I thought it would be good to look back on the last year or for me 18 months of my Diabetes diagnosis, for anyone that has recently been diagnosed with Diabetes on what to expect of this Chronic Disease and how it will change your life. This guide works for both Type 1 and Type 2 although for Type 1 Diabetics the medication will be different, please bear that in mind.
For me diagnosis was simple. I knew I was Diabetic, I knew other people with Type 2 Diabetes, I knew the symptoms and what would be required of me, I knew I was drinking 3 pints of drink in a single sitting, having too many toilet breaks so diagnosis for me wasn’t that hard. For many though it can be a mix of emotions, you’ve caught something or so you may think, but it’s actually been dormant in your body for many years and has now been detected.
If you’re like me you hate going to see the Doctor or Dentist and put it off as long as you can. Your Doctor (and Dentist) will now become regular visits. When diagnosed and titrating medication you’ll find yourself visiting the doctor every 2 weeks until your blood sugar becomes under control. Like me, you probably don’t like blood tests and have had one every 5 years if you’re lucky, well you’ll now be having blood tests and being stabbed with needles every 6 months to check your blood sugar and asked to pee in a cup and provide a sample in a test tube. Then there’s the Retinopathy scans, having eye drops once a year placed in your eyes that force your pupils to stay open and be sensitive to light so they can photograph your retina’s for any damage from high blood sugars over time, these happen once a year.
As you have Type 2 Diabetes you’ll probably be overweight so every 6 months when you have your Diabetes checkup, think of it like your annual MOT car service, you will be weighed, have your blood taken, provide a urine sample, then a medication change may occur depending on how good your HbA1c is. You will also have your feet checked for loss of feeling (neuropathy) which is another Diabetic Complication. You may not realise it at first but you are now sitting a 6 monthly exam, you’ll be told if your blood sugar is bad (you’ve been bad) and whether it’s no change (you haven’t worked hard enough) or if it’s better (we all hope it will be better) but here’s the problem with Diabetes. Diabetes is a degenerative disease, that means that it gets progressively worse over the years, so your blood sugar will always get worse over time. More lifestyle changes and medication will need to be made over time. That leads nicely onto the Lifestyle changes you’ll be making now you are diagnosed.
The first thing you will be told is you need to make lifestyle changes, that’s exactly what I did. Stop eating pizza’s 3 days a week, curries 2 days a week, you’ll soon start to realise that the foods you love the most will now be off limits, or more off limits like a Sunday roast where you only have it 1 day a week instead of 7 days a week. You’ll switch to eating more healthily like having salad with most of your meals, actually salad will be the main part of your meal, and vegetables, yes those horrible green things for the most part. Reducing portion sizes, choosing meals that are low in fat, low in carbohydrates and low in calories are also a must. Think of it as what you would eat if you were on a diet, but this is a lifestyle change, you’ll be eating this 365 days a year.
All of this will help lower your blood sugar a little but not a lot, you’ll need to add some form of exercise, whether it’s a 2 mile walk 4 days a week, using the stairs more instead of a lift, walking to the shops instead of getting in the car, or doing some aerobic video workout in the home. However, that said again this won’t lower your blood sugar to normal levels for most that are diagnosed at >10% HbA1c, even combined with a new diet. So why do it? Well simply “Every little helps”. Can’t I just have medication and that’s it? No new diet and no exercise? I’m afraid not, and you’ll find out why if you keep reading.
So you’re newly diagnosed and you are now starting medication, for most Type 2 Diabetics that means starting on Metformin on a low dose and titrating up to the maximum dose of 2550mg a day. When you get above a single tablet of 500mg you’ll find these tablets or pills are like horse pills, massive! Metformin will help lower your blood sugar by moving sugar out of the blood stream and into your urine and if you are only just Diabetic around the 7% HbA1c then that may be enough for the time being. If like me you come in around 11% mark then it won’t be enough and there will be additional supplemental medication you will need.
Some doctors will add Gliclazide which helps reduce your blood sugar more but can cause hypo’s where you feel sick and unwell regularly, others will add Sitagliptin, Pioglitazone or even Byetta, Victoza or Lixisenatide. I have gone through most of these and am now on Victoza. It’s important to know that every person is different, some react better to certain medication than others. There’s side effects with all these medications, even a higher risk of cancer with some. Many find it better making bigger lifestyle changes like diet, exercise and losing some weight to reduce the amount of medication needed.
