Wincanton Community Hospital

The pathological changes associated with type 2 diabetes (T2D) can be reversed through lifestyle measures, in some cases leading to remission.1 The low carbohydrate diet (LCD) is recognised as an effective option that is clinically inexpensive with few side effects.2 Many patients are achieving significant improvements in glycaemic control, with associated reduction in drug costs from cessation of hypoglycaemic agents.3 Digital-technology behaviour change solutions for T2D remission are being delivered at scale.4 Primary care clinicians need to be competent to adjust diabetes medications appropriately in individuals who follow an LCD. An LCD comprises <130 g of digestible carbohydrates per day.5 Digestible carbohydrate refers to sugars and complex carbohydrates such as starch, which is digested to glucose. Aligned with national guidance, carbohydrate choices in an LCD will typically be higher fibre and low glycaemic index (GI).6 Reduced total carbohydrate ingestion and low GI choices give the LCD a low glycaemic load (GL). In T2D the GI and GL of food consumed is a determinant of blood glucose level and thus the requirement for hypoglycaemic medication. Blood glucose levels typically fall substantially when an individual adopts an LCD. This article discusses key considerations regarding hypoglycaemic medications for an LCD and provides practical suggestions to prescribers. The recommendations are developed from the experience of the authors, discussion with …

Regarding Norman Willcox's letter about the problems of using solar panels for domestic heating (August p21), I also have thermal solar panels installed. However, contrary to his disappointing experience, I have found that they provide my family with a useful amount of hot water. In our system, the solar energy is used to heat a store of water, which has no other source of heat. Mains-pressure cold water passes through this store via a heat exchanger, removing heat from it and warming up. If the water becomes warm enough, an unpowered thermostatic valve allows it to go straight to the hot taps (mixing it with cold if it is too hot). However, if it is not hot enough, then the water is directed first through our previously installed gaspowered combination boiler and then to the taps.

Nursing students should be paid the minimum wage while they are training (news September 28).