Interview 26

Age at interview: 16

Age at diagnosis: 9

Brief Outline: He has been on several insulin regimens: Humalog, ActRapid, Insulatard and NovoRapid. Around the age of fourteen, while on Insulatard he started to experience problems with controlling his diabetes. He began to have high blood sugar levels and felt sad and frustrated about it and was compensating by eating chocolate. Six months ago he went to see a new consultant who decided to change his insulin regimen. The consultant explained that Insulatard was not the best choice for him because it is for

Background: Lives with parents and siblings; he is a first year A level student. Says that when he was experiencing problems with controlling his diabetes he talked to his father and that his entire family have been very supportive.

His mother took him to the hospital and he was diagnosed about 15 minutes after the blood test.

When I was nine and a half years old I experienced frequent urination and I was really thirsty. I'd be running back home from school going straight to the kitchen to drink a lot, two or three cups as soon as I got home. And I was also wetting the bed really often and after a week of this happening my mum got concerned so we went to the hospital and we told them what was happening and they said they needed to take a blood sample to analyse. After about 15 minutes they came back and they said I needed to see the doctor to explain what were the results. And they said that I was, had high amounts of sugar in my blood, I was, had ketones and they said these were symptoms of diabetes. And this didn't come as a shock to me because I'd no idea what diabetes was and they, he explained the whole situation and explained what I needed and strangely I really you know, wasn't surprised. I didn't think of what this had, how this would affect my life at all. 

He explained that I'd have to take injections and luckily enough I wasn't a squeamish person and just the, you know, he was very nice in the whole, on letting me know how to do this and asked me frequently how I felt and it was really it was, he comforted me. Which is really important I think at that stage. 
 

Says that doing injections is not something you get used to in a day but with practice you will...

How long it took you to get used to injecting yourself?

It didn't take me long. It took me maybe a few weeks, maybe a month. I'd have my mum would help me in the mornings. She'd help me just injecting my leg because just the concept of putting a needle into my leg was a bit, it took me a while just to put it in and she helped me with that. But after a while I realised I'd have to learn to do it myself and I did. And the, the simple thing is, if I just kind of keep changing the needles it really doesn't hurt at all. It only hurts if you don't change the needles. 

But the, but I got into it quite easily. I think I'm just an exception. Because I know quite a lot of my friends are really squeamish about needles, when it comes to vaccinations [background noise] they get all jumpy and I'm like, 'Oh, it's fine, you know, it's just a, an injection in your arm, it's nothing' So I get used to it, and it's no problem at all now.

If my mum was busy or anything she'd say, 'You're going to have to do it yourself this time.' And I did. And you know, every time I'd do it I always like to think of ways to make it easier and quicker and you know, and, over the years, you know, I've found a way to do it quickly. And you know, pinching just pinching the skin and inserting it slowly and you know, just slowly injecting it and then leaving it in for a few seconds for the insulin to absorb and I don't know, it's just practice, really, practice makes perfect. And this experience over the years, you, you can't just automatically find the best way to do it, it takes a lot of times. But, you know, I do it often so I get used to it and find the best way to it really quickly. 
 

He kept forgetting to do his lunchtime insulin injection at school because he wanted to be with...

How are you finding the regime?

Now? It, it's working out fine. It's better than it was before. It still requires me to push myself to take the injections when it's required. The problem is, now, at school, is when, when I come back from lessons I usually come back with my friends and we used to go straight to the cafeteria and I have, I know I have to go off and take my injection while my friends go off to take their meals and there's a line in the meals and if I go off I'll be separated from my friends and I'd have to hope that they, you know, not eat their lunch as quickly so I can stay with them and eat. And on occasions I might feel, you know, I really don't want to miss out sitting with my friends, we're talking about something really interesting. So I would, I would not take my insulin and I think I'd just take it afterwards. And afterwards I'd want to go with my friends to sit in the lounge and watch TV or talk something and I really wasn't in the mood to go off take my injection. And I'd end up missing my injection for my lunch which meant that I felt high blood sugar throughout the afternoon which really wasn't nice throughout the lessons and I really didn't want to go out the lessons to take my injection and I really was underestimating the importance of taking insulin because I at that time of having high blood sugar makes you feel tired and lethargic and in a state of mind which is really negative. And it's not a good state of mind to tell yourself to be, to asked to be excused from the class and to go off to do injection and so on. And that was dangerous. 

Are there any other reasons why sometimes you forget to take your insulin?

It might be on the rare occasion that I'd forget to take my injection with me, which is very rare, it happened to me a few times. But no there isn't really any other reason apart from the continuous, you know, movement with friends, just going along with the group, being part of the group of friends. You don't want to just seclude yourself so, just to take some insulin because once you do they're off, they continue off to take, to have their lunch and I'd have to just I'd be a few metres behind because I'd had, I had to take my insulin. And that's the reason. I didn't want to be left behind, I wanted to stay in the group, have lunch with them at the table and talk with them and then go off with them for the, for the free time we had. Whereas if I'd taken my insulin I'd have to eat quickly just to stay with them. And either that or find other people to sit with to eat. Which wasn't really bad but I really wanted to be with my friends for the time.

