Countries with Highest Levels of Diabetes and Some Wild Data Swings

Countries with Highest Levels of Diabetes and Some Wild Data Swings

Sean No Comments

The other night I got curious as to whether the numbers of Type 1 and Type 2 diabetics around the world are correlated- that is, whether countries with higher rates of Type 1 diabetes also have higher rates of Type 2, and vice versa. I assumed there’d be a big overlap but maybe some small interesting outliers to look at. What I found was a more than a few interesting outliers, and some really wild data swings.

This fantastic map view at worldbank.org shows numbers from 2015 and right off the bat the four highest listings (Nauru, Mauritius, Marshall Islands & Palau) are all tiny Southern island countries, as are plenty more further down but still high in the list. But this shows us a weighted average for prevalence of both Type 1 and Type 2 and despite the interesting groupings of countries, doesn’t show us anything between the two types.

Next I looked at this 2011 diabetes.co.uk list of countries by prevalence of Type 1 diabetes in children (0-14 years old) and we immediately see some radical differences. Only 2 of the top 5 countries from the other map even appear in this list and here there’s a much stronger grouping towards western and northern Europe, though some of this could be because Europe tends to have better medical data sourcing than many other areas. Interestingly, Saudi Arabia is one of the countries highest and at a similar rate in both lists, likely due to a number of factors such as a high genetic susceptibility, a cultural diet rich in high-calorie & high-carb foods and increased obesity and poor diet. Headlines from this data have cited everything from fast food to cleanliness being part of the explanation but based on the fact that many of these are northern European countries where people spend a lot of time in doors I think a more interesting thing to look at or draw from this data is the effects of lowered Vitamin D in correlation to Type 1 diabetes since we’re very aware of the deficiency of Vitamin D in people both before and after Type 1 diagnoses not to mention the many conditions in large part correlating melanin, vitamin D and the effects of Type 1 diabetes and impaired immune system like Vitiligo and Acanthosis nigricans. The links between Vitamin D and diabetes are still not understood but the data and results commonly overlap and I find it interesting, if nothing else when looking at these data sets.

Since we know that both Type 1 and Type 2 diabetes rates are on the rise world-wide, and that both (though less correlated in Type 1) are linked to obesity it’s understandable that rates in Europe are high but are increasing world wide. While this is purely a glance at the data and a very poor comparison of data sets, what isn’t clear is the visible difference in numbers of Type 1 and Type 2, especially considering an estimated 90% of diabetics are Type 2. It leaves me searching for more complete data and wondering how the two vary locally as well as globally.

MyDiabetesMyWay

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This is a somewhat limited-appeal post as MyDiabetesMyWay is a service only available in Scotland, but I was unaware of it for years and found it so useful when I finally did hear about it that I feel I owe it to anyone who may it useful to show it off. It’s a website run and managed by the NHS in Scotland which offers the ability to view all of your historical medical records and data like hba1c’s, cholesterol and creatine levels, as well as your medications and more. It takes a few days to register because it ties together your health centre and NHS data but is absolutely worth the wait.

a1c Test Results HistoryIt’s pretty humanising and humbling being able to see your weight gain or accumulating health problems for the past 15 years, but it’s also extremely beneficial being able to track your results and I love that I can add and edit some of my information and results from home. They also offer summary screens and links to details and information for most of the lab result terms which can be useful if you’re trying to find out what something on your last clinical report means or how far out from the norm you might be. There’re some tacky promotional videos and some pretty generic information pages but otherwise it’s a genuinely useful resource and I’m happy to have access to it.

Daily Fresh Vanilla Almond Milk in 3 minutes

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almond milkAfter making my own almond butter and peanut butter in the past almond milk became a staple part of my diet. It’s ridiculously filling for so few calories and probably tastier (at least in my opinion) compared to the store bought stuff, not to mention cheaper. Nut butters like peanut-butter are pretty bloody dense in calories and great for adding weight but conversely nut milks are very low in calories for volume, lower than even skimmed milk. To boot, they’re lactose-free, some (like Peanut and Almond milk) can be high in protein, and they taste great so they’re fantastic for cutting and at times I’ll just replace my breakfast and lunch with a litre of thick Almond milk and it keeps me going while avoiding hunger.

