Lawrence - Interview 33

Age at interview: 38

Age at diagnosis: 37

Brief Outline: Diagnosed a year ago, Lawrence takes gliclazide and losartan.

Background: Lawrence works in the catering trade and is married with three young children. Ethnic background/Nationality: Born in Zimbabwe.

More about me...

Lawrence was born in Zimbabwe and has lived in the UK with his wife and children for 5 years. A year ago he noticed he was having more 'toilet stops' than normal and asked his GP for advice. He was diagnosed with diabetes which he had heard of before but was shocked to discover that it could not be cured. Once he realised that diabetes is a lifelong condition he researched as much as possible on the internet, but he found much of the information was too medical and not 'social' enough for his needs. His relationship with his GP and the diabetes nurse is excellent and they have helped him a great deal. Initially his blood glucose level was 30, but since he started to get control of his diet - he and his wife made radical changes to the kinds of food they ate - his glucose levels have improved.

He is very concerned about the future, particularly about the security of his wife and young children. He wants to stay fit and well and says that worrying about his family makes him depressed from time to time. He wonders if stress triggered his diabetes.

Lawrence has been prescribed gliclazide and losartan potassium, which suit him fine. He would like to take more exercise but because he is on his feet all day at work, it is difficult to do more walking apart from at weekends. He enjoys tremendous support from his wife, his sister and his family and he has made sure that his children understand what diabetes means. He tries not to worry about the future, but is concerned to know whether his internal organs such as his kidneys are bound to become affected. He wonders if he can stop that happening to him by maintaining good control of his diabetes.

Lawrence explains his careful approach to weight control and diet.

Very much so you know you learn to be observant in terms of your body, how your body's operating, but also you learn to be very disciplined in what you eat, and that also has a huge influence in terms of, you know, what effect it has on you. So I tend to prefer going for the dry foods, you know your dried meats, your white meats, beef yes but then you stay away from things like bacon and fatty sausages and so forth. Because one of the other problems you have with diabetes is that it becomes much more difficult to control your body weight. The net result of that is that it affects your blood pressure, and that also can be a problem, so you then have to manage the sugar content of your food, and the fat content of your food so that, you know.

And, and by instinct you then learn to read the labels - as soon as [laughs] you want to eat something the first thing you read is the label - you know what is the sugar content of a drink. So those sorts of things then come into play in terms of making sure you don't set yourself off. Now and then I get tempted and [laughs] and the sugars go high a bit but, because you know, you learn to control it, you can bring it down quickly enough, either in terms of the food you eat to try and absorb, or in terms of the frequency of eating.

As I was saying, you know the third aspect (the first aspect is in terms of the sugar content, the second aspect is in terms of the fat content) the third aspect that I always monitor is the metabolism rate, because that relates to your food digestion and that relates to your body weight and your blood sugar, and your blood pressure. So, you learn to play the tricks and know the rules.

How do you know your metabolism rate?

I don't have a medical or official calculation but I just notice, because I weigh myself regularly, so I know that if I know for a fact that if I eat a lot of bread I pick up a lot of weight, so I've cut out bread altogether and I stick to other things, but now and then when I do eat bread I notice that, you know I'm a bit more bloated and my weight picks up. So, and even the scale tells me that, you know I've put on a bit more weight, so it's my interpretation I could be wrong, I could be wrong but I think, [clears throat] that's where I know that my metabolism is sort of like, [in] a direct relationship, so when I eat the lighter foods or the easier foods I don't pick up any weight. So I have to check my weight, you know, every other day literally, yeah.

Lawrence has wondered about the causes of his diabetes and thinks that a series of stressful events may have caused it.

I've no idea, I've no idea, but when I went through the web search just researching on my own in terms of trying to understand what exactly is diabetes and how you come up with it, one of the possible causes, they said that, you know, there's a myriad of causes or you just don't know. But one of the possible causes they said was, was possibly stress, so' Maybe it could've been stress I don't know, but of all the possibilities they listed, I couldn't identify with any of them except the stress element. So maybe it might've been stress but I really don't know. The doctor said officially they don't really know what causes it, they know how it occurs, the mechanism of it but, they can't really tell you what actually triggers it off, but to me, the only one I could identify was possibly stress but I couldn't say for sure.

Without wanting to pry into that, was it severe stress over a long period of time?

