Philip - Interview 02

Age at interview: 68

Age at diagnosis: 46

Brief Outline: Diagnosed at 46, Philip took metformin for 5 years and is now on insulin (NovoMix 30). He also takes amytriptyline, alloprinolol, simvastatin, bendroflurizide and atenolol.

Background: Philip is a retired company director who is married with no children. Ethnic background/Nationality: White British.

More about me...

Philip is 68 and lives with his wife. He had his own business before he retired, and played rugby for many years. type 2 diabetes was found when he was in his mid-forties, when he saw his doctor about a sporting injury and happened to mention that he had been feeling a 'strange thirst'. After checking his blood and diagnosing type 2 diabetes, the doctor gave him advice about the illness, including about the experience of having a hypoglycaemic attack. But Philip didn't actually experience a 'hypo' for about the first fifteen years after diagnosis. Only much later, on a holiday in Spain 10 years before the interview, he missed two meals and as he was driving back to his holiday home, he had a hypo. It was quite scary and he didn't understand what was going on. He managed to get home in time to find some sweet food in the fridge, and since then he keeps emergency supplies of sweets and lemonade in the house.

Philip is on insulin and feels comfortable about giving himself injections. He checks his blood glucose at the right times, and keeps a record of his readings on his computer using an Excel spreadsheet. He shows a printout to his diabetic nurse every 6 weeks or so. He is very pleased with her and is very happy with the quality of care he receives. 

Philip has diabetic neuropathy affecting his feet' he finds it painful to walk for any length of time, he has lost sensation in his feet which affects his balance. Despite the neuropathy, Philip feels that type 2 diabetes has not affected his ability to enjoy life, and he does not worry about it much. He feels that if he follows the doctor's advice, and eats sensibly and does exercise regularly, he can enjoy all the things he loves doing, especially travelling and socialising with friends. He has taken no exercise lately because of a leg injury, and also because he finds it boring, but he intends to return to the gym soon. Recently, he was also diagnosed with leukaemia, and while this was a shock initially, he feels much more relaxed now. He thinks that he's had a very fulfilled and happy life and can get on with things without worrying. 

Philip is satisfied with the information he gets from the GP and practice nurse.

If we talk a bit more about information. Because sometimes it's very useful to have clips from people talking about what information they received that they found really helpful to know and what information wasn't that helpful. And how you went about finding information, and what the doctor told you and that kind of thing?

This is going to be so boring because I've never had any information. I've never bothered to read it up on the Internet. Nobody's given me any books. I really had no information given to me at all, other than what to eat, when to take my insulin and how much to take. So I really can't help on the basis of, of h-, having read all the books and got all the information. Nobody has ever given me any information, what I should and shouldn't do, in the written form.

Would you have liked to have had more information?

I've never thought that I needed it. Because every time I've been to see the diabetic clinic they've said, "Everything looks fine. You're, you're doing well." So I thought, "If it ain't broke, don't fix it."

Philip keeps track of his blood glucose readings by putting them on a spreadsheet.

I've just written a little Excel package that I just, you know, put it on. It actually helps me to remember to do it, because I walk past my computer and I think, "Oh, yes, I must do that." So it's an aide-memoire really. But it also enables me to give the nurse and the doctors at the clinic accurate feedbacks of my last six weeks' readings.

So do you update it every time you take a reading?

Yes, oh, yes. It's an ongoing reading. It's only about six weeks now that I've been actually doing it like that. Because my testing kit actually has a memory on it and we could, if they wanted to, I could take that in to the clinic and they could actually print a readout of all my readings over the last six months. But they don't.

Philip has recently changed from Mixtard 20 to NovoMix 30 and says he keeps a record of his blood...

So if we talk a bit more about your treatment and management at the moment.

At the moment. Currently my sugar levels have been reasonably erratic, and they've gone from anything between 6 to 23, and that has caused the diabetic nurse at my practice to investigate different regimes. And at the moment we've gone from a Mixtard 20, and we changed that recently mainly because it was just about to be discontinued in manufacture. So we had to have another insulin to take. And so they recommended that I took NovoMix 30, which is long-lasting but not as long-lasting as the Mixtard 20. And I take 22 units in the mornings and take 20 units in the evenings.