The only problem I had was the time it takes to turn Almonds into Almond Butter. It couldn’t be simpler (literally just blend almonds until it turns into almond-butter) but it takes close to 25 minutes with my ageing blender. So after discovering a place where nut butters are pretty much the same price as the nuts themselves at NaturalChoice.co.uk (I’m not affiliated with this company in any way, I receive no benefit from their sales but I highly recommend them for anyone in the UK) and ordering a ridiculous amount of nut butters I’ve gotten back to experimenting with recipes and flavour combinations like Walnut and Cashew milk and Blanched peanut and paprika satay, so stay posted for some of those. Here’s my take on fresh homemade Almond milk in 3 minutes.

  • 2 tbsp or approx 30g of almond butter
  • 4 drops vanilla essence or 1/3 of a vanilla bean, scraped
  • 1/4 teaspoon of xanthan gum1
  • 1 pinch of salt
  • 1 litre of water

1This is the secret ingredient for thickness- most store bought nut milks use this and it’s not bad for you (made from cabbage weirdly enough!) and cheap over at Amazon or your local supermarket, so give it a try. Alternatively you can use something like chia or flax seeds, which also thicken in liquid, to turn it into more of a pudding, but if you’re worried about keeping it low carb I recommend xanthan.

Blend everything on high for 1-2 minutes and pour into a 1 litre bottle to drink throughout morning/lunch or whenever you like. If you’re die-hard about the smoothness and left with a little almond meal, or your blender isn’t very powerful you may want to pass it through a sieve. Pour into a bottle when done.

Customisation and extras
Add Greek Yogurt or Protein Powder to help thicken it up even more with that dairy taste. Maybe other sweeteners (no carb options like Erythritol, Stevia or even a single spoonful of Xylitol if you’re doing low carb) or something like zero calorie MyProtein flavour drops (Toffee and Maple Syrup are particularly awesome) for a sweeter, flavoured taste.

The whole thing takes 2-3 minutes and if you hold onto a couple plastic 2 litre soda bottles you can make a months worth of low calorie delicious almond milk in one go, but take note not to add dairy products like protein powder if you’re making a large batch as they tend to go bad in less than a week once added to water. I like to warm it up on the hob for 2 minutes before serving, especially in the winter for a comfortable cup of warming vanilla & toffee almond milk.

Strength and Progress Report May 2017

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Checking in with my strength- I think I’ll try to make this a regular thing where I can track and correlate my progress and I might be able to share hints and tips and things that I discover work for me while I increase my strength for anyone who might find it useful.

  • Overhead Press – 57.5kg x5
  • Benchpress – 105kg x5, 110kg x1
  • Squat – 170kg x3
  • Deadlift – 160kg x3

My Overhead press has actually went down over the past month from my 1x 60kg previous result as I’ve been focusing on Bench Press and since they both use front deltoids I’ve focused too heavily on Bench and basically stopped Overhead Pressing for 2 weeks. I think the key here is to do a lot more volume with OHP but with light weight moving forward to keep it steady while I get my Bench Press up to 120kg, then I can switch focus to OHP and put Bench on the back burner for a bit, and so on and so forth.

Here’s my Bench at the end of last month

Similarly the Squat and Deadlift use a lot of the same leg and lower back so they love to help each other but also hate meeting each other on the same day. BUT Deadlift should never reasonably be less than Squat if everything else is right, and mine is, almost purely because my grip is weak. My form is maybe a touch better on Squat than it is on Deadlift but grip is definitely the limiting factor as I can only manage a rep or two with double overhand grip, and up to 5 or 6 with mixed underhand grip. I’ve tried hook grip but failed so far as my little girly fingers and thumb don’t have much overlap around the bar but I think it’s mostly because I’m gripping too high in the hand and will try again next session. It’s also worth noting I tried a Hex-Bar for the first time the other week and instantly managed to pull another 10kg and could likely pull a little more. I also picked up some cheap chalk on Amazon and will give this a try and report progress. I’m thinking I’ll write a comparison of Grips, Chalk, Straps and Hex Bar for helping with Deadlift, and which I prefer and why, but that’s time and content for another post.

Here’s my Squat at the end of last month

I should say these are the first time I’ve recorded myself in the gym and though I was nervous and self-conscious I’m glad I did, it makes checking your form and getting feedback easy and shows off any mistakes you’re making. I still don’t like having an expensive DSLR right next to heavy weights and moving people and machinery, but that’s how it goes.