Well I wouldn't say over a very long period of time, but it was certainly over, you know it was a series of events over a short period of time, because you know I'd just lost my parents, and we were having problems with our visa renewals, and because of that my wife had stopped working for a while, so financially we were under severe pressure, so I'm just' Because I traced you know, my life back and that's the only period I could think of that I could have gone through stress, but other than that I've no idea, I've no idea.
 

Lawrence says he used the internet to find out as much as he could and also asked his medical team about anything he didn't understand.

But the other thing I did was go on the internet, but I was searching in terms of topic, I didn't know any websites to go to, so I just searched by topic then in terms of, you know, diabetes and social diabetes, and sex with diabetes, and food, and looked through those and read those, and, and really while I might not have a specific book or a specific website to, to recommend, what I do recommend is just soak yourself with information, information, information. Because it helps you (a) in terms of making decisions about how you're going to conduct your life and (b) in terms of understanding the condition that you have, because if you don't understand it it'll be extremely difficult to, to get around it, life and it'd be extremely difficult to manage it, and, to comply with what the doctor tells you, because you might think the doctor's just, you know, giving you grief, but in effect he's just, you know, giving you the correct information.

But of course having said all of that it, it's up to you, really how you respond and how you deal with it. If you take it as a challenge and a positive tone yes but if, you can see it as a burden and you say, 'Well I'm gonna adjust my life to accommodate the diabetes and hope for the worst and, you know, I've given myself five years to live and so forth.' Then you will have five years to live [laughs].

They went to great lengths, as I said between, between the doctor the dietician and, and the diabetes nurse, between the three of them they really gave me a thorough [laughs] update on what was going on. So I'd a lot of information then and of course, you know, whatever questions you come up with at the time, they're just a phone call away so I always used to phone them, 'Oh what about this? And I've just thought of that.' So, they gave me a lot of information from the onset, it was really more of me absorbing what they were telling me. They also gave me a lot of literature, in terms of reading material, so, you know, you read for yourself the pamphlet - there's a standard pack that they give you - and you read through that and it is really very handy because it gives you all the information you want to know. And if you're not too sure you can always ask them.

But they gave me so much information that, you know, I was able to cope, from the beginning but it just depends. I think also how they presented it to me, helped me in that, you know, they said to me, 'Look this is what you have and this is what can happen. You, you won't, you don't necessarily have to think you're going to die from it, you can live with it, you can manage it, but, you have to do a, b, c, d,' so, you know telling me that it's something I have but I can live with it and I can cope with it, straightaway gave me the hope to say, 'Well okay so it's not as bad as it seems to be.'
 

Lawrence understood the clear unambiguous advice he was given by his GP.

Well I mean, I've been with my doctor for years, so we've got a good relationship, he just said to me, 'Look I'll tell you straight what the situation is and what you have. This is what you have and these are the risks that are involved with it, and these are the possibilities.' So he just laid it all on me, and if I had any questions I asked him, and, and he says, and of course with the, with the subsequent visits that we had, whatever questions I had I would, I would always ask him and then he would answer me, you know, straight up. And, and we just took it from there.

So it was a pretty intense 'download' as it were and 'upload' on my part, but I think it helped me because it hit the message home and his concern was that, you know, I get into the groove of things quickly now, because my sugar levels were, were that high, so he was anxious that they come down as low as possible, as quickly as possible so... I think it helped me as well, you know, coming to terms with it quickly enough.

Lawrence noticed occasional erectile problems before he was diagnosed with diabetes and thought they might have been caused by stress.

In fact it started it started, that was probably one of the early symptoms but I didn't understand or didn't associate it then because, I started having erectile problems earlier on before my toilet runs increased. And I thought maybe it was just fatigue or stress or whatever, so I didn't put much to it, and it didn't occur on a regular basis it was, you know, once in a while. So you know, then I understood that I had an erectile problem and then when the diabetes picture then came in and then I put one and one together and I realised that okay that's what it is. But, you know, you come to, to understand that that's what it is and you get a choice of how you want to deal with it, either you go into abstinence or you use medication so, you know, we've gone the medication route and we, and that's what's helped us yeah.
 

Lawrence describes how he and his wife have coped and how the GP helped them sort things out.

