Okay so after a year or so on competact (competact tablets contain two active ingredients, metformin hydrochloride and pioglitazone hydrochloride) my lovely Diabetes Nurse Sarah has agreed to change my meds. Her suggestion is to keep with the Metformin, but to add a different active ingredient, VILDAGLIPTIN. At my request the metformin is being upped to 1g from 800mg – everything i read suggests that my blood sugars should be as low as practical, and I am hovering around the 6 mark. Hopefully the extra 0.4g per day will help. The pioglitazone also may be contributing to my weight gain – 15kg since Christmas, and hopefully the vildagliptin will be more weight neutral. Watch This Space! I have put some info on vildagliptin below for anyone remotely interested.

Note the trade name for the combined metformin and vildagliptin is Eucreas

Galvus (vildagliptin)

Main use Active ingredient Manufacturer

Type 2 diabetes Vildagliptin Novartis

How does it work?

Galvus tablets contain the active ingredient vildagliptin, which is a type of medicine called a dipeptidyl peptidase-4 (DPP-4) inhibitor. It is used to treat type 2 or non-insulin dependent diabetes (NIDDM).

Vildagliptin works by increasing the amount of two incretin hormones found in the body, called glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). These hormones are normally produced naturally by the body in response to food intake. Their function is to help control blood sugar (glucose) levels.

GLP-1 and GIP have two main actions that help to control blood glucose.

Firstly, they stimulate the pancreas to produce insulin in response to increasing levels of glucose in the blood. (Insulin is the main hormone responsible for controlling sugar levels in the blood. It causes cells in the body to remove sugar from the blood.)

GLP-1 also reduces the production of glucagon. (Glucagon is a hormone that normally increases glucose production by the liver.)

GLP-1 and GIP are normally broken down by an enzyme in the body called dipeptidyl peptidase-4 (DPP-4). Vildagliptin works by binding to this enzyme and preventing it from breaking down the GLP-1 and GIP. This increases the levels of these hormones in the body and so increases their effect on controlling blood sugar.

What is it used for?

* Type 2 diabetes (non-insulin dependent diabetes).

Galvus is used for people with type 2 diabetes whose blood sugar is not sufficiently controlled by other antidiabetic medicines. It can be added to treatment with metformin; a sulphonylurea, for example gliclazide; or another type of antidiabetic medicine known as a thiazolidinedione, for example pioglitazone or rosiglitazone.

Warning!

* Hypoglycaemia (low blood glucose) has been commonly reported when this medicine is used in combination with metformin or sulphonylurea medicines, eg glimepiride. Symptoms of hypoglycaemia usually occur suddenly and may include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness or weakness, confusion, difficulty in concentration, excessive hunger, temporary vision changes, headache, nausea and palpitations. You should talk to your doctor or diabetes specialist about this and make sure you know what to do if you experience these symptoms.

* Your ability to concentrate or react may be reduced if you have low blood sugar, and this can cause problems driving or operating machinery. You should take precautions to avoid low blood sugar when driving - discuss this with your doctor. This medicine may also cause dizziness or fatigue. If affected you should take care driving or operating machinery.

* People with diabetes have a higher risk of developing foot ulcers and blistering of the skin. It is therefore important to have a good foot care routine. Consult your doctor if you get any new blisters or ulcers while taking this medicine.

* Rare cases of inflammation of the liver (hepatitis) have been reported in people taking this medicine. For this reason, your liver function should be checked before starting treatment, every three months during the first year of treatment, and regularly thereafter. You should consult your doctor if you develop any of the following symptoms while taking this medicine, so that your liver can be checked: unexplained nausea, vomiting, abdominal pain, fatigue, loss of appetite, darkened urine or yellowing of the eyes or skin (jaundice).

Anne

A wet white towel lay crumpled at the side of the bath as a slight gurgle announced the last of the water had emptied down the drain. Steam hung in the air and condensed in rivulets on the frosted glass of the bathroom window and stainless steel of the taps. A dusting of fine white powder lay before the open doorway with footprints leading out of the now empty bathroom.

