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Philip - Interview 15

Age at interview: 81
Age at diagnosis: 72
Brief Outline: Philip was diagnosed with diabetes nine years ago when he was hospitalised after a heart attack. He was put straight onto insulin.
Background: Philip is a retired senior sales engineer and is married with two adult children. Ethnic background/Nationality: White English.

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Nine years ago, Philip had a heart attack (not his first) and was taken to hospital. On his second day in hospital, doctors told confirmed he had had a heart attack,  and also that he had type 2 diabetes, and would need insulin. Philip didn't recognise the symptoms of diabetes that he had been getting, but now looking back he remembers that he had felt tired and thirsty and needed to visit the loo more often. Also, he had hurt his shin, and it didn't heal as quickly as it would have done in the past.

A few days after leaving hospital, Philip saw a nurse who showed him how to manage his insulin injections. Philip liked the way the nurse involved his wife because having someone close by who has shared information has been useful. If he missed anything, his wife has always remembered; she has also remembered to ask questions when he forgot. 

Philip is very active in a local support group that gets speakers such as podiatrists, and eye specialists. He is also part of a discussion group at the hospital which includes doctors as well as patients talking about how best to handle diabetes-related issues. He also took part in an Expert Patient course, and found it very helpful. Philip's diet has not changed much since being diagnosed with diabetes, but he eats only at fixed times because this helps him regulate his insulin dosage better. He regularly goes fly fishing and enjoys it very much.

 
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Philip checks his blood to avoid possible problems from a change of routine.

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Never had any need for it really, because I tend to work my own regime out. As far as my blood sugar, if I am travelling a journey, if I am going a distance say, if I am going down the South Coast. Going down, I've got a niece down there. I tend to take my blood sugar when I have started, and I tend to take it part way down on the journey. So that I know that I am in control all the time. I mean doing long journeys you don't know how it is going to affect your blood sugar levels. And I am very careful about that. Anything exceptional I will look at my regime that I am doing. Does it, will it, what I am doing affect it and I can take precautions then to eliminate possible problems. You're looking ahead, it is going back to the self-management again, you know you've got to manage your diabetes. It is yours. It's all yours you are not going to give it away. You've got to manage it and I think the sooner you learn to manage it, the easier it will be.

 

Philip felt constantly thirsty on holiday and put it down to being too hot.

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I would say they were there for a very short time. I got the symptoms, and on looking back afterwards I could recognise those symptoms, but I didn't recognise them at that time. We'd been on holiday abroad and of course it was hot there and you tend to drink a lot. And being warm you feel tired, a natural thing, and one thing that, I knocked my shin, and up until that particular time I healed very, very fast. But this time I didn't. It took weeks and weeks to heal over and it is something that you don't think about and you think oh it is taking a long time, but you know more than that' I can recognise the symptoms now that I had. And I can recognise the symptoms in other people now. But how do you show people what their symptoms are. They come on gradually. What I gather. Although I can't remember them coming on.

But how would you describe the symptoms that you have, apart from the slow healing? Did you have'? 

Oh yes, I wanted to drink a lot. I was passing a lot of water and what I didn't realise then I was also passing some sediment in the water as well. I thought it was from the toilet cistern itself. Not from me