Pamela - Interview 08

Age at interview: 54

Age at diagnosis: 50

Brief Outline: Pamela was diagnosed with diabetes four years ago. She takes metformin and rosiglitazone.

Background: Pamela is the Director of a health-related organisation. She is divorced with one adult child aged 28. Ethnic background/Nationality: White British.

More about me...

Pamela has a high-pressure job and commutes to work. Type 2 diabetes was diagnosed 4 years ago. She went to see her GP about something else and happen to mention that she had been feeling intensely thirsty. She now believes that she may have been developing diabetes for several years before the diagnosis, and that she had ignored the symptoms. Even after diagnosis, Pamela found it hard to accept her diabetes. She experienced many complex emotions which led her to deny her diabetic status. She did not want to be ill, so she decided that she wouldn't be. Also, she felt that she could do nothing to change her diabetes, for instance with her lifestyle or diet, and believed that ultimately it was not her but her body that was at fault. She felt that as a single woman, working long hours and having a stressful job, she couldn't afford to have the added burden of a chronic illness. 

It was only when after one of her retinopathy examinations, six months before the interview, when she was told she had an aneurysm in her eye, that her attitude to diabetes changed. With encouragement from her GP, Pamela decided to follow the GI (Gluco-glycemic Index) diet and became proactive about controlling her blood glucose levels. She still finds it hard to resist ice-cream and dark chocolate, but no longer goes to sandwich shops for lunch or snacks on the commute home. She makes large amounts of vegetable and bean soup at weekends and takes some to work everyday. 

Pamela is taking metformin and rosiglitazone, but hopes eventually that she may be able to come off medication completely if her blood glucose levels remain consistently low. Her diet has also helped her lose weight. She does have some pain in her feet, but overall feels much healthier and in control than she was before.

Pamela felt the advice to eat a yoghurt during important meetings at work was inappropriate for...

I found that, when I went to the dietitians… Lovely women, but had no concept of my lifestyle. Somebody suggested I mean I go to meetings, (and they're quite senior level meetings, which doesn't make them any different from other meetings, [at] any meeting this could happen) and I said, “But sometimes they overrun or whatever.” And somebody suggested I ate a yoghurt in the meeting. Now… Yes, I could do, you know - women can breastfeed if they want to - but on the whole you don't. There's a bit of a credibility issue. And it also highlights that you have a condition and do you want people to know that you have a chronic condition? I don't as a whole mind, but I don't think I necessarily want, you know, the Director General of the Department of Health R & D to know that I'm a diabetic. And sort of some of the suggestions were quite inappropriate.

Pamela reads articles about diabetes in medical journals, buys specialist cookery books and talks...

So where do you get most of your information from?

Now, well, I found one or two sites on the website, but mainly it's about the GI indexed food. I will try and look at some of the scientific paper if I, I have access to the BMJ (British Medical Journal) and so I will have a pop-up for anything that's to do with diabetes or whatever. And I look, I tend to look through things like the HSJ (Health Services Journal) or whatever, you know, to see if there's anything, primary care magazines, to see if there's anything coming out about diabetes. I buy cookbooks, I buy recipe books and, you know, with GI index food. You can now get GI index food recipe books. But I guess probably a lot of my information comes from asking the GP. But I would, I think Diabetes UK are pretty good, and I think they're good.

Pamela recalls how casual she was about her diabetes until she discovered that it was affecting...

Okay, I'll start what I think of as the, the very beginning. It was four years ago that I was diagnosed. I'd just met my 50th year and I'd completed an Open University degree and my daughter had finished college and I was just thinking, 'Great, I can start, you know, I can start the new decade. Okay.' And during the, just before my birthday I was beginning to feel very, very thirsty. And my father was diabetic. In the back of my mind I thought, 'Oh, no, I'm, I'm diabetic.' And I, refused to do it, to believe it until my thirst became overwhelming. I would have a pint of water at least before I left in the morning, and an hour and a bit later when I got off the train at Marylebone I'd have to have a, at least two Cokes. I was craving for Coke to, just to assuage the thirst to get me to the office, where I'd be, drink again. And I went to my doctor's.

I have high blood pressure. Anyway, and I went to my doctor. And as I was leaving the appointment, I said, 'Oh, by the way, I seem to be very thirsty. Do you think there, do you think there might be a problem? You know, should I have a test?' And he said, 'You might be diabetic. You know, how long has this been going on?' etc, etc. Anyway I had the test, and I got a phone call from the, from the nurse saying, 'Would I please go immediately because it was, it was high.' It was something, I think it was 19. It wasn't, I mean I didn't think it was sort of like outrageously high. I've heard of people being much higher. So I thought, 'Oh, well, it's, okay. It's not a bad diabetes' knowing really nothing about it.