Anne shook her hair and leant forward, her wet hair hanging over her face as she groped around the dresser top for her comb. Finding it she began to slowly tease it through her tresses, beginning the process of untangling her main of blonde. A draft of cool air blew across her back causing her to shiver and involuntarily press her knees together, a process that subconsciously reduced her feeling of naked vulnerability.

The man stood quietly in the lane looking at the thatched roofed cottage, his attention ranging wide for any sound that disturbed the sense of what should be. Rivulets of water dropped from the brim of his hat onto the waxed shoulders of his coat, his feet stepping across the puddles that were gathering together preparing to form into a flood. He prepared to take a step towards the cottage garden when a car pulled up past him and turned into the cottages gateway. The man shrugged his shoulders and walked on. He would return later.

 

As Anne combed the last of the straggles and knots from her hair she felt arms encircle her waist and reach up to cup her breasts. Lips nuzzled at the back of her neck and she turned to a full embrace, tongues dancing and eyes fixed as her hands clenched behind Gerald's back.

"Wow" she uttered when she was finally able to pull herself from his embrace. "Still chucking it down I see."

Gerald stood back his arms at full stretch his hands in hers."Yup sweets, it is absolutely hammering it down. Hasn't stopped all day. Some poor wretch walking outside the cottage when I got here, must have been soaked to the skin. Lord only knows what imperative meant that he had to go out in this filthy weather."

"Not every one dislikes the rain like you do 'Rald. I well remember dancing naked in the rain in the summer as a child. Rain renews and brings life to the earth. Plants can't grow with out it."

"Once a hippy always a hippy. Come on then," Gerald pulled his hands free and started tugging at his shirt, pulling it over his hair, still wet from the rain. "Let's go and dance naked on the lawn."

"You wouldn't?" Anne shrieked in laughter as she helped pull his shirt from him, "come on then, put your body where your mouth is." Gerald pulled his trousers off and then danced around the room in the way that only men did as he tried to peel his socks from his feet to follow Anne down the stairs.

Anne stood holding the back door open as Gerald cleared the last of the stairs and he rushed past her, grabbing her hand as he went, pulling her onto the lawn, his feet slipping on the sodden grass. Anne laughed as her toes curled trying to grip the grass, long and awaiting dry days to be cut, her hand still holding Gerald's, as they danced around each other, the rain running into their eyes blurring what little vision they had.

As Gerald laughed at the pointlessness of their dance he was pulled forward as Anne slipped and fell to the grass, he too fell, his knees hitting the lawn causing a jolt of pain through his spine and a gasp to escape his mouth.

"Bloody ouch Annie, your grass his hard." Anne said nothing she lay where she fell, unmoving. Gerald ran his hand around her jaw, his fingers teasing at her lips. "So you want to play that game do you?" Gerald asked, as his hand slipped from her face down to caress her breast, "You are a minx, Annie, a real minx."

Gerald looked down as his hand moved beyond her breasts and he stopped, startled. "Shit Annie" he screamed, "What the fuck did you fall onto?" There was no response from Anne, her eyes closed and blood dripping from a wound at her side. He knelt by her side and put his hands under her and lifted her to him and then managed to stand without falling, Anne cradled in his arms he went back through the door and put Anne carefully onto the settee. He ran through to the kitchen grabbing a phone handset and some tea-towels.

"Annie, Annie, can you hear me sweetie?" He spoke urgently as he pressed the tea-towel to her side, she didn't respond. He tried to feel for her pulse at her wrist and then her neck, but wasn't sure whether he could feel it or not. He needed help, this was far beyond his capability, and he needed it quickly. He dialled 999 on the phone.

As Gerald was phoning for an ambulance the man from the lane had reached his hired car. He pressed the remote unlock and quickly got in to the drivers seat. Strapping the seatbelt as he started the engine he slid the stick to drive and pulled smoothly away. It was time for him to be somewhere else. The gun dug painfully into his side as he drove and with a free hand the man eased it, a practised hand ensuring that it was still easily available, should he need it, not that he expected that he would, not just yet anyway. He was pleased how an obstruction had turned into an opportunity. After walking purposefully in the wrong direction away from the cottage when the car pulled up, he had turned around when he judged the coast to be clear to get back to his car, he had seen her cavorting naked in her garden as he came level once more with the cottage. Priding himself in his professional abilities, it had taken him only a moment to pull the pistol from his pocket, take aim and then walk on.

