Understanding and coping with diabetes in mid-life

I was aged 42, height (5' 10) 1m 78, weight (just under 12 stone) 73kg with a healthy diet, undertaking moderate exercise but with excessive international travel. Then suddenly I was diagnosed with diabetes. Had I known to recognise the symptoms of drinking litres of water, going to the loo all the time and having pins and needles in my hands and feet, I would have probably gone much sooner to get it checked out.

For over 12 months there was no diagnosis of the diabetes type due to extremely high blood sugar levels. A ‘normal’ person of my age and build would have a daily blood sugar range of 3.9–7.8mmol/l [1] (as measured by a fasting blood glucose test). My levels were closer to 17–18mmol/l.

The 3–6 months measurement for blood sugar is referred to as HBA1C [2] with normal HbA1c levels being 30–42mmol/mol, mine was measured 134mmol/mol; one of the highest in the region where I lived in southern England. The doctors who discovered my high levels of blood sugar (glucose) were concerned that I may have a heart attack or a stroke at any point if this continued. Add in the Glasgow Effect (yes, I’m Scottish) and suddenly my life expectancy rate changes dramatically.

I’m posting this for all those of you out there who’ve recently been diagnosed with diabetes out of the blue, possibly because you are overweight or possibly because it’s genetic or possibly even just bad luck (my non-medical view)!

At the very least it is confusing and concerning, at the lowest points it can be very tiring and exasperating, even depressing. I remember waking up one day right at the beginning of my diabetes experience just after I’d been diagnosed and I couldn’t see. Everything around me was hazy. I jumped into the shower, threw water on my eyes and rubbed them quite vigorously. When I got out the shower it still looked as if everything was hazy. I rubbed the mirror with the towel, but still no clarity of vision. Mild panic set in, but somehow I had remembered to call the number for the diabetes helpline in Hampshire. They were fabulous. They explained what was happening and that it would correct itself, eventually. [3] [This is one reason why Google is pioneering the development of contact lenses that measure blood sugar levels in tears] The West Hampshire Community Diabetes Service pointed out to me that if I visited an optician any refractive changes, indicating that a change in glasses might be needed, would likely be resolved so I was advised not to get a new prescription for specs. The blurred vision should resolve itself once glucose levels settle back to normal, although the blurring can continue for a few more weeks. This was great advice that helped me to understand the situation and not panic.

Then the pills started. Less than I take today, but 100% more than I’d ever taken in the past. I started with Metformin, 500mg every morning and evening resulting in quite considerable physical and psychological outcomes.

The physical ones were highlighted to me, but still not particularly expected. Feelings of tiredness, bad stomach cramps and random flatulence (yes uncontrollable farting)! I had to test my blood 3–4 times per day, completely change my diet (that’s a whole other blog post) with a massive reduction in carbs and other foodstuffs containing bad sugars. I even had to give up my two biggest weaknesses — Irn Bru (think fizzy, orange and rammed full of LOTS of sugar) and chocolate. I tried diabetic chocolate, but that also gave me stomach cramps and tasted rubbish. I already ate fish fairly regularly, notably salmon and mackerel, but something else I discovered was that I’m also fairly deficient in vitamin D (again more than the fairly normal levels of vitamin D deficiency across the UK). And I pretty much gave up eating bread. Have you ever tested your blood sugar levels after a slice of processed white bread? Holy cow.

This kind of all or nothing approach fits my personality, but I don’t recommend it. Poco a poco or little by little will have less of a feeling of ‘cold turkey’; you do obviously have to talk this through with your doctor, dietician or diabetes consultant.

So I progressed from Metformin normal release to Metformin slow release to reduce the stomach cramps and actually the general feeling of tiredness also helped. Then I started on Gliclazide (oral hypoglycemic classified as a sulph onylurea) to help increase the insulin produced by my pancreas. My blood sugars reduced dramatically over a 3-month period, HBA1C went down to 66mmol/mol Feb 2014 . However, I also had a very unhealthy cholesterol count of 7.3mmol/l (ideal <4mmol/l) with LDL 5.44 (ideal <2mmol/l), which meant improving the good cholesterol (HDL — high density lipoprotein) and reducing the bad cholesterol (LDL — low density lipoprotein) was important to reduce my risk of heart attack and stroke. So a statin was added to the list of daily pills. I think these have been giving me extensive pain in my knee, but that’s something else to check soon... My cholesterol had reduced to 2.9mmol by Feb 2014 and maintained at 3.5mmol/l June 2016.

The first thing I really struggled with was sticking small blue needles (known as lancets) into my fingers 3–4 times per day. I think it was possibly the shock of the lifestyle change, plus the pills, plus the tiredness, plus the wholescale change of diet that all added together created a compounded negative effect. My wife (who previously went through extensive radio and chemotherapy with bigger needles) was there for me and able to help me get over this initial setback. Eventually my pinkie on my right hand became my favourite finger to prick for blood tests (and quite easy) and it still is today.

Then I started to get cranky. Moody. Irritable. Quick tempered. Part of this was most likely my frustration at the situation and also my willingness to accept that I had a disease. Especially accepting the fact that I would now have to take drugs for the rest of my life. Probably all that and a fairly hectic job trying to grow an international business exacerbated my situation. If I don’t gauge the timing correctly for taking my pills even now, I still get tired and irritable but not on the same scale. Today, the pills also now include Sitagliptin, which helps control the additional hunger pangs from the existing medicines I take. Although my weight has increased to 78kg (partially due to limited exercise from a prolapsed neck disc — it never rains and all that) I definitely feel more alive again.

This is a bit of a ramble and I want to try and make it meaningful or helpful for some of you reading it. So I guess there are several reasons for doing this. Firstly, people often say to me, what type of diabetes do you have and then try to classify it as serious or non-serious (all are serious) or the genetic vs. the excessive lifestyle type. Type 2 is more strongly linked to genetics (apart from the rare MODY forms of diabetes, which I don’t really want to mention here) i.e. runs in families. [4] I don’t think people should generalise like this and to be honest most people only know a little about the impact of diabetes in sufferers. If you can get supporters around you that can empathise or at least understand your situation that’s massively helpful.

Secondly, I’ve learned that even among those with diabetes there are many different ways to handle outcomes through diet and exercise (and resulting levels of success). Some diabetics can just get on with it while others like me keep adding to the list of prescription drugs taken and the impact that has on lifestyle and general wellbeing (mental and physical). So even other diabetics can misinterpret the impact your diabetes has on you.

I’m apparently going to take insulin every day for the rest of my life at some point. It may be in 1 year, 3 years or 5 years, but I’ve been advised that it’s likely to happen. Again, some people already on insulin advise me that it’s no big deal; maybe the case if you’ve had it all your life. In the meantime I hope that my family, friends and colleagues continue to learn more about my situation and understand what it means for my relationship with them. To be honest it seems that we still have a lot to learn about diabetes and the numbers being diagnosed every year is not insignificant, so let’s remember that it’s all relative and we all have different reactions and outlooks.

Notes on diabetes:

1. https://en.wikipedia.org/wiki/Blood_sugar

2. http://www.diabetes.co.uk/what-is-hba1c.html

3. http://www.diabetesnet.com/about-diabetes/diabetes-complications/eye-complications/eye-changes

4. http://www.diabetes.co.uk/diabetes-and-genetics.html