Diabetes and Me: A Life-Changing Diagnosis So Glibly Revealed

In diabetes and meRNZ’s Megan Whelan shares her learning journey for living with type 2 diabetes.

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Discovering that you have a life-altering condition is a moment of clarification. I discovered it in a somewhat horrifying way.

My GP had ordered blood tests, but I had not received the results. I waited to know, almost sure I knew what they were going to say.

I was seeing another doctor for something entirely different, and as she was going through my medical history, she blurted out the blood test results. “Oh yes, it will be diabetes,” she said.

That day, and the weeks that followed, was definitely a setback in my personal body positivity journey.

I was mad at my body, I felt like it had betrayed me, just when I started taking care of it. Not only did I have to very quickly start to think of my body as something that was actually part of me, but I had to change the way I took care of it.

I realized very quickly how important a medical support team was going to be. And that I had no idea what it would really be like.

Since then, I’ve often wondered how different things might have been had someone told me, “Your blood sugar is high and that puts you at risk for type 2 diabetes,” rather than, “You should lose weight, or you’ll get diabetes.”

Kirsten Coppell is a public health physician at the University of Otago who studies diabetes and obesity, with a focus on diabetes prevention. I contacted her because she was one of the authors of an article on diabetes and Covid-19, so her work seems particularly timely to me.

The result of this research is that anyone with a chronic disease should try to avoid contracting Covid-19, and people with diabetes need good glycemic control and good access to their professionals. of health.

But we quickly left the subject of Covid-19 – sort of. She mentioned that she was baffled that there was a global public health response to Covid-19, but there was none for diabetes, which also affects millions of people. (This interview has been edited for length and clarity.)

This must be frustrating for you?

Incredibly… There is no magic bullet for diabetes. It’s on many levels and I think the only way to fix this is to have all of our ducks aligned, which includes government engagement down to individuals. It’s kind of like, ‘OK, we’re all told personal responsibility, now we’re in [Covid] stage three. We have to wear our masks and all that kind of stuff. The government has shown some commitment, and I think it’s exactly the same with diabetes – we have to have a strong commitment from the government, like all the money that has gone into vaccines.

I’ve written in previous columns that my instinct is to blame myself (for having diabetes). And there are absolutely things that I have done, but there are so many things that are not under one person’s control.

In the program we run [in Hawke’s Bay for people with pre-diabetes], it’s not a diet. Most of the initial questions ask “who lives at home, what’s your food budget” – all that sort of thing. In this way, achievable goals can be identified within the context of people’s lives.

I was looking at a case study that one of the [programme’s] what the nurses were talking about. One of this person’s goals in our study—well, it was actually the nurse who did it—was to set up a WINZ date. What we’re doing isn’t just about food, it’s about recognizing these broader influences on health.

The study is about pre-diabetes, it is probably useful to explain what it is?

In different countries, if we look at numbers and blood tests, they define it slightly differently, but, in essence, a person’s metabolic system is not quite normal, but not advanced enough on the disease path to call it diabetes. And then we can reverse it. And what we’re trying to do in our study at Hawke’s Bay is, traditionally, we’d say “prevent progression to type 2 diabetes”, but we’re saying, “wait a minute, let’s get people back to normal”. [blood sugar levels]’. And so that’s what we’re focusing on.

And so what we do is look at the data and ask, for those who came back [to normal levels], are there factors that have helped them? So if you came to see me as a nurse practitioner and those factors would mean you were more likely to develop diabetes, then let’s give a higher dose of the intervention. While someone who is in an environment where they can easily make changes, they may need a smaller dose of intervention. And when you think that a quarter of adults have pre-diabetes, that’s a huge number of people.

It’s so crowded. I guess it comes down to better prevention than cure, to use a massive cliche.

Especially when we know that lifestyle interventions work.

And I guess that gives me feelings, because, well, I wish I had known that before. And that the term “lifestyle interventions” didn’t immediately put me to shame, because I associate it with “lifestyle disease”.

That’s what we tried to do with our program – empower and say, “OK, we’re in this risk zone, we can do something about it.” So be positive and work with people. Most of the people we interviewed, which was a subset, knew about diabetes, they had many reasons why they didn’t want to get diabetes. I think it was incredibly powerful.

But I agree, we need a system that does not bring or exacerbate any guilt. For the individual, it should be completely the opposite.

There was someone in the program who was unemployed because he had breathing problems so he couldn’t do the physical activity he used to do. But once they started feeling better, well, “I may not be able to do physical activity, but I can actually drive.” It’s completely amazing, this simple intervention.

But that involves very well-trained nurses and supportive practice. Although GPs were not necessarily directly involved, the system allowed them to see what people achieved and provide positive reinforcement that they noticed. We have a quote from someone in one of [programme research] papers saying, “As long as I’m noticed, I can do anything”.

Do you think the medical industry is ready for such results?

Well, we just published. But I think one of the things I find difficult about this is that we’re always looking for a quick fix. And if it’s not wrapped up in a vaccine or a pill, it’s a really tough sell.

You mentioned the need for government commitment. What would that look like?

I think, tackling the tough stuff, the food industry, and being multi-pronged. Funding the health system sufficiently. So if we know that managing pre-diabetes can reverse the disease process, then I think there needs to be a focus on pre-diabetes as well. So I think, yes, we have to look at prevention. We must consider a good treatment for people with diabetes.

I asked Associate Professor Coppell if there was one thing that could be a quick fix, what would it be? I envisioned diet, exercise, medication, a supportive medical team. But she didn’t want to prioritize, referring to the Ottawa Charter of the World Health Organization, which she describes as “to make good choices, we need an environment that helps us make a healthy choice.” (The charter includes conditions such as peace, shelter, and sustainable resources.)

Health is an extremely individual and complicated thing. What an individual does or does not do for his health is none of my business. But I know that what works for me is so much more than diet and exercise – although of course these play a huge role.

Sleeping better and managing my stress better helps me, as does having enough income to pay for the things I need for my health. Having people who love me and are willing to support my endless search for a pasta substitute is probably the most important factor.

But if I could go back in time and find a doctor who made me feel like he was treating my health, not my size, that would have been a game-changer.

Diabetes and Me will be a weekly column on Wednesday mornings.

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