Sampler

Extraction Techniques

The dark heavy wooden door opened and a man walked in. He was wearing a dark suit with a close weave. His hair was clipped short and white against his light skin. He spoke to the woman behind the desk.

"How many hours now?"

The woman put the top on the gold fountain pen that she had been using and placed it carefully in a groove in her blotter pad.

"We have been giving him the treatment for 15 hours."

The man sharply inhaled, his breath whistling slightly in his impatience.

"How much longer?"

The woman leant back in her tall backed chair, the white leather acting as a frame for her auburn hair and close fitting dark red blouse.

"I do not plan discussing anything with him for at least another 5."

The man rocked on his heels, determined to keep his dissatisfaction in the lack of progress from showing.

"The water leaves no marks you said?"

She knew that things were not going as quickly as others would like, and knew that before her was just a puppet, a high ranking puppet, but still a puppet. She had explained her techniques at the highest level, and been granted approval. She knew the stakes, she knew the risks of leaving traces of her methods, the consequences were unconscionable. She steeled her voice to remove her irritation and explained once again.

"No. The continual dripping across his body comes from one of over two hundred points at random. As you are aware the old single drip to the forehead so popular in literature will actually leave a bruise, and if continued for long enough can cause a local depression of the skull. These are forensic trails that can be detected. No, my method is far more effective. Random drips of ice cold water over the wholly restrained body at random time intervals. There is no respite for the recipient. Drugs would leave a trace in his tissue, in his hair. This method whilst slower leaves absolutely no trace on, or in, his body."

The man needed results, his master needed results, this was going too slowly, surely she knew how high the stakes were?

"The restraining will leave marks, why hide one forensic trail and leave another more obvious?"

"No Peter, the restraints will not leave any trace. They are broad and tightly bound to the skin, the subject is bound to a padded base. No chemicals in the bindings to leave trace, no drugs in his system to tell tales later. Believe me, this is totally untraceable, and very effective. I could arrange for you to have a personal encounter if you wish to judge for yourself how effective?"

The man snorted.

"Don't be so presumptuous and Margaret, if results are not forthcoming soon, a scapegoat will be found. You know the way it is."

"Peter, my method will, given the correct conditions and time, get the results that you need."

"That is as maybe but we need the results now. This chappy did his utmost to do away with Her Majesty's Government and with Her Majesty and family also."

"I understand that Peter, although I suspect that after recent events there are many that wouldn't have missed the Government lot." She smiled, a little humour she hoped would relax him, get him off her back and allow her to get on. It did not work.

"That is not the point, and most certainly not for you to conjecture upon," came the staccato reply. "We need to know who he was working with. I need to know that you are going to deliver results."

"I will Peter, I just need time."

"Time you have, but it flies dear woman and like sand in a glass jar time has a habit of running out."

"Indeed Peter, but as time runs out of the jar it also runs out for our subject. His resolve is almost broken. As you go and report, just imagine. Just imagine being naked, restrained unable to move in a silent and totally dark room. For fifteen hours ice cold water drops on you, each time on a different part of you, sometimes the interval between drops is so short as to be barely noticeable, other times, just as you think they have stopped, they start again. No one asks you questions. You don't know how long you have been there, you don't know how much longer. No one comes in to the room, you don't even know if it is a room. You know that you were taken by security forces after you attempted the most outrageous of crimes. You know all about rendition, you know all about what Governments can do to their enemies. You know that even Sadaam broke, you know all these things, they buzz around your brain, but still drip, drip, drip."

Margaret paused to let him take in the scene before continuing."Just about now I start the random lights. Faint spots of light will come on and off in the room, very small, barely detectable. At first you may not notice them, but then you will, but they will be out of sequence with the water, the water drops will feel like daggers, ice cold, random other drops will now be at body temperature, and will assault your ability to relate your senses to what you think is happening. Your belief that this is simply a technique to extract information from you , which has kept you going wanes, you will not be able to co-ordinate your sensory inputs and your brain will lose control and begin to let go."