I’ve started the keto diet around the 1st of May too and I’m blown away by the change to my appetite. I instantly reduced the number of meals I was eating per day from 4 to 2, and both of those are within the same few hours in the evening. I remember being very sceptical of Keto because studies showed it had zero benefit over standard caloric deficit for weight loss- but I’ve come to realise that keto doesn’t directly make your body burn more fat, it simply makes you less hungry which indirectly makes it easier for you to burn more fat. Anyway, I’m down to 79.6kg this morning from 82.4kg last week, and that’s after my bajillion calorie pancake pig-out last night.

Gym-friendly take on Keto Pancakes

Sean No Comments

Being diabetic I naturally gravitate towards Keto recipes, particularly when cutting because it’s low carb (great for stable blood sugars which reduce hunger cravings) and helps me feel fuller for longer because of the fat and protein. After looking through Google results of what is probably the most written about keto recipe imaginable, the keto pancake, and trying them with mixed results I’ve finally arrived at my personal and favourite recipe. I’ve tuned other recipes to get fluffy pancakes that taste as close to normal high carb pancakes as I could without that over eggy or over-coconutty taste that isn’t great when warm and doesn’t replicate pancakes at all. Here it is.

Keto Pancake Frying

  • 120g soft cream cheese
  • 4 Eggs1
  • A few drops vanilla essence or extract
  • 2 tbsp sweetener of choice2
  • 4 tbsp coconut flour or almond flour3
  • 2 tbsp baking powder
  • a splash of nut milk or cream4
  1. Yes, that’s a lot of eggs. No, it wont taste overly eggy.
  2. I recommend Erythritol as it’s pretty much sugar but Xylitol or even something like stevia works fine
  3. I prefer almond flour as it’s more mild and pancakey but anything with the texture of flour is fine here as it’s mostly a thickener.
  4. Add as needed (if at all). Again, almond milk recommended as it’s mild but any will do

Stack o Pancakes
Combine and whip/blend everything but the flour and baking powder- add those after combined and give a stir/final blend. Your batter should be thick, sweet and easy to fold.

Just like regular pancakes, fry your batter in butter until it bubbles or until golden brown on the underside, then flip, fry for another 2-3 minutes then serve.
Beware- this batch has about a bajillion calories (OK, roughly 700cals) but serves 4-5 good sized pancakes for about 140cals and 6-7g protein each, but it’s a lot more filling than regular pancakes so you might want to save some batter for later. Either way, happy eatin’

The Best Things for Hypos- Why I love Dextrose Tabs

Sean No Comments

We’ve all had it- when hypoglycaemia strikes at 2 n the morning and after stumbling to the kitchen the first sweet thing to hand is what we’re going to damn well treat our hypo with- whether it be 4 chocolate bars, 2 big bowls of sugary cereal, or enough soda to take a bath in. It tastes great at the time and gets us out of the hole, but inevitably the next 2 hours are spent combating the effects of the abundance of sugar we over-consumed and if we’re lucky we’ll get a few hours of regretful hypoglycemic sleep.

I’ve done this more times than I’d care to admit, and can attest to how bloody difficult it can be to limit yourself to weird suggestions like Half a can of Coca Cola or 1 Small Banana. Heck, even the NHS recommends strange things like a glass of fruit juice or non-diet soft drink. Not only are these usually difficult or frustrating to accurately measure when your head isn’t working at full capacity, but they’re mostly going to have different Glycemic Indexes, different types of sugar and definitely different results, not to mention they’re things most diabetics wont regularly buy anyway. So what are some better solutions?

To answer that we need to get nerdy and define what we want. For me, over the years I’ve realised the ideal hypo treatment should be-
The same shape, size and weight every time with the same results, but measurable and easily adjustable.
As fast acting as possible, so a very high GI.
Not overly tasty- this is important because otherwise I tend to eat at my supply when I’m not low.
Easy to transport.
Cheap, and last a long time.

