Recently, I had dinner with a friend of a friend who has type 1 diabetes and has had since he was only seven years old. We met to have a chat about some of his experiences with type 1 diabetes (not to be confused with type 2 diabetes), a condition which means his pancreas does not produce any insulin at all and requires him to regularly check his blood glucose levels and inject insulin.
What initially struck me in talking to him is that he doesn’t seem to let his diabetes control his life. It is part of who he is and because he’s had it so long, he doesn’t really remember any different. So, we spent the evening chatting about how he manages the condition, the impact it has on him, and his hopes for what technology could do in the future…
How does he manage it – especially in a scenario like going out for dinner?
I asked him this, and he said that the key word with type 1 diabetes is ‘balance’. Over the 20+ years he has had the condition, he has learnt to manage it largely by how he feels.
He admits that on some days he doesn’t test his blood glucose because he just ‘knows’ what it will be (and has been proven to be correct on those instances when he has tested). For him, an average evening meal requires 25-30 units of insulin, and he will usually give himself something in this range, perhaps adjusting for whether he’d had a dessert or not, or whether he was going to have a couple of biscuits later. But, if he has a Domino’s pizza he knows he’ll need to take double his normal amount.
As we sit down for dinner, he orders a Diet Coke, ‘Jack’ burger and rosemary fries and sets about testing his blood sugars before eating. He uses his old, favoured (and smallest) lancet, test strips and glucose meter which he pulls out of his trouser pockets (complaining that ‘pocket fluff’ gets in his meter, as he does so).
Before eating his blood sugar is 4.7 mmol/L – on the lower end of the range of 4-10mmol/L that he tries to stay within. He doesn’t inject insulin before he eats, preferring to inject afterwards as his rapid acting insulin gives him the flexibility to be able to do that.
This way, he only compensates for what he’s actually eaten, and he doesn’t need to see the dessert menu at the start of the meal to predict whether he was going to fancy pudding or not (if he’d take insulin to compensate for pudding before the meal – he would have had to have had it whether he wanted it or not as otherwise his insulin levels would have been too high).
As we keep him talking, eating takes quite a long time and we carry on chatting a while after we’ve finished. It’s only after some time that he politely interrupts the conversation saying ‘I really need to go and take some insulin’ that we embarrassingly stop bombarding him with questions and he checks his blood sugars again.
It’s now at 12.1mmol/L – out of the top end of the range and so he makes his excuses and disappears off to the toilets to inject himself with the insulin pen he uses. Due to some injection site issues, he’s injecting in his thigh and understandably doesn’t want to do this in full view of the restaurant. His return reveals he has given himself 28 units of insulin – which is a little bit less than he’d normally give at this time as he knows that they are out of biscuits at home so he won’t be tempted to have any when he gets there.
What impact does having type 1 diabetes have on him?
During the meal we spoke about all sorts of aspects of diabetes, but in the nearly 3 hours we met, I am pretty sure that had we not known he was diabetic and asked him to bring all his equipment to show us, we would probably not have even realised.
He manages his condition discreetly and without letting it interfere with his life as much as is possible but he admits he’s actually more frustrated with the NHS and the logistical issues with getting his repeat prescriptions, than he is with actually having type 1 diabetes.
That said, whilst he manages his condition without too much impact on his life right now; he is very concerned about the long term complications such as blindness and foot problems which could arise from his condition and is very aware that he doesn’t want to be a burden to his wife in the future.
What does he think technology could do to help?
We asked him this question, and he said that a complete ‘game changer’ would be for a system that could take care of everything like a working pancreas would, meaning that at last he could almost forget about his diabetes.
We know that recent advances in technology are getting us ever closer to this Holy Grail but having had a fair bit of exposure to the complexities of type 1 diabetes recently, I can only hope that this actually becomes a reality for him and others like him.