Anyway I had got it into my head that I really didn't want to be diabetic. I didn't want to have a chronic illness. You know, discovering that I could get my medications free didn't really highlight for me just how, how serious a condition it is. So I went on for several years just, you know, thinking, 'Oh, well, one day, one day I'll take it seriously, one day I'll take it seriously.' And it took me actually three and a half years to take it seriously. And there were two things really that, prompted me. Are you all right with that? [noise outside] that prompted me to take it seriously. One was I was beginning to get very painful feet.

And the other was I went for a retinal screening, I think it's called retinal screening, for my eye. And the den-, the, the optician said, 'Oh, I can see you've got diabetes. You've got a small aneurysm.' And my heart just stopped. It actually, I thought, 'Oh, my goodness. You know, it's going to rupture. I'm going to go blind.' So he reassured me that it was very small and, but they'd have to keep an eye on my eyes just to make sure that it wasn't. So I came out of the, I came out of the optician's determined that I was going to change my lifestyle.

I'd been very, it was very silly really, because I kept making excuses. I was working in London, and I ate a lot of processed food. I ate a lot of prepared food or I, you know, I don't often get on the train until half past six, seven o'clock at night, and I was starving. And I'd have, I'd have a baguette or, or something. I'd always have, and I'd have some chocolate. And I did find that actually, just before I was diagnosed, I could eat three or four bars of chocolate in one go. I just felt the need to eat that kind of sweet thing. So it was, it was... My lifestyle did not lend itself to being diabetic.

Pamela attributes her diabetes to both hereditary and lifestyle factors.

Oh, I got it because I overate, I'm in no doubt about it. I mean I've got a genetic disposition to it. My grandmother, my father had it. But, no, I ate completely the wrong things. I mean I was reading an article earlier on today about clotted cream in, I think it was in the Sainsbury's magazine. And I thought, “My goodness, I lived in Somerset, next to a dairy farm.” We grew up on whole milk. Never heard of anything other than clotted cream in my life. You know, cheese, butter, I mean it was just in abundance. We had, you know, and that was fine. My mother made cakes and all of this sort of thing. And that was fine. The way we ate was fine when we were doing a lot of activities, children whatever. It was when the processed stuff came in. Like, you know, suddenly you could buy cakes or you, you know, you, home-made jams or ice cream, you know, things that were suddenly different. And that I think is when, and we stopped, then I stopped being so active, in my mid 20s I wasn't so active.

And I think I've had a lifetime of eating, you know comforting foods, and I think that's just what I enjoy eating, but I ate too much of them. Oh, yes, I think it's, it's definitely that, and certainly the last five or six years that I've been in London because I was tired and working hard and travelling and commuting, whatever, you know, I was grabbing whatever I could, whenever I could.

Pamela works full-time in London and would like to be able to see her GP on a Saturday morning.

But looking back at your experience of type 2 diabetes so far, is there anything that you feel like you could have done with more support on?

I would have liked to have had evening access to the GP, that would have been... or Saturday morning, that would have made my life much, much better. I had access to dietitians. I'm not, I'm not sure that anything else would have really helped. It was about me not wanting to be helped I think. But just from a physical point of view, certainly having' I mean you can't even pick up a prescription at my GP on a Saturday morning, you know. I've now got them arranged that they will take them to [supermarket]. They go to [supermarket] and I collect them there. Because [supermarket] pharmacy stays open till 9 or 10 o'clock at night. Which is really useful, you know, when you work. So I think that, you know, just that would have made a difference. It would have meant that I wasn't so worried about the effect on my working life. I think that would have, would have eased that pressure, yes.

When she started following the GI diet Pamela found her glucose levels lowered quickly. When she...

So I read up a lot about low GI index foods and really realised that actually that was the kind of food that I liked eating. I actually like wholemeal bread, I like soups, I like pulses, I like healthy food. I don't like a lot of sauces and things. And actually what I needed to do was to develop a lifestyle that would allow me to do that.

So the first day I did it, I amassed all this information and I got the right things. And the very next day my bloods dropped from 13 to 8, just literally overnight. And I thought 'It works - it actually works.' And then over the next I suppose two weeks it went down to about 5.5. And it now sort of goes between 5.1 and 7 depending on how good I am with the diet. And I talk about it as a diet, it's actually a healthy way of life. I don't feel as if I've had to give up a lot, because I still have the odd chocolate, the odd bar of chocolate, piece of cake, but in a much more planned way.

So I find that like today, I go to college on a Tuesday evening, and the food, it's a small college, very very good food. And they always do afternoon tea with home-made cakes, and I allow myself a piece of cake on a Tuesday. But I will not have had a lot of food before I went. And when we have the main meal later on in the evening I will just balance it. Just about, you know, not having too many what I used to call the foods that are really, are comfort foods for me, like bread and potatoes and cakes, chocolate. So I think it was because it worked so quickly that it you know, encouraged me to go on.

