In Diabetes and Me, RNZ’s Megan Whelan shares her journey of learning to live with type 2 diabetes.
Discovering you have a life-altering condition is a clarifying moment. I found out in a slightly horrifying way.
My GP had ordered some blood tests, but I hadn’t had the results. I was waiting to find out, pretty sure I knew what they were going to say.
I was seeing a different doctor for something entirely separate, and as she went through my medical history, she blurted out the blood test results. “Oh yes, that will be the diabetes,” she said.
That day, and the weeks that followed, were definitely a hiccup in my own personal body positivity journey.
I was mad at my body, feeling like it had betrayed me, just as I had started looking after it. Not only did I very quickly have to start thinking about my body as something that was actually a part of me, I had to change how I looked after it.
I realised very quickly how important a supportive medical team was going to be. And, that I had no idea what that would actually be like.
Since then, I’ve frequently wondered how different things might have been if someone had said to me, “Your blood sugar levels are elevated and that puts you at risk of type 2 diabetes,” rather than, “You should lose weight, or you’re going to get diabetes.”
Kirsten Coppell is a public health physician at the University of Otago, who researches diabetes and obesity, with a focus on preventing diabetes. I contacted her because she was one of the authors of a paper looking at diabetes and Covid-19, so her work seems particularly timely.
The upshot of that research is anyone with a chronic condition should be trying to avoid getting Covid-19, and people with diabetes need good glycaemic control and good access to their health professionals.
But we quickly got off the topic of Covid-19 – sort of. She mentioned that she is baffled that there has been a global public health response to Covid-19, but there hasn’t been one for diabetes, which also affects millions of people. (This interview has been edited for length and clarity.)
That must be frustrating for you?
Incredibly so… There’s no quick fix for diabetes. It’s multi-level and I think the only way we’re going to get this sorted out is having our ducks all lined up in a row, which includes commitment from government right down to the individuals. It’s a bit like, ‘OK, we’re all being told personal responsibility, now we’re in [Covid] phase three. We’ve got to wear our masks and all that sort of thing.’ The government has shown some commitment, and I think it’s exactly the same for diabetes – we have to have strong commitment from government, like all the money that went into vaccines.
I’ve written in earlier columns that my instinct is to blame myself (for getting diabetes). And there are absolutely things I did, but there is so much that isn’t in one person’s control.
In the programme we’re running [in Hawke’s Bay for people with pre-diabetes], it’s not a diet. A lot of the initial questions ask, ‘who lives at home, what is your food budget’ – all that sort of stuff. So one can identify achievable goals within the context of people’s lives.
I was looking at a case study that one of the [programme’s] nurses talked about. Now one of the goals for this person in our study – well, actually the nurse did it – was to arrange a WINZ appointment. What we’re doing is not just about food, it’s recognising those wider influences on health.
The study is about pre-diabetes, it’s probably useful to explain what that is?
In different countries, if we’re looking at numbers and the blood tests, they define it slightly differently, but, in essence, one’s metabolic system isn’t quite normal, but isn’t sufficiently down the disease path to call it diabetes. And at that point, we can reverse it. And what we’re trying to do in our study in Hawke’s Bay is, traditionally, we’d say ‘prevent progression to type 2 diabetes,’ but we’re saying, ‘hang on a minute, let’s get people back to normal [blood sugar levels]’. And so that’s what our focus is.
And so what we’re doing is looking at the data and asking, for those who did go back [to normal levels], were there any factors that helped them with that? So if you came along to see me as a practice nurse, and there were these factors that would mean you were more likely to progress to diabetes, then let’s give you a higher dose of the intervention. Whereas someone who’s in an environment where they can easily make changes, they may need a smaller dose of the intervention. And when you think a quarter of adults have pre-diabetes, that’s a huge number of people.
It’s so many people. I guess it comes down to prevention being better than cure, to use a massive cliche.
Particularly when we’ve got the knowledge that we know lifestyle interventions work.
And I guess that gives me feelings, because, well, I wish I had known before I did. And that the phrase “lifestyle interventions” didn’t immediately fill me with shame, because I associate it with “lifestyle disease.”
That’s what we’ve tried to do with our programme – to be empowering and say, ‘OK, we’re in this at-risk zone, we can do something about this’. So being positive and working with people. Most of the people that we interviewed, which was a subset, they knew diabetes, they had loads of reasons why they didn’t want to get diabetes. I think that was incredibly powerful.
But I agree, we need to have a system that doesn’t bring or exacerbate any guilt. For the individual, it should be completely the opposite.
There was someone in the programme who was unemployed because they had respiratory troubles so couldn’t do the physical activity they used to do. But once they started to feel better, well ‘I might not be able to the physical activity, but actually, I can drive vehicles’. It’s been completely astounding, this simple intervention.
But that involves really well-trained nurses and a supportive practice. While the GPs weren’t necessarily directly involved, the system allowed them to be able to see what people achieved and give positive reinforcement to say they’ve noticed. We’ve got a quote from someone in one of the [programme research] papers saying, ‘As long as I’m being noticed, I can do anything’.
Do you think the medical industry is ready for results like that?
Well, we’ve only just published. But I think one of the things I find difficult about this is we’re always looking for a quick fix. And if it’s not wrapped up in a vaccine or a pill, it’s a real hard sell.
You’ve mentioned needing a commitment from the government. What would that look like?
I think, tackling the hard stuff, the food industry, and being multi-pronged. Financing the health system sufficiently. So, if we know that management of pre-diabetes can reverse the disease process, then I think there has to be huge emphasis on pre-diabetes, as well. So, I think, yeah, we’ve got to look at prevention. We need to look at good treatment for those with diabetes.
I asked Associate Professor Coppell if there was one thing that could be a quick fix, what would it be? I was imagining diet, exercise, a medication, a supportive medical team. But she didn’t want to prioritise, referring to the World Health Organisation’s Ottawa Charter, which she describes as “to make good choices, we need to have an environment that helps us to make a healthy choice”. (The charter includes conditions like peace, shelter and sustainable resources.)
Health is a hugely individual and complicated thing. What an individual does or doesn’t do for their health isn’t any of my business. But I do know what’s working for me is so much more than diet and exercise – though of course, those play a huge part.
Sleeping better and managing my stress better are helping as is having enough income to pay for the things I need for my health. Having people who love me and are willing to put up with my endless search for a pasta replacement is probably the biggest factor.
But if I could go back in time and find a doctor who made me feel like they were treating my health, and not my size, that would have been a real gamechanger.
Diabetes and me will be a weekly column on Wednesday mornings.