Type 2 Diabetes: Karl’s Story

In his words, Karl shares his experience of being diagnosed with type 2 diabetes in his 30’s and how it has changed his life. Doctor Murphy debunks common myths and offers advice on successful T2D management.

This episode is part of a 5-part series focusing on a different aspects of managing life with type 1 or type 2 diabetes and is kindly supported by Diabetes New Zealand and sponsored by Sanofi New Zealand.

Disclaimer: These episodes are intended for a non-US audience. Units of measurement for blood glucose are referred to in mmol/L rather than the standard US mg/dL.

May 15, 2019

Rebecca: Hi there and welcome to In My Words, Jumo’s podcast series that brings the experiences of real patients directly to you. At Jumo we provide resources for children and families to understand, manage, and own their health.

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Karl: In my words, having type 2 diabetes means that your life is a little bit different from a person who doesn't have diabetes, but you can have just as successful and enjoyable a life as the other person with some careful planning, some good food, some good exercise. And remember: you’re not alone.

Lee: Hello everybody! This is Lee and we’re back in New Zealand for another In My Words episode on diabetes. Today’s topic: type 2 diabetes. We’ll be talking about diagnosis and management of type 2 diabetes with Karl. Karl was diagnosed with type 2 diabetes in his early 30s. He’ll be sharing his story with us today, along with his advice on how he manages his condition.

Karl: Hi! My name's Karl Rudolph. I'm just coming up to 57 years old. I presently have a job which involves piloting wide loads on the road and I deliver swimming pools New Zealand wide and work very unsociable hours.

Lee: We’ll also be hearing from Dr. Murphy, who will share her clinical perspective on what it means to have type 2 diabetes and how to manage it well.

Dr. Murphy: Hi! My name is Rinki Murphy. I'm a diabetes specialist. I work at Auckland District Health Board and Manukau SuperClinic™. I am an associate professor of medicine at the University of Auckland where I do research and teaching.

Lee: Everyone who has type 2 diabetes has their unique diagnosis story. For Karl, his began in the one to two years leading up to his diagnosis, when he was generally feeling unwell.

Karl: I was a young man working hard and recreating hard so I was drinking and I was having late nights and enjoying life and enjoying work. On regular occasions I was just generally feeling unwell in myself. I’d have these terrible sort of short fuse in terms of temper. I’d become agitated and I didn't know why so I went to the doctor and the doctor said to me “Well let's do some tests”, and [when] the tests come back: “You have diabetes”. And I went, “Well, what does diabetes mean?” He said, “Well you've got type 2 diabetes”, and I said, “Well how does that affect, you know, my life, what I'm doing now?” He said, “Well, you have to stop drinking or you’ll die young”.

Lee: A diagnosis like type 2 diabetes can be upsetting and turn your life upside down. Not understanding your diagnosis can make matters worse, so educating yourself can help you own your health and feel more in control of its management. We asked Dr. Murphy to explain type 2 diabetes to us.  

Dr. Murphy: So, diabetes is where your blood glucose level is above the threshold where blood vessels are healthy. So the cause of type 2 diabetes is a condition called “insulin resistance” whereby the insulin that the body produces is not effective in lowering blood glucose. The reasons for that is thought to be sedentary lifestyles and carrying excess weight, but we do know that some people are more at risk of type 2 diabetes and have a family history of this.

Lee: Education is also helpful to put mistaken beliefs about type 2 diabetes to rest. We learned on our last episode that there is a misconception that type 1 and type 2 diabetes are the same thing. Another misconception is that type 2 diabetes is associated with a shortened lifespan. Latest research suggests that the gap between mortality among people without diabetes and with well-controlled diabetes is narrowing.

Dr. Murphy: We can and should do everything that we have available to manage type 2 diabetes well and manage it early. So another myth would be that you don't have to worry about taking care of diabetes now, and perhaps if you put more effort in later on in life in your 50s that things will be okay; but actually every bit of effort from when it's first diagnosed counts and there is a sort of memory effect of taking good control of your diabetes early. Having said that, putting in the effort at any stage of type 2 diabetes is better than not. So a bit like smoking, it's better not to smoke in the first place, but if you can give up at any stage you're better off. And so the effort that you put in to managing type 2 diabetes from the start at diagnosis right the way through is really important to prevent complications and live a long and productive life as if you don't have diabetes in the first place.

Lee: Another common misconception is around what contributes to an individual person having type 2 diabetes. Although a person is more likely to get type 2 diabetes as they age and if they live a sedentary lifestyle and are overweight, this doesn’t mean that all people with type 2 diabetes are overweight. Genetics also play an important role.

