Craig provides us with some background information, personal insights and common misconceptions on a disease that most will have heard of, but I expect less know a lot about.
Diabetes affects around 4.5 million people within the UK, with an average of 700 diagnoses each day. Despite this, there seems to be a lack of understanding of what diabetes actually is and the difference between the two main types. Additionally, often overlooked are the mental health implications of living with a condition such as this. Here’s my experience of this illness and its effects.
Do you have the good type or the bad type?
I’ve been asked whether I have the good type or the bad type of diabetes numerous times and this highlights the inaccuracies with the information people have been provided with. There are no good types and bad types of diabetes… there are several different types – mainly type I and type II. It could be argued that type I is harder to manage overall but the condition is self-managed making it very individualised. Additionally, many people, understandably, assume that having type I and type II diabetes is very similar but this isn’t the case. So, to explain this I’ll briefly outline what the two main types are and why they are different.
Type I diabetes is an autoimmune disease, meaning the body’s immune system reacts against its own cells, causing it to kill the beta cells in the pancreas. The pancreas is then unable to produce the hormone insulin, which means glucose cannot be transported from the bloodstream into the body’s cells causing a person’s blood glucose level to increase and become too high. This then requires regular insulin injections to reduce the blood glucose level and keep it within a normal range – in my case this is normally five to seven injections a day. One of the main differences with type I is that hypoglycaemic episodes are common. If you inject too much insulin this will cause a hypoglycaemic episode. These episodes are where the blood glucose becomes too low and there is a high risk if it isn’t treated quickly that the person will enter into a diabetic coma. Lots of people also ask me what’s best to do if I did collapse and the simple answer is call an ambulance and explain it’s a threat to life. The other differences with type I diabetes is that it can’t be prevented and it isn’t caused by lifestyle choices; the symptoms usually start in childhood or young adulthood. In total only around 5 – 10% of all diabetics have type I diabetes.
Type II diabetes is essentially where the body isn’t able to use insulin the right way, which is called insulin resistance. As type II diabetes gets worse, the pancreas may make less and less insulin, which is called insulin deficiency. The management of type II diabetes includes healthy eating, regular exercise, blood glucose monitoring and possibly diabetes medication or insulin therapy. Some people can achieve their target blood glucose levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. Type II can be delayed or prevented by having a healthy lifestyle and there are no hypoglycaemic episodes unless the person is taking insulin or certain diabetes medicines, which is why type I may sometimes been seen as harder to manage. Finally, this type is more common in adults and accounts for 90 – 95% of all diabetics.
The Alternative Perspective
If you have ever considered how it feels to live with diabetes or been around someone who has it, I assume many of you will have only considered the physical aspects, including injecting insulin, carbohydrate counting, checking blood glucose levels and adhering to a healthy lifestyle. To me these aspects are now second nature, I don’t think about the injections because quite frankly I’ve done 20,000+ of them now. If you put a plate of food in front of me I would have a pretty good estimate of how many carbohydrates there were within a matter of seconds. So, I want to give you a true reflection of what I feel can be a really difficult aspect of living with type I diabetes.
Personally, I’m very aware of, but rarely publicise, the emotional and psychological toll that comes with living with diabetes and this is the same for many ‘physical’ conditions. For example, being a type I diabetic involves making frequent, often life or death decisions, sometimes in stressful and physically uncomfortable circumstances. I am constantly thinking about whether I have injected too much insulin which could put me into a diabetic coma – especially if I inject too much before sleeping. I often need to force myself to eat food when I’m having a hypoglycaemic episode and this can sometimes be a really tough mental battle as hypoglycaemic episode can drastically alter your mood. Then on top of this, if you consider what is necessary for effective diabetes management it quickly becomes apparent why it can be overwhelming.
Every day, you have to consider what you eat, plan when you will eat, decide how much insulin is required to cover any food, when or whether to exercise, how strenuous the exercise will be (this can send blood glucose levels up or down), how to interpret a blood glucose reading, how many carbohydrates are required to cover a hypoglycaemic episode, whether alcohol, outside temperature, stress or illness is affecting blood glucose readings, the list goes on… Then, even if you do everything ‘correctly’, diabetes can still be unpredictable and frustrating. So, the mental health implications for me far outweigh the physical aspects that this condition has but I also appreciate that for other diabetics this perspective could be very different.
As a diabetic, I often get asked questions about my condition, which I very much welcome. However, now and again I get asked something that quite frankly shocks me. So, I’ve listed my top five favourites, which include some which I am often asked and others which I raise an eyebrow at.
Is that an EpiPen?
What you are most likely referring to is my blue diabetic FlexPen, which is prefilled with insulin and I almost always carry one of these. An EpiPen has nothing to do with diabetes and is a medical device for injecting epinephrine (adrenaline) and is used to treat anaphylaxis.
What happens if you collapse… should I inject you with insulin?
Insulin is used to bring down blood glucose levels, so if someone has collapsed during a hypoglycaemic episode definitely don’t inject them with any insulin, as this will make the situation worse. Your best option is to call an ambulance immediately explaining there is a danger to life and the person is having a hypoglycaemic episode.
Can you eat that?
Yes. As a type I diabetic I use insulin to lower blood glucose levels so if I decide to eat something higher in carbohydrates I adjust my insulin accordingly. Having said this, I have found there are many benefits for diabetes management from eating a diet consisting of low GI food and lower carbohydrates. Type II diabetics normally are stricter on their diet, especially if they aren’t on any diabetic medication.
Does injecting hurt? I couldn’t do that…
Believe it or not, most diabetics were probably scared of needles before they were told it’s a necessity and they don’t have a choice but to inject several times a day. After 20,000 or so injections, you tend to get good at them, so 99% of the time it is completely painless.
Can I catch diabetes?
I think I’ve only been asked this once but it was so outrageous I’ll never forget it. If I share a drink with you, I won’t pass on my diabetes…
By Craig Young (Stephenson JCR Transition Officer)