I keep a record of my sugar levels on my computer, and I do a reading in the morning before breakfast and before having insulin. I have a reading at lunchtime; I have a reading before dinner when I have my second injection, and I have a reading when I go to bed. The reading when I go to bed is quite high, because I usually have a hot chocolate before I go to bed - along with the gin but I have the gin before the chocolate - and it's usually quite high in the mornings. But it's usually back down to 8 or even 6 in the mornings.

He can no longer walk up and down stairs without a rail to support him.

One of the other problems of my diabetic feet is you don't have any point of reference of where your feet are. You can't feel them on the end of your leg. And that in turn affects your balance. So nowadays I can't walk up and down steps without the aid of a banister or a rail. And that, that is the most recent development. And that's one of the things that I find the most worrying, the fact that I can't walk up and down steps. As I said, I'm a rugby fanatic. And you go to Twickenham and you've got to walk, or if you're unlucky enough to be in one of the higher seats you've, you've got twenty or thirty steps, very steep steps, to go up with no railings. So now I usually get one of my friends to walk up with me and I put my hand on their shoulder. And coming down is even worse, because you're well aware that if you fall, there's about 5000 people in front of you, and if you start the old domino effect, you know, it could be a problem. So I'm very, thoughtful about when I go from a stadium. And I wait until most of the people have gone, and then my friends and I just walk down. I have support from them. But my feet are no, are no more painful now than they were five years ago. They're no worse, but they're no better.

You mentioned about the blue badge?

Yes.

How do you feel about that?

I'd rather have the full use of my feet. But I do find the blue badge is very useful because I find it hard to walk more than 100 metres without pain. Well it, I'm always in pain. When I walk I'm always in pain. I can stand it for a while, but then I do need to rest. I mean that is the only way that my life has changed, that I cannot walk any distance at all now without resting, without taking the weight off my feet. So I do find the blue badge is absolutely necessary to me.

Philip says that remembering to test blood glucose levels at regular intervals can be difficult...

So can you tell me how taking insulin on this regular basis affects, affects your life?

It affects my life very little. The only problem is if I go out to dinner at night. And just before I eat I go into the Gents and give myself my jab. Or if I'm with friends who are not worried about it, then I'll just lift my shirt up and put a, put an injection in the side of me. Other than that it really doesn't worry me at all. I mean I'm used to doing it in the mornings before breakfast. I have to say that once or twice I have forgotten to take it in the evening. But basically I just have my insulin there on the side of my dinner, on the side of the table, and just before I eat my dinner I take another 20 units of insulin. And it's no problem at all to me.

What about testing your blood glucose levels? How do you find that?

Then again, in the mornings it's fine, at lunchtime it's fine. It depends what I'm doing in the late afternoons. It also, depending, it depends where I've been at night whether or not I actually remember to do it before I go to bed.

One of the things I stopped doing a year ago is drinking as much as I used to. I mean being a rugby player, you, your whole life revolves around beer and partying, and I must admit until fairly recently I used to drink more than I should. I've recently had leukaemia, and one of the things that I was told is that I had to cut my drinking right down. Which I've done. So if I go out at night and I've had one or two drinks, I come home and I may forget to do it late at night. But usually, as I'm becoming more used to doing it, then I do it without even thinking about it.

Despite increasing problems with his feet, Philip says his diabetes is manageable and does not...

I'm finding that as I'm getting older I'm more aware of being a diabetic. And that's mainly because of my feet. But I still travel. I've been away, this is May 2007 and I've been away for three and a half of the four and a half months that we've had. So I've not really suffered because of being a diabetic. My own feeling is right from day one that it's not altered my life, it's not interfered with anything that I've wanted to do and, mainly because I've not allowed it to. It's not a terrifying disease. Type 2 is one thing you get because you, usually because you've always been overweight. So, you know, you reap as you shall sow.

Other than my feet, I could count the number of hypos that I've had on one hand. And two of those have actually been in the last month, where we've been trying a new regime of insulin and it is just trial and error to get the balance right. And at the moment we're nearly there, but my sugar levels are still quite erratic. They will go from anything between 6 to 11 in a day. I've been taught the levels they should be. I've been taught the food that I should eat and I don't eat, and that I should eat and shouldn't eat. My wife is very careful about the diet that she gives me. And we just do not eat fatty food. We have lots of fruit. We have very little red meat. We have fish and chicken. We just eat extremely well, but sensibly.