Dr. Murphy: And so we need to be mindful of that and not have the stigma associated with type 2 diabetes in terms of someone's body size, or shape, or physical activity, and diet history. We really can't make those assumptions.

Lee: Type 2 diabetes used to be considered a condition of older adults in their late 50s and upwards, only. Now, younger adults and adolescents and even some children are developing type 2 diabetes. This means the average age of diagnosis of type 2 diabetes is decreasing, and this trend is worrisome.

Dr. Murphy: We're doing less physical activity and our supermarkets are chock full of foods and high calorie drinks, and these are readily available so that it's very easy to eat more than we should. And that's thought to drive the epidemic of type 2 diabetes in parallel with the obesity epidemic.

Lee: Karl admits, prior to his diagnosis, he didn’t exactly have the healthiest diet.

Karl: It was just eating whatever you wanted, as much as you wanted, until you were full. So I had quite a, you know, probably just a normal Kiwi background: you know a lot of fried fish and butter, and mashed potatoes, and lots of gravies, and ice cream, and cakes, and sponges, and Nana's date scones laced with butter and jam —homemade jam full of sugar—everything was full of sugar, sweet as anything—that was my precursor and it was tempered off after work with a beer. So a lot of contributing factors in that food pre-diagnosis.

Lee: How someone might feel and the symptoms experienced prior to a diagnosis of type 2 diabetes varies from person-to-person. We asked Dr. Murphy about the typical symptoms of type 2 diabetes that a person may experience prior to diagnosis.

Dr. Murphy: So the typical symptoms of type 2 diabetes can vary from having no symptoms at all, through to feeling quite subtle symptoms, such as tiredness and feeling like you were more thirsty, through to really florid symptoms of waking up in the middle of the night to pass urine, and having insatiable thirst, and developing skin infections and urine infections.

Lee: Some people have few to no symptoms at all, while others may have quite noticeable symptoms. If you have any concerns about how you’ve been feeling, visit your health care professional.

When it comes to living well with type 2 diabetes, managing your diabetes is key. The sooner you start managing your diabetes, the better. For Karl, it was unfortunately a whole year after his original consultation before he was told he definitely had type 2 diabetes.

Karl: And my management of the diabetes during that time was null, was very little, because I didn't actually have any instruction in the management of it.

Lee: Managing type 2 diabetes is all about tailoring someone's treatment to their particular needs. The goal is to reach your target blood glucose range. Most people start managing their diabetes with changing their diet, eliminating sugary snacks and drinks, and increasing their physical activity.

Dr. Murphy: And if those lifestyle measures are not enough to control the blood glucose to the target range, then medications are needed. And it's hard to predict who will be able to control their diabetes just by diet and exercise and who will need more complicated treatment regimens from medications of tablets and insulin. And it's not always due to someone's lack of effort or enough lifestyle change that more and more treatments are needed.

Lee: A healthy-eating plan is part of Karl’s management of his condition, and what he eats is rather different than when he was first diagnosed.

Karl: Where I used to have porridge laden with fresh cream and brown sugar and really enjoyed that, my breakfast now consists of a couple of poached eggs or cereal. Lunch, where I might have had pies or thick shakes and that type of food, now I'm looking at a food roll, generally no mayo. For the meal where we'd fry or roast or boil meat and not trim the fat, these meats would be trimmed, they may be steamed, grilled. For dessert, I tend just to have fruit. I drink lots of water. I have a Soda Stream device which aerates the water so you can just squeeze lemon juice or chop up bits of pears, or chop up bits of plums and nectarines and so on and have them in water with ice. You can be very creative and you must be.

Lee: Karl also exercises to keep healthy and walks to control his blood sugar levels.

Karl has been managing his diabetes for over two decades now. In addition to the positive lifestyle changes he’s made, Karl needs medication to manage his diabetes. Finding a treatment regime that works for him has taken time.

Karl: It's taken easy 10 years. We've tried multiple types of insulin, multiple types of medication, with different levels of success.

Lee: As Karl explains, managing your diabetes requires more than sitting back and letting the medication do the work.

Karl: The system I'm on now is achieving the best results we've seen of all the options we've been using so far. But, of course, that also is dependent upon my work with the drug. You can't just take the pill or the insulin and expect it to do all the work; you've got to participate in that, as well. It's part and parcel with managing the disease.

You must maintain a regular regime or a regular timetable of meals and taking your medication. You must test yourself. You've got to keep an accurate record of your life. Once you get into this routine right from the beginning, it's easier as you get older because you can self-identify crises coming. You can feel your own body feeling a little sweaty or a little unusual. You know you could be going into a “hypo” or something.