I am a 2/3rds full kind of guy, I like stability, hate change, so I worked quickly to change my diet, my lifestyle, chucking out the pizzas, the pasta, the rice, the curries and the pasties along with crisps and chocolate and switching diet. Don’t get me wrong, you can still have these but within moderation, small portions and not every day, even doing a 2 mile walk 4-5 days a week. I managed to titrate through medication and settled initially on Metformin and Gliclazide and my blood sugars had reduced from 11.2% to 6.8%, brilliant! That’s the last i’ll see of the doctor for 6 months now, that’s the medication I will be on along with a Statin to reduce heart problems (another Diabetic complication), and I won’t need to change my medication for a long time. That’s what I thought, and I was very wrong. Every 3 months our blood sugars are different, our bodies are constantly changing. This leads very nicely onto Insulin and weight gain and the downward spiral.
Insulin and weight gain
So you may have had problems with weight for a long time, you pack more weight than you should do, you’ve tried diets for a month or two or maybe three and lost weight in the past but for the most part your weight remains stagnant or sometimes creeps up rather than down. Many of the Diabetes drugs works by getting your pancreas to secrete more insulin, Metformin is the one that doesn’t, everything else either helps you secrete (make more) or help in how insulin is absorbed from your blood stream into your cells to lower the blood sugar quickly. For the class of drugs that help secrete more insulin, this will most certainly mean weight gain. This is why diet change is key, when on Gliclazide I had 2 months of stable great blood sugars but then my body seemed to change in the winter, I started getting more and more hypo’s which means you need to eat or drink something sugary to get your blood sugars out of the low danger zone and into the normal zone so you don’t pass out, and because you are eating/drinking more sugar, guess what? You start gaining weight.
I lost 3 stone around the 3 months of being diagnosed with Diabetes, I made the lifestyle changes but once I started on Gliclazide, weight loss all but stopped and I started to gain weight. To the effect of 3 stone in 1 year! So be careful, if you go on any medication that either helps secrete more insulin or injects insulin, it’s a very slippery slope, even more so because you are over weight. I eventually was able to come off Gliclazide and move to Victoza injections, and that moves onto the next section nicely.
Finger pricking and injections
So you’re now Diabetic, there’s a mix of doctors that do and don’t want you to test your blood sugar, my previous GP preferred self management where my new GP prefers no self management and leave it up to the doctor. You will probably find yourself finger pricking at some point if not soon after diagnosis, that involves taking a small needle in a lancet and stabbing your finger to draw blood so you can offer it up like a virgin sacrifice to a test strip to check your blood sugar.
For Type 2’s that can be up to 6 times a day if you don’t need to overcorrect with insulin, it may just be once a day to check fasting blood sugars, it all depends on how severe your diabetes is and what your GP and Diabetes Specialist Nurse (DSN) prefers. For me it was 6 times a day. On top of that you like me probably don’t like needles, but trust me you will get used to it very quickly. You will at some stage move to injectable medications like Victoza, Byetta or Lixisenatide, or even insulin and these are even less painful than a finger prick test, but you WILL get used to the needles. It’s all part of the lifestyle changes, you are now Diabetic.
If you can lose weight and shed some of the weight you have accomplished over the years then it will help your Diabetes and help reduce your blood sugar, but mark my words, if you thought it was difficult losing weight prior to being diagnosed with Diabetes, it will be harder now that you are diagnosed. The medication will be working against you to add weight. Maybe when sitting exams you were an average person hitting around 70% in exams, you strived to hit the 90% mark but never could achieve it, that’s what you need to hit now to try and lose weight, a lot more time and effort will be needed to try and lose weight than ever before.
It’s actually an ever decreasing circle, your blood sugar becomes worse over time, you add more medication (insulin) to reduce your blood sugars because that’s what insulin helps to do but that adds weight, in turn your blood sugars become worse again, you add more insulin…well you get the idea!