If we go back to the insulin taking at lunchtime when you were at school, what do you think it would help?

If I think if what, what really helps is once, if I do take my injection on time, every, before lunchtime I think I've realised that it's really not that much effort that I'm just exaggerating the need and I think I should realise, I'm realising that it's more important to take control of my sugar than to than just to have that moment where I'm with my friends. Because my, I know my friends, they won't reject me just because I'm, I have to take my injection and I think the benefit of feeling good inside of having controlled blood sugar is, overtakes that of having the feeling of talking with friends at lunchtime.

Be sensitive to teenagers' reactions. Be reassuring to build confidence.

I think it's important to be very sensitive to the teenager's reaction because the way you tell them how to look after the sugar's important because they might be a very fragile in, you know, the way of how you feel like, they control the sugar. If they're, if they're really out of control it's best not to get really angry and trying to scare them into controlling. Be very reassuring and if it's really dangerous don't, if they're in a dangerous situation, don't act panicked, just help them as much as you can. Every opinion counts really. Even if you just tell them that they're improving, and really emphasise it, even it's a little improvement in their blood, blood sugar control, it really makes a difference because it makes them feel much better confidence and self-esteem's really important in the process of controlling your blood sugar and keeping it that way.

Decided not to use an insulin pump and says that his new insulin regimen works in the same way...

He said the insulin I was taking was, wasn't appropriate to my situation. So he told me I, and we also talked about the pump because previously in the year I went to Israel to this diabetic camp. It was for like all these kids in Israel who had diabetes. It was fun, you know, and most of them had pumps, insulin pumps in them. And it seemed quite a good idea because all they had to do was push a button to increase insulin level and I was interested. And coming back to England we looked around but we found it really wasn't popular because the doctors they just weren't, no there was no doctor in England who just used the pump. And I told the specialist in London. He said the pump was available for me but he asked if there was any other way that he thought I could approach it. And the other way was this insulin which was a really base insulin, 24 hours, which meant I only had to take one injection in the day. I then NovoRapid, which is only, a quick acting insulin, for the meals.

So you're taking Lantus?

Yeah, Lantus in the morning and NovoRapid with every meal.

And, which is why the Lantus is better because it was fixed, twenty, it was a 24 hour insulin. Which was like the pump because the pump it releases NovoRapid at, at certain times throughout the day. But I didn't really want to use the pump because I thought it would be uncomfortable. I mean, as convenient as it was, you know, to have a pump, for some people, for me it wasn't as suited because I like being free of the clutter, medical, you know, instruments. 

So the, the Lantus seemed much suited, there was, there was Lantus and there was another type which came with my pen but he said that the, the other type wasn't as reliable as Lantus so I went on Lantus and it works really well for me now. I'm adjusting it really nicely and I'm on a fixed unit of 30 and I haven't changed from that till, ever since I met him in July. So it's been half a year now and it's been working really great. It's really been helpful.

He was unable to control his blood glucose levels and felt depress and lacking in confidence. He...

I have, I was feeling the hypos and the hypers which I really didn't like at all. And they were affecting my concentration and my daily life. 

So it took about a month or two to adjust to a right, the right amount of insulin to take per day. So I ended up on small amounts and to be honest it was quite easy at the beginning because the first year they had, they said it was the honeymoon period where the body was still kind of producing a little insulin in the body and thats good. And that was easy for me. But after that time when I was reaching around 13 and I started growing up, it was much harder to control. And I found I was taking much larger doses of insulin. And I jumped up to 20 units and then to 30 units and then changing insulins and I was taking a base insulin and a short acting insulin. And from then I moved on to mixed insulin because I was taking two injections in the morning which was a nuisance and it took up more time. And I had to inject twice in my leg. And it was getting quite painful because my leg started swelling up and the same with my stomach. My stomach started swelling up. And so I took Mixtard, which is mixed insulin and it helped me with the injections but still I was experiencing the problem where there was a cycle that is common with a lot of diabetics where you take insulin in the morning and then you get a hypo mid-morning and then you have something to eat, and then before lunch it becomes too high and you take more insulin, low again before dinner, you eat too much. And then you take, then you take more than you need in the evening. Then you wake up in the morning and in the middle of the night, and you wake up with a high and it gets really frustrating and having a high blood sugar, you get frustrated but also the feeling, just, it gives you a feeling of you don't have any confidence and you don't really, can't be bothered, you have no energy, literally, to you know, take control again.

And it's, it got quite dangerous because during the years when I was experiencing lots of high blood sugars, not as much low blood sugars, I was getting quite, well depressed, not intensively depressed but quite sad about it secretly. I wasn't telling everyone about it. I was in moments when I had a high blood sugar and I was getting quite frustrated I might lash out and buy chocolate and eat it regardless of my sugar levels. And it was it was quite serious. I after about a year of that I explained to my dad and he is the one who I used to go to for these problems, because he was good at very calmly assessing a problem and he helped me through it. And only recently at around April this year, I went to a doctor, a private doctor in London and he suggested that I completely move onto another insulin regime.