Lee: To stay on top of his diabetes, Karl carefully plans his days and makes sure he devotes sufficient time to his diabetes management. A typical day for Karl as a type 2 diabetic goes something like this:

Karl: Well, a typical day for type 2 diabetic starts the day before. So you must think the night before about your day tomorrow. Are you having an early start or late start? [Are] your meals going to be around the same time? Are the medications going to be on time? You're going to get up. You're going to test your blood. You're going to take whatever countermeasures are required. You may have a level of insulin to take. You may have pills to take. And then you have your meal. Of course, you've got to monitor what you have, what happens after that meal, your snack, your lunch, your afternoon snack, your dinner. All of these require management. So the type 2 diabetic day is managed in terms of that. I can have a normal life, but you've got to manage how it runs.  

Lee: When it comes to managing his lows and highs, Karl uses food and physical activity to help get his blood sugar level back on track.

Karl: I find 8 to 15 jelly beans to start bringing the sugar up and maybe a 250­mL fruit juice will help, also. That's been my best solution for a low.

When I get a high blood sugar I worry quite a lot about that, because I normally pop off to sleep or can just go into a period of rest, let’s say. I normally just consume water and walk.

Lee: We’ve talked a lot about managing diabetes, but it’s important to also understand the negative consequences of poorly controlled diabetes.  

Dr. Murphy: So with poorly controlled diabetes, in particular, the complications relate to small blood vessels that tend to block, such as those in the eyes, causing diabetic retinopathy and visual loss; those supplying the kidneys that cause kidney damage and may lead to needing dialysis; and the small blood vessels in the feet that can lead to infections and a need for amputations. So those are the three main small blood vessel complications of type 2 diabetes. There are also the medium blood vessels that are affected in type 2 diabetes that lead to stroke, heart disease and peripheral vascular disease.

So, the good news is that type 2 diabetes can be managed and there is a lot of support out there in terms of tailoring the treatments that are available and the monitoring to achieve a good result.

Lee: Controlling your diabetes helps minimize complications. Karl is proof of this. His healthy lifestyle and treatment have been working well to keep him healthy.

Karl: Medically, complications, I've been very lucky I've just had a few of the eye tests have come back with some of the little veins playing up in my eyes. But other than that, I've been reasonably lucky.

Lee: More than ever, young people are being diagnosed and having to live with type 2 diabetes. Karl shared with us his advice for young people.

Karl: Ultimately, for a young person, who's been recently diagnosed with diabetes, or people living with people with diabetes, that person has to come to grips with a tremendous upheaval in their life. A young person who's already got so much in front of them now has this burden thinking, “I am a diabetic. I'm going to have to have needles or injections or medication. I'm trapped”. That's not the case. You can just have a normal—same as everybody—life with diabetes, you've just got to be a bit more careful. A young person must learn to live with it, because at the end of the day if you go the opposite way it will affect how you do enjoy your life. It's very difficult for a young person; you're under peer pressure, but once you involve your friends and they know about your diabetes, they'll help you manage it.

Lee: Remember, even if you feel lonely and like no one understands what you’re going through, you are not alone.

Karl: There are lots of other young people in the same position as you and more mature people in the same position, and we're trying very hard to manage it. And if you ever need some support, there is support there for you. Type 2 diabetes can be lived with, can be managed, and you can have a very wonderful life. Take the chance now and learn about it, get on with it and go forward.

Lee: How you live each day with your type 2 diabetes is up to you. Your involvement in choosing what you eat, being physically active, taking your medicines, monitoring your blood glucose, and learning all you can about your condition, can help you be your best self. And remember, support is out there—take advantage of it! You can speak to a health psychologist if you are feeling down or overwhelmed. You can seek out a dietitian for dietary advice. Get involved with support groups, like Diabetes New Zealand, which is an excellent resource for people living with diabetes. You can visit www.diabetes.org.nz to learn more.

We would like to thank Karl for opening up to us about living with type 2 diabetes and Dr.Rinki Murphy for her insight and advice. And, as always, thank you for listening.

Up next, we’re back onto type 1 diabetes. We’ll be discussing lifestyle and mental health. Stay tuned!

This episode was created using excerpts from our interviews with Karl Rudolph and Dr. Murphy.

This episode has kindly been supported by Diabetes New Zealand and sponsored by Sanofi New Zealand.

Rebecca: Thanks for listening! Interested in hearing something special - or want us to help share your story? Reach out to us, we’d love to hear from you! See you next time!

The health information contained in this Podcast is provided for educational purposes only and is not intended to replace discussions with a health care provider.

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