I have been a type 2 diabetic for at least five years. I turned up for work to anaesthetise patients in the operating theatres one day, feeling lousier than ever before, and developed palpitations. My blood pressure was measured by the recovery nurse and was 160/110. My breath smelled sweet. (Sweet breath equals diabetes until proven otherwise.)
So I got packed off to Casualty. There they also found my blood sugar was through the roof, as were my lipids. I was suddenly an official member of the ‘metabolic syndrome’ club. This shouldn’t have surprised me, really. I have been sloth-like and food-loving since birth. Ask any of my friends.
I was given time off work and saw my GP for the first time in decades. Despite feeling poorly for as long as I could remember, I put this down to my crazy working hours. And, even though I was a doctor myself, I wasn’t in the habit of doctor-bothering. It was strange to suddenly be on the receiving end of modern medicine. I was both humbled and consoled by the skill and compassion shown to me. I realised I wasn’t indestructible after all, and I needed help, and my colleagues were stepping up to the plate to provide it.
The old saying really is true. Doctors make the worst patients, medicate themselves instead of seeking help, and present their diseases late.
I was started on ramipril for my blood pressure, and simvastatin for my cholesterol. Both of these bog-standard treatments worked immediately. My blood sugar was more resistant, however. I was started on metformin, which stops the liver from making glucose from fats and amino acids. Even though it was ramped up to the max, my glucose control remained bad. That said, it is a good, old drug, very safe and ubiquitously used for type 2 diabetics like myself, and I remain on it.
Then I was started on gliclazide and sitagliptin. They work by flogging the failing pancreas to produce more insulin – but, again, even at maximum dosage, my long-term glucose control was not good. These drugs introduce the risk of blood sugar dropping to dangerously low levels if the supply of glucose, from the digesting food in the bowel, drops.
By this stage I was beginning to feel like a walking pharmacy – but still my diabetes dogged me. I often came over faint at random times of the day and would crave sugary foods and drinks. Like insulin injections, they also can make you put on weight. My waistline began to expand as, like most people, I tended to overindulge in food to ward off the frightening feeling of hypoglycaemia.
After four years, I wasn’t feeling well in myself either. There may have been a hint of depression and hopelessness creeping in. I was chronically tired, only able to sleep fitfully, and I suspected that my diabetes was beginning to ravage me.
This is where being a doctor can make your condition more scary. I knew that chronically raised blood sugar causes the smallest of blood vessels to grow abnormally. These are the tubes that supply blood to the cells of your brain, heart, kidneys, eyes, major blood vessels, and nerves and are essential for their health. The effects of poorly or untreated diabetes are the total degradation of all your critical organ systems. Stroke, heart attack, kidney failure, blindness, peripheral vascular disease and neuropathy are the fruits.
At this point I was offered insulin injections, which I was dead against, given my job: I work very irregular hours all around the clock. My access to food can be prevented by urgent clinical situations, and my ability to make sound clinical decisions is what I am well paid for. My fear was that if I went hypoglycaemic while in a tight spot, patients might die.
So, this spring, my doctor suggested I try a new drug called dapaglifozin and I jumped at the chance.
This medicine works by stopping the kidneys from reabsorbing glucose, so it gets peed out instead. The higher your blood sugar is, the more of it exits in the urine. You also lose all those unneeded calories painlessly: up to 70 grams per day. Genius! This drug can be used by type 2 diabetics. It reduces insulin requirements markedly. A potential side effect of sugary urine is an increased risk of urinary infections and thrush, more common for women than men. Adequate fluid intake to wash away all that sugar is essential. As a new drug, it is still being closely monitored by the authorities on these things.
Almost immediately I began to feel better. I had my first normal finger-prick glucose test results since my diabetes was diagnosed. My mood and energy lifted immediately and people began to remark on how well I looked. The inspiration to write this article came when I met up with an old schoolfriend. He was astonished by how healthy I looked. My weight is falling gently and I need fewer naps. I have had no side effects. I’m not claiming, of course, that this treatment is right for everyone – but, on my recommendation, my brother-in-law is about to start on dapaglifozin too.
Oh, and I’ve stopped planning for early retirement. Things are looking up.