Pat

Age at interview: 80

Brief Outline:

Pat has diabetes, Carpal Tunnel Syndrome, Irritable Bowel Syndrome (IBS), an abnormal heartbeat and has had a skin tumour removed. Whilst she considers herself well for her age, Pat experiences everyday problems from IBS and diabetes which have complicated other illnesses and treatments.

Background:

Pat is a retired psychologist who lives with her husband. She has 4 grown up children, 2 of whom work in medicine and can be referred to for advice. Ethnic background: White English.

More about me...

Pat was a lecturer in Health Psychology and practising psychotherapist. When Pat was diagnosed with diabetes at 62 years of age, she initially resisted the diagnosis as she, “felt I was actually losing control over my own body.” However, she views diabetes as a ‘condition’ rather than illness, with the capacity to complicate or worsen other health problems. At the time of the interview she had been experiencing more hypos and was discussing the possibility of moving from self-injection to an automatic insulin pump.

Pat stresses the importance of seeking specialist advice and finding an understanding GP. She lost confidence with a GP concerning diabetes management and went to a specialist hospital service which she has been attending for 18 years. She recently had a bad experience with her GP who prescribed a drug which was described as contraindicated (should not be used) in people with diabetes on the instruction leaflet. This is part of the reason that she prefers specialist diabetic care. She prefers to see a specific GP, although finds this difficult in practice. However, she considers herself lucky that her GP has given her an email address which gets round some access issues.

Pat takes a range of food and dietary supplements to help manage her conditions (e.g. glucosamine and probiotics). She found that she cannot tolerate statins and prefers to manage cholesterol through her diet. She takes 2 tablets for high blood pressure. Pat has daughters working in hospital and pharmaceuticals who can be called on for advice.

Pat’s diabetes has become worse and her consultant has recommended an insulin pump. Pat doesn’t like the idea, but she realises that now she’s getting older it might be needed.

Is that the only time you've experienced hypos or is…?

No, it is. No, in fact I had three last week.

Right.

And I think this is why, you know, the consultant's talking about the pump.

Right.

Are they…is this the pump, it's quite a new technology?

It's fair…well, my daughter tells me they have lots of [patients] at the hospital, she's at the [name] hospital, with pumps and it's…really works very well. But I think it's, it's almost like it's another step in the progression, 'cos I know it's a progressive condition, and that's why it's not particularly… On the one hand it's very good news 'cos it…you don't have to keep stabbing yourself, 'cos I inject five times a day and test my blood.

Yeah, I was gonna ask you about the testing?

Yes. So well, that's not a problem. But I mean one gets fairly funny fingertips, but… and obviously I vary the site. So the pump would avoid most of that.

So that's the good news. I just don't like… I suppose I'd feel the same if I had to have a pacemaker, which again, I know are brilliant, I've got two friends with them and they're fantastic. But it's like introducing something into the body which wasn't supposed to be there. And I suppose if I think about it, if I think about it, it's because, in a way it's control but it's also in a way, pride is perhaps the wrong word, but you know, your body should be doing this. You shouldn't have to have some intervention to help the body to work the way it was designed to work. 

But then I have to remind myself that at my age it's quite likely that the body needs a bit of a helping hand. So I rationalise obviously when I'm faced with this sort of health issue, I look at the pros and the cons. And yes, I didn't want to go on insulin but I did and I was delighted with the, the change it made in the way I felt. And, it was much easier than medication. Tablets, you can't control in the same way that you can control insulin. So you know, I always looked… I saw the… sort of the negatives and then the positive emerge and I stick with the positives.

Pat isn’t sure whether high blood pressure causes her diabetes or vice versa. Diabetes complicates other conditions. Recent treatments and investigations have badly affected her diabetes.

Have you got any other health problems at all apart from, apart from the diabetes?

I have raised blood pressure of course, but I don't know whether that's cause or effect. My cholesterol is higher than they like it, but none of the statins or fibrates suit me at all and I've tried about five different types. And so now I just manage it partly through diet but also… well, this is commercial, Benecol - the drink which the consultant advised me to use. And I mean it's not terribly high, it's five point two which in most people would be considered okay, but with diabetes obviously they like it to be lower.

Blood pressure treatment, I have two tablets a day, I was on three and recently I had quite a low blood pressure, it was actually a hundred and fourteen over forty seven. So I was passing out, so that had to stop. 

… I regard diabetes as a condition rather than an illness, 'cos I think if, if you label one… yourself as ill… I don't feel ill, most of the time I'm very well. 

But having diabetes does affect other illness, 'cos two years ago I had viral pneumonia and I actually was quite ill.

And my blood sugars were all over the place. And that took some dealing with really, 'cos I was having hypos because the GP didn't suggest that I cut down my background insulin. So I dropped to two point seven two nights on a run. But I rang the diabetes nurses and they said to me, you know, cut your insulin down to eight from twenty four. 

And I had actually had to phone the GP because he'd prescribed an antibiotic which I think obviously I know it was viral, but there were… the risk of secondary infections with diabetes. So I read the information leaflets it said this medication should be prescribed with care in people with diabetes. So I rang the practice and spoke to the GP, and he said, 'oh no, that's fine, it's perfectly alright.' And then of course I had these horrendous hypos which were a bit scary.

So I rang the diabetes nurse for advice and so she told me to cut it down from twenty four to eight. And in fact I've never got back to twenty four I'm only on twelve now. But it was just… First of all they refused to come to the house. I'd been into the practice the previous week saying that I felt really ill, and he gave me a prescription for antibiotics and said, 'don't take them unless you absolutely have to.' It was somebody I'd never seen before. 