"Yes Margaret, spare me the details, how will you know when the time is right?"

Margaret turned the computer monitor round so that it faced Peter. He could see that it was a medical readout. It had various figures in the upper section, heart rate, body temperature he recognised, and a number of traces going left to right beneath. At the bottom was a close up of eyes. The subjects eyes he presumed, open, looking at nothing, not staring, just looking.

"Peter, I am monitoring him constantly, I look and I know what all these mean, I know what I am doing, I shall know when the moment arrives."

"And then what Margaret?"

"And then Peter your subject shall be broken and I shall get you the answers that you want to questions that you don't even have to ask."

"Jesus Margaret, how the hell do you sleep at night?" He turned and walked towards the door, he had heard and seen enough.

"In a water bed Peter, it relaxes me, and Peter?"

He turned back from the door and nodded to her, "Yes Margaret?"

"Now that you know Peter, now that you have seen all this, now that you are complicit, how are you going to sleep tonight?"

I don't profess to be an expert on hotel design and operation, but I offer here my observations after many years of travel.

1. Arrival. You know that we are coming, we booked ages ago. All we ask is that our room is ready. It's not difficult especially when travelling as part with a tour operator who will know what time our plane arrives. Don't keep us waiting for hours, especially out of peak periods when all rooms are not fully booked and so there can be little excuse.
   
2. Rooms.
   
   1. Nothing is more irritating than having a third person sharing in your room but only having the essentials for two people - it drives me mad. Time and again we have had a 'roll away' bed in our room for a child, but only had two lots of towels, cups, glasses, chairs on the balcony etc. We should not have to remind the room service people every day that we need extra. The third bed is a bit of a bloody big clue.
      
   2. Cleaning. Try to have the rooms cleaned at roughly the same time each day. We are not all stupid and if we know our room is going to be serviced between 1100 and 1200, then we can chose to be there or not, but at least we know. Again, it is not difficult to do with a little bit of planning. The evening turn down service should start at the same time as evening meals service starts. Nothing is more irritating than trying to get ready for dinner when the door knocks for room service. Again, a little planning.
      
   3. Have a good selection or room types, basic, enhanced, club, junior and suite etc, and always have 'accessible' rooms. If guests have paid a bit more for a room that is not 'basic', then let them know that have a better room, make it obvious. Tea/coffee facilities, robes, a free daily paper – these are all relatively inexpensive ways to upgrade a room.
      
      1. Accessible rooms should have wider doors, no steps into the shower or onto the balcony/terrace, and be minimalist in furniture – to allow easier movement for those with limited mobility. When furnishing the rooms it would be prudent to seek specialist advise in such matters as bed height, shower alarms etc.
         
      2. Club rooms are a good selling point and a lure for returning guests.
         
         1. The club lounge should be adults only and should enforce a 'No Swim Wear' rule to help keep the seating dry and to enforce a basic standard.
            
         2. A happy hour with free cocktails and spirits is essential and should start just before the main hotel dinner service starts to allow guests to enjoy a pre dinner drink.
            
         3. There should be a supply of newspapers, and this could be where the book library is housed.
            
         4. The club lounge should be adequately staffed for the number of guests who should not have to wait excessively for drinks.
            
         5. Afternoon tea with nibbles and sandwiches should be provided.
            
         6. Make club guests feel special with their own check in area. You could also offer a private airport transfer service.
            
         7. A club guest private swimming pool is an excellent option in larger hotels
            
3. Pools.
   
   1. Have more than one pool where practical. Two medium sized pools are better than one all in large pool.
      
      1. The main pool should have a children's area and a swim up bar, and pool access should be limited to only staying guests – not members of the onsite health club! This pool could allow the use of inflatable's and general pool toys, but the lifeguards should be empowered to stop abusive or inappropriate behaviour.
         
      2. Make the children's area pool surround no smoking.
         
      3. Adults pool. Have a quiet pool with no children allowed. Have signs that clearly state that it is an adult only pool and empower staff to enforce it. Lilo's and other inflatable's could also be allowed here, but enforce a no horseplay rule.
         