It's something that you learn as you go along, you know, as much as the doctor can tell you, 'Look you're gonna have problems in terms of your erections.' And you say, 'Oh okay, fine.' But it's different when you get into the practicalities of things and you know, fortunately I have a very understanding wife so she understood that. But it does have an effect, you know, when I was going through the internet that's when I really read it in detail and the biological effects it has, you know, on your , on your erectile system and so forth. So that again was so like a sub-shock in itself to say, 'Oh okay, right this is...' because obviously any healthy marriage, sex is an intimate part of it, and that then compromises in terms of, you know how you deal with it and so forth. But fortunately my doctor's able to help me and , you know, that's, that's come about quite nicely so, again it's something that you have to learn to do.

Is the medication route viagra basically?

Yeah it's viagra I wasn't sure whether I should use the name or not but, but yeah it is viagra and, and I think also [name] the other thing that helps is both the husband and wife's attitude towards it. Because, you know if, if you take it as a loss it, it can create so much stress in your marriage, and, and it can cause complications in terms of the relationship between the two of you, the emotional response to it because you know, as a man, you know, [laughs] you measure your manhood in terms of your sexual prowess and so forth, for want of a better word. And so when that's taken away, that's like taking an engine away from a car, it can't operate, but because my wife and I, you know, discussed this and came to an understanding about what is going to happen and how it's going to affect us, we took a positive approach to it, in terms of well this is what we have, how can we get around it, or how can we get by with it? 

And I spoke to my doctor and he said, 'Look there are options.' And back then I thought viagra was just something, but he says, 'Look you, you've got an option of viagra.' Which I discussed with my wife and we said, 'Yeah well let's go for it.' So that's the upturned side. But you know, even now I don't necessarily need it all the time it's just, you know, periodic that once in a while that I get to use it but, that's also helped, and, and of course just being positive about it, yeah.

Occasionally Lawrence's blood glucose is very high which makes him feel sluggish in the mornings at work but by midday he picks up pace.

Not, not the work itself affecting my diabetes, but the diabetes influencing my physical condition and as a result that now and then I mean you can't escape it, now and then your sugar levels will, you know, kick in and rise. I just, I don't know how it works but maybe just a physical thing but, but it does kick in now and then, I mean maybe once or so every three or four months and, and you will get a morning that you will wake up and your sugar level is very high - it might even be like eight or nine - and so you're struggling for strength, at the begin, in the starting part of the day, so you know you're a bit sluggish at work. But through the course of the day I've found that by about midday, and it's cleared up, I don't know, but it, it will have cleared up, and, and then I pick up pace. So if it does catch up with me it's normally in the early part of the day, usually around the, the, eight, nine, ten o'clock in the morning, and then it tapers off by about eleven I can find my strength coming back. I think also in terms of work I, I'm blessed to have a very understanding boss, and, you know, he understands that I have this problem so he's very, very supportive and he knows that at times when I'm sluggish, I'm not sluggish by, by choice but it's, it's a situation that's there, and he accommodates me a lot and then, you know, I pick up pace again as we go through the day. So yeah my work does get affected but, in the mornings when I, you know when I struggle a little bit, but that's something you know you learn to expect.
 

Lawrence explained diabetes to his young children by telling them he had too much sugar in his blood.

And then I had to explain it to my family, you know, what is going on and what I have, to the kids as well I explained it to them, what it is, but I had to find the, a lower level of language to explain to them what is going on and then I, you know, got them involved when I do my sugar, my blood sugar tests, and when I take my medication. I got them involved so that, you know they, they come to terms with it and then it just, that's how I slid it into the family and that's how we've been managing it.

And, and in terms of the kids, of course the kids didn't quite understand what it is, but, all I explained to them was, you know, 'I've got too many, Dad's got too much sugar in his blood, and he's got to make sure that we cut back the sugar in there.' And they took it on board, in fact [laughs] my daughter was, was so into this, that , up to now she still does it, whenever either we've visitors or on a visit she says, 'My daddy's got a lot of sugar in his blood so don't give him any sugar okay? He's got enough sugar.' And, and whenever I have tea, says, 'Daddy did you put any sugar?.' 'No I didn't.' 'Good 'cause you've got enough sugar.' So she's understood it from that basic level, that I've got sugar that I've got to manage in my blood, and that's how she's understood it. My son of course is, you know, understood it more, more intensely than that. So they came to terms with it in that respect that all I've got to do is make sure my sugar level's okay. But I didn't, you know, give them the, the life and death side of things, yeah.