300 GlucotabsAll these things point towards dextrose tablets. Initially designed and marketed towards athletes and runners, dextrose has the property of being the fastest acting sugar, meaning it goes to the liver and the blood stream faster than even sucrose or fructose from typical sugar sources. They don’t contain fats or fibre that might affect GI, and although they come in a variety of flavours they’re just not that tasty, I’m never tempted to binge on dextrose tablets! Furthermore, they’re accurately carb measured- brands vary but most have 4g of carbs per pill. If you take note how much one pill raises your blood-sugar by when you’re low then it becomes easy or even thoughtless to measure how many you need just by taking a reading on your glucometer. Finally, they’re cheap, last as long or longer than granulated sugar (several years) without detriment, and are specifically designed to be compact and easy to travel with or store away for later use.

If you still rely on whatever is to hand or buy something you tend to eat when you’re not low then I highly recommend you give dextrose tablets a try, they make hypos a lot more consistent to deal with and take away some of the complication. My favourite brand is Glucotabs as they’re softer and quick to swallow, I’ve also found you can order in bulk online- they come in a bunch of flavours. The tablets are all identical in size so filling up small tubes for transport and for keeping at work, in your bag and at home works great too.

Some Approaches if you Forget your Basal/Background Insulin

Sean No Comments

This is something most of us diabetics on MDI have gone through once or twice and it sucks. Whether it’s waking up in the morning with really high blood-sugar and thirst and realising you fell asleep before taking your shot, getting mixed up after changing your routine or whatever else- it happens and we feel stupid about it and frustrated, but like so many things with diabetes, it’s a small issue and easy to deal with once we understand how to deal with it properly.

There are three main approaches for when this happens, and none of which are better or worse than the others, nor set in stone. The best solution might depend on how long ago you took your last shot, or simply whichever you prefer.

First, you can choose to simply inject your full regular basal amount as soon as you realise. This is usually the best solution if it’s only an hour or two after you normally take your insulin like if you usually take it at 10pm but you were playing video games and got distracted until midnight. The two hour lapse isn’t going to make a huge difference if you haven’t eaten, but you should typically test your blood sugar anyway just in case you also need to administer a bolus correction.
Extra tip: In all cases you should take note, remember or set a reminder for the following day that you’ve taken insulin later than normal and so your chances of hypoglycemia during the following days overlap (if you go back to 10pm) are slightly riskier.

A Second option is to cover the rest of the day using bolus corrections. This is the most recommended approach if you’ve went more than 2 hours since your last basal shot. There are no hard and fast rules here- Should you inject extra units before meals? Should you take small correction shots throughout the day? And then there’s the added complication of chasing your rising blood sugar- your blood sugars may have already risen significantly and because of the typical 20 minutes to 2 hours to reach peak activation on fast acting insulins you might take too much and overcompensate, or you might never catch up. As a general rule I’ll test my blood sugars throughout the day and take a correction dose with an extra 15% units if I think I’m still rising.

A Third option is to take a reduced basal shot based on how long it’s been since your last one. This might be a better solution if you’re closer to your last shot than your next, so if you normally take your shot around 8pm and you realise you’ve missed it around 1am. If you normally take 30 units per day then divide by 24 and multiple by the number of hours left in the day. So 30 % 24 = 1.25. Divide this by the number of hours left in the day from your last shot- so 24 – 5 = 19, 19 x 1.25 = 23.75, or 24 units.
There are some problems with this approach- namely your background insulin might not be enough to cover your fasted glucose levels causing your blood sugar to rise. To compensate for this you might take a couple of small bolus corrections throughout the day to compensate. The other issue is that you’ll have an overlap the following day when you inject your regular 30 units. This overlap will be smaller than in the first approach, but might still be a concern, particularly if you’re normally sleeping during the overlap period.

None of these approaches consider medium profile insulins or NPH like Humulin and Levemir, and using a combination of an NPH with correction dosages, followed by your standard basal dosage may provide a better solution, but also includes a lot more calculations and numbers to worry about and so I recommend it only to those who are already very knowledgeable and familiar with what they’re doing and not the typical person who might find this page useful.

Remember too that elevated blood sugar coupled with lower levels of insulin in your system mean your ketone levels are likely to rise and that you should take extra care to drink lots of water throughout the day to help compensate.

Whichever approach you decide to take understand the added risks of hypoglycemia and test more than you normally would and you will minimise the problems of missing a basal shot. At the end of the day all it really is is a period of less than 24 hours of slightly elevated blood sugars and something every diabetic will likely have to learn at some point, take it as a learning experience at the price of small inconvenience.