The colonoscopy upset my [chuckles] blood glucose levels dreadfully, and that was to do with the…obviously you have to fast and purge and god knows what for two days beforehand, and you have to gradually reduce your insulin and then come off it altogether, and then go back on it. So that, that was quite a…that was quite intrusive really and then I also had a steroid injection for a trigger finger, which also upset my diabetes control. But things do, if I have an infection that affects it. So it's, it's not an easy condition to manage.

Pat could not tolerate drug treatments for high cholesterol so she manages it using diet. Diet is also seen as the best way of managing her IBS (Irritable Bowel Syndrome).

Have you got any other health problems at all apart from, apart from the diabetes?

I have raised blood pressure of course, but I don't know whether that's cause or effect. My cholesterol is higher than they like it, but none of the statins or fibrates suit me at all and I've tried about five different types. And so now I just manage it partly through diet but also…well, this is commercial, Benecol, the drink which the consultant advised me to use. And I mean it's not terribly high, it's five point two which in most people would be considered okay, but with diabetes obviously they like it to be lower.

Blood pressure treatment, I have two tablets a day, I was on three and recently I had quite a low blood pressure, it was actually a hundred and fourteen over forty seven. So I was passing out, so that had to stop. 

I have irritable bowel syndrome for which I recently had a colonoscopy, and everything was normal and with irritable bowel syndrome they don't seem to be able to do anything basically, other than diet and that's how I control it. But I do self-medicate, I have a probiotic which I told the consultant I was using and he seemed to think that was okay. They offered me hypnotherapy, for a thousand and something pounds, so I stick with the probiotic.

Pat’s diabetes was affected when she was prescribed antibiotics. She read the drug information leaflet and saw that it should be prescribed with care in people with diabetes. She phoned a GP and a diabetic nurse.

But having diabetes does affect other illness, 'cos two years ago I had viral pneumonia and I actually was quite ill.

And my blood sugars were all over the place. And that took some dealing with really, 'cos I was having hypos because the GP didn't suggest that I cut down my background insulin. So I dropped to two point seven two nights on a run. But I rang the diabetes nurses and they said to me, you know, cut your insulin down to eight from twenty four. 

And I had actually had to phone the GP because he'd prescribed an antibiotic which I think obviously I know it was viral, but there were… the risk of secondary infections with diabetes. So I read the information leaflets it said this medication should be prescribed with care in people with diabetes. So I rang the practice and spoke to the GP, and he said, 'oh no, that's fine, it's perfectly alright.' And then of course I had these horrendous hypos which were a bit scary.

So I rang the diabetes nurse for advice and so she told me to cut it down from twenty four to eight. And in fact I've never got back to twenty four I'm only on twelve now. But it was just… First of all they refused to come to the house. I'd been into the practice the previous week saying that I felt really ill, and he gave me a prescription for antibiotics and said, 'don't take them unless you absolutely have to.' It was somebody I'd never seen before. But my daughter's a consultant at the children's hospital and she said, 'For goodness sake, mum, take the antibiotics.' So I did, but over the weekend I became very ill and couldn't get out of bed without passing out.

Following advice from a nurse, Pat got her GP to refer her to a diabetic clinic. She has been satisfied with the service which she describes as “a very good experience of treatment”.

The only time I wasn't happy with my treatment was when I was being seen by my GP who at the time, since retired, who was himself diabetic. And when my blood glucose levels got rather high I bumped into the practice nurse outside the practice one day and she said to me…, I didn't know at the time she was also diabetic, but she said to me, 'if you were attending the hospital clinic they'd put you on insulin.' So when I next went in to see the GP, I said, 'You know, this is what I heard.' I didn't tell him the source of my information. And he said to me, 'I'm loath, I'm loath to put my elderly patients on insulin.' 

And I thought well, I don't mind being called elderly, because I was sixty something, I thought well, what do you do with your elderly patients whose control is not good? So I just asked him then for a referral to the hospital clinic, and I've been there ever since. So that's about eighteen years.

And I have to say it's been fantastic service. And also there's a drop-in facility with the diabetes specialist nurses who are wonderful, and you can actually ring them up virtually any time, they always get back to you. But you can drop… you can go in on a Tuesday and take, you know, take your problems there and they solve them usually. So that, that's you know, been a very good experience of treatment.

Pat got pneumonia and was prescribed a medicine that the information leaflet said was unsuitable for people with diabetes. This made her hesitant about seeing her GP in the future.

You ended up feeling quite poorly because of something that the health service had prescribed, is that…?

Well, no, I ended up feeling quite poorly 'cos I had pneumonia.

Right.

But the drug that was prescribed for me, really it was contraindicative for people with diabetes. And I read that in the information leaflet. I tend not to read information leaflets until after, because I think if I read them before I'm going to say oh, I've got, you know, and I tick all those boxes. That's not quite true, but generally speaking I believe that the experts are prescribing me the appropriate drug. But in this case, I'd thought well, this is something different, and I do feel quite ill, and I'm going to read this before I start taking it.

And it was there quite clearly. And it was… I don't remember the name of it now, but it was one of the…not Erythromycin but that group of drugs.

Okay.

But, so yeah. So that was dreadful and it…it made me very hesitant about consulting a GP in the future.

Pat is able to communicate with her GP by email if she needs to change her blood pressure medication.

GP, well, I have, have good contact by email if need to change my blood pressure medication, I can just send one of the practice an email and he will respond very quickly. I think partly because they know at the practice, 'cos I have got access to help within the family really. So although I don't like ever to ask my daughter, 'cos she's very busy, but she's always saying, 'for goodness sake, mum, ask me if you're worried about something.'