Your extra pouch
Call it a man bag, a larger purse for a lady, but it will contain all your diabetes gear. That will usually be a Blood Glucose Test Meter, Lancet, Test Strips, Lancets, and usually your medication. You’ll get used to carrying this around with you a lot more, think of it like a large mobile phone pouch to start with but will start to grow over time.
Hypo’s and Hyper’s and your mental state
Hypo’s are when your blood sugar drops too low and hypers when your blood sugars are too high. Have you ever had that horrible sick feeling in your stomach, you have a headache, you’re sweating that cold sweat, you feel weak, you feel like you’re just about to pass out unconscious and you can’t think straight? That’s what a hypo feels like, you feel completely drained, what makes it worse is you need to know this feeling and treat it with sugar to boost your blood sugar. Hypo’s can happen if you have too much insulin swimming around in your blood stream or likewise not enough sugar. With Diabetes we need to try and balance our blood sugars between two levels, 4 mmol/L and 8.5 mmol/L.
Think of it like flying a plane, for the most part you are doing good, the plane is flying great, but wind or turbulence comes along and the plane (or blood sugar) starts to drop, you have to take evasive action to avoid crashing the plane and killing everyone on board, or in this case, avoid passing out or even dying which can happen from severe hypo’s. So you treat with something sugary, and your blood sugar starts to rise, that’s great, you’re out of the danger zone! Well not quite, because to crack that wallnut instead of using a walnut cracker you just used the largest sledge hammer you could find, so now your blood sugar is starting to soar, not like a bird but like a rocket taking off for the moon. The problem is we have to stay within range like I mentioned earlier, having your blood sugar too high is like parsing battery acid through our veins, it’s not good, it poisons organs within our body and they start shutting down over time, causing things like kidney failure, renal failure, heart failure and cut off blood supply to limbs causing infections that go unnoticed and that lead to amputations. Yeah that’s not good, but unlike hypo’s that are quick to fix, these complications happen over longer periods of time so we need to keep our blood sugars as low as possible without going too low over a longer period of time. There’s that exam again! So this exam we’re now taking as a newly diagnosed Diabetic is not just once every 3 months or 6 months, but DAILY! You’re now in exam hell, taking exams 365 times a year, and each day its probably up to 6 exams, so that’s a staggering 2,190 exams a year you are now sitting. For someone that didn’t like exams, that’s a lot of exams but get those exams right and you’ll get better blood sugars and this amount of exams will become a lot lower, but if you’re above 10% on your HbA1c at diagnosis then you won’t be far off this number of exam tests.
The other problem is hyper’s, the opposite of hypo’s, hypo being low and hyper being high. If you don’t keep yourself within the range and go high is when you have a hyper attack, you also feel unwell, but a different unwell and you may or may not recognise it. The first is headaches, a throbbing thudding headache, you feel the pulse in your head and your neck, you feel tired, lathargic, and you may not realise it until after the effect but you are grumpy and getting into heated arguments and lose your temper extremely quickly. You’ll realise it more when your blood sugars return to normal and that argument you were in just a little earlier you now realise you sounded like a stupid, argumentative oath! You will lose your temper very quickly, the smallest of things will annoy you when you are hyper.
When you are hypo or hyper your mental state changes, you cannot think straight, so you are constantly feeling unwell when within these ranges.
For me sick days was when I had the flu, man flu, it was when I felt really sick and just couldn’t get out of bed and go into the office. You’ll find with Diabetes whether it’s Type 1 and Type 2 you’ll have a lot more sick days, sometimes more than your employer will permit. It’s important to let not only family and friends know you have Diabetes, they may be more understanding and realise when you are low and high quicker than you do and try not to get into too many arguments with that big oath of an ogre you may have become, but also to let you’re employer know.
If they are an understanding employer they will understand what Diabetes can become and be more forgiving that you may need more sick days because you are now living a chronic disease. For me those sick days have become more, and sometimes it can just be because you’ve had too many hypos and feel utterly, drained and sick, for me I hit an all time high of 17 hypo’s in one day, I just wanted to end my life, I didn’t but that’s how I felt.