I also knew I had to lose weight. And I realised that there isn't a correlation between where my blood sugar levels are and weight loss. So although I had dropped from 13 to 5 in two weeks, I actually hadn't lost any weight. And I really sort of thought, 'Now why, what am I doing, why am I not? I'm not eating any processed foods; I'm eating fruit and veg and, you know, everything in its right quan-.' And then I realised that I was eating too much. It was the quantity. It's not actually what you eat so much, for me - I obviously can't speak for everybody else - but for me it's not what I eat, it's how much. It's the quantity. And so I cut my portions down, not ridiculously, but just cut them down, and I started to lose weight. And I have in the last six months lost over two stone in weight. So that's coming, that's another benefit as well. Although weight loss wasn't a priority for me, it's actually quite nice and it's made me fitter.

Pamela found using a blood glucose monitor was simple to learn and testing was generally quick...

I have a glucose monitor machine. And you get, you have little lancets, like little needles. And you turn the machine on, it whizzes round, and a little strip comes out the end. You prick your finger with the lancet. You put the machine with the little thing that comes out the bottom on to the blood. It soaks up a bit of blood, takes about two seconds. It then does something in its machine and a reading comes out. So it's very simple.

But I think the cylinders for the little tabs are probably not cheap. Well, I know they're not because I've bought some. But I think it's my way of, that's my way of keeping my sugars down, my sugar levels down, is to do it every day. I mean maybe it will come a time when I don't feel I have to. But it's working at the moment and that's okay. And I don't mind the needle, I don't mind the pinprick every morning, you know. That's fine.

Do you use a different finger every time?

Yes. And, but even so they do start to get (looking at fingers), because I don't, I mean I don't know what people, I've not really examined what people do who are on insulin and have to check their bloods four times a day. Presumably there's, they use different parts of their bodies or something, I don't know. But, no, that, that seems to work for me at the moment.

Her relationship with the GP is good because he listens well, is responsive and doesn't...

And is there anything that looking back you feel worked particularly well for you?

My GP letting me take control of it or not control of it' I mean he was' I mean I said to him in January, 'I want one last try to get these under control.' And he said, 'Okay, but you've said that before.' And I said, 'No, I really mean it this time. I will, and then if I don't get it under control, I will start insulin. And you can put that on my card, that I will do that.' And he let me do that, you know, without, and he hasn't sort of, he hasn't pressured me into stuff that I didn't want to do. It's been negotiated. The increase of medication has been negotiated.

The, I mean I said to him about the atenolol, coming off the atenolol when my blood pressure went down. And he said, 'Oh, I don't know. Oh, all right then, we'll give it a try.' So he responds to my requests. And if my bloods continue to stay the same, I shall ask if I can take lower doses of the metformin. And I'm sure he'll let me if he thinks that's okay, as long as I monitor it.

So there's a lot of, I think for me I'm glad there's a lot of self-monitoring. And you have to take responsibility for it yourself because it is a lifelong condition - it's a 24-hour condition. You can't just take your medicines in the morning and expect to go through the whole day then just doing what you like.

A small blood clot found during a retinal screening test gave Pamela such a shock that her...

So I went on for several years just, you know, thinking, 'Oh, well, one day, one day I'll take it seriously, one day I'll take it seriously.' And it took me actually three and a half years to take it, to take it seriously. And there were two things really that prompted me to take it seriously. One was I was beginning to get very painful feet. And the other was I went for a retinal screening, I think it's called retinal screening, for my eye. And the den-, the optician said, 'Oh, I can see you've got diabetes. You've got a small aneurysm.' And my heart just stopped. It actually, I thought, 'Oh, my goodness. You know, it's going to rupture. I'm going to go blind.' So he reassured me that it was very small and, but they'd have to keep an eye on my eyes just to make sure that it wasn't. So I came out of the optician's determined that I was going to change my lifestyle.

Pamela thinks it would be more constructive to promote healthy lifestyles for everyone than to...

...I don't think I have very strong feelings, but I do think I would like to see it more of a less of a health thing and more of a lifestyle. I think it might appeal to different groups of people. I mean some people like it to be a health issue. They like it, they like the idea they have a health condition. I would like to see a lot more, a lot more attention given to the prevention of it. How can you, what can you do in your life? I mean thats getting a bit better, but I think it would be really, really good.

I mean at the moment they're saying, you know, there's an advert in some of the papers saying 'If you're Afro-Caribbean, or age such and such or this weight or your waist measures this, go and get a blood test for diabetes, you may be have diabetes. But that's such a, that is such a negative, it seems to me quite a negative approach. You know, yes, you might need that, but it would be have you thought about changing your eating to include this, or that, sort of being a bit directive, but allowing a choice.