      4. If the complex is large enough third or forth pools can be an excellent idea, and can take the pressure off the main pool.
         
      5. Optional small plunge pools around the hotel grounds are an excellent idea, but should be signed that no children without adult supervision. These pools do not need a lifeguard but should not be in isolated areas and should have a telephone to raise an alarm or seek help if required.
         
      6. Have a Club Pool (see above) where possible.
         
   2. Control the pool water temperature. 30 Centigrade is a good temperature for a holiday pool – cool enough to be refreshing when the sun is beating down, but not cold enough to give you thermal shock when you plunge in. I have been to hotels where the pool has been cooled to 25C – much much too cold, the clue here at the time was that there was no one in it!
      
   3. Every pool should have plentiful sun loungers (they are relatively cheap to buy and having more loungers than guests ensures that everyone can get a lounger when they want one), and lots of shade. Shade can be by a mix of planted trees and shrubs and parasols and sun shades, either way there needs to be plenty.
      
   4. All pools, except small plunge pools, should always have lifeguards on duty, and use be banned after dark, this allows an opportunity for cleaning etc.
      
   5. Do NOT scrimp on cleaning. Pools must be chlorinated daily, shocked periodically (keep guests out whilst shocking, but then you have more than one pool don't you!), and also scrubbed to inhibit algae growth. Illness amongst guests is not good, and it is not always the food that causes it.
      
4. Prices.
   
   1. Drinks. Not so cheap that everyone gets intoxicated, but not so expensive that people only buy one or two drinks. Have a happy hour.
      
   2. Food.
      
      1. Have a pricing structure that makes is beneficial to book All Inclusive over Half Board, and Half Board beneficial over B&B etc. If you have a renowned chef, perhaps Michelin starred, then by all means let the price reflect that, but an ordinary steak in the hotel restaurant should never cost $50. If guests feel they are cheated then they will get a taxi and eat out – and that eats into your profit margin.
         
      2. Poolside snacks should be flexible and not exorbitant in price. They can be simple like pizza or burgers, and do allow guests to split a meal across two plates. Again, encourage guests to eat in your hotel with realistic prices. $25 for a lunchtime snack is stupid when a fast food outlet 100metres away from your hotel will feed your guest for $5.
         
      3. Offer lunchtime meal deals – burger and chips and soda all in for $X for example.
         
      4. Have speciality evenings, such as Indian or Italian night, but remember that not all of your guests will appreciate the speciality food. Ensure that you always have some standards available.
         
   3. Extra's.
      
      1. You could offer discounts for returning guests or vouchers for the A La Carte, or loyalty points that enable guests to upgrade rooms.
         
      2. Have live entertainment, such as in a piano bar, or musicians playing at the tables
         
      3. Have special cheaper rates available for excursions, or free courtesy buses to local Malls or outlet centres, water and theme parks etc.
      4. Cats are very popular with a lot of visitors, and they also help keep down unwanted pests. Don't be overrun with them, but a small family group of healthy cats living in the grounds is good.
         
5. Smoking
   
   1. All rooms on a floor should be no smoking. Do NOT mix the laundry from smoking and non smoking rooms – non smokers can tell at a whiff.
      
   2. All public indoor areas, such as dining rooms and bars must be non smoking.
      
   3. Outdoor areas should have designated no smoking areas – non smokers should be able to enjoy having a drink outdoors without the waft of smoke.
      
   4. Do not allow smoking in children's areas, such as by the children's pool or by the children's play area.
      
   5. Beach. Obviously dependant on if it is private or not, but generally:
      
      1. Have a lifeguard and a safe flag system
         
      2. Have shade available
         
      3. Have plenty of sunbeds
         
      4. Showers by the sand edge to allow guests to wash off the sand before going back into the hotel
         
      5. Don't allow beach hawkers and bumsters access to annoy your guests
         

   
   

   This is by no means exhaustive, there are many other hints and tips that I cold add, but I have tried to add pointers that should encourage repeat and recommended guests. My guess is that I am targeting the 4/5* range of hotels.