Danger and how to overcome it
Hypo’s are the immediate danger, you can pass out or even die if left untreated and your blood sugars don’t rise, you hear about people dying in their sleep, you’ll be surprised that a lot of people that die in their sleep have Diabetes due to being unaware of the hypo because they were sleeping. When I hit 17 hypos in a day luckily I did have an additional form of protection. I had decided to self-fund (pay for) a CGM (Continuous Glucose Monitor), I wanted to protect my driving license and just imagine what would happen if you had a hypo whilst driving, you not only lose conciousness, but you lose control of the car, you crash, not only injuring yourself but others, maybe even death! I had invested in a CGM to protect myself as I was having a lot of hypo’s when I went onto Gliclazide. These are an injectable sensor you inject into your arm or abdomen, wear for 5-15 days, have a wireless receiver that you carry and it tells you what your blood sugar is doing every minute of the day. A CGM also allows you to rest your fingers from all that painful fingerpricking. They are not cheap, they cost a small fortune and for the most part are not funded on the NHS, but if you do a lot of driving, or become hypo unaware and are at risk of a lot of hypo’s especially at night then a CGM can be your best friend, mine is Anna and my significant other!
So you’ve read all about this reversing Diabetes. Well yes it is possible, if you’re pre-Diabetic or have a HbA1c around 7-8% then yes you could reverse Diabetes, but it’s a lifestyle change of diet and exercise, it may be possible. For anyone vastly overweight and have a much higher HbA1c it’s either not possible or extremely unrealistic that you would be able to reverse Diabetes.
Reversing Diabetes is only possible in Type 2 where the pancreas hasn’t entirely shut down and unable to produce insulin, if you are a Type 1 Diabetic reversing Diabetes is off. Although to be completely honest, reversing Diabetes for anyone suffering from Type 2 is like running 10 marathons in 10 days, extremely unlikely and you’ll probably kill yourself quicker if you try. So don’t expect any quick ways out of this Chronic Disease, especially if you’re overweight. Reducing your weight to an average BMI is the best course but for most with Type 2 that have struggled with weight all their lives, this just isn’t going to happen unless you’re that lucky to be a winner of a lottery and have a lot of luck on your side, in which case it might be achievable, but for the most of us it would just be a dream.
Will I need to inject insulin?
Probably one of the biggest questions most Type 2 Diabetics will ask around diagnosis. The simple answer is for the most of us, yes over time. If you can get away with diet and exercise alone to keep your blood sugar in tact then great for you! For most of us we will need other forms of medication whether tablet/pills or injectables, but they don’t have to be insulin, at least not to start with.
However, over time when these become less effective on your body and your blood sugar then yes you will need to transition to injecting insulin. For most it’s not a matter of if but a matter of when. For people living in the UK and some other countries, you’ll find that once you start injecting insulin you go onto a restricted driving license, in the UK with DVLA it’s a 3 year renewable driving license. It sucks, thankfully I’m not quite there yet but many of my Type 2 friends are and are on restricted licenses. If you can stay away from injecting insulin but use tablets/pills or other injectables that help secrete more insulin from your pancreas or help absorb insulin better, stick with these for as long as you can, as I mentioned earlier, the more insulin the more weight gain, so it becomes a very slippery slope.
This is what my last 18 months post diagnosis of Type 2 Diabetes has become, I’m striving to lower my weight (which I have now started to do now starting Victoza which helps food intake) and also lowering my blood sugar, but every day is a new test, some days are better and some days are worse, but you do the best you can when you can. I still eat the odd pizza, the odd curry or pasta, some snacks like crisps or chocolate but all within moderation, they are more of a treat than a daily occurrence.
For a look at Type 2 Diabetes medication, take a look at another blog post I wrote that helps explain the medication available.
Also be aware that just because you are overweight doesn’t mean you are Diabetic, and that weight has caused your Diabetes. Yes it can have an influence but there are millions of people that are overweight and obese in this world we live that are not Diabetic and do not show signs of Diabetes. Here’s a great video from a Health Care Professional that is something all newly Diagnosed Type 2 Diabetics should watch.
You may also want to check back on my blog here regularly as I am always writing posts, this is a blog dedicated to Diabetes, I do talk a lot about CGM’s but it’s 100% about Diabetes and the life we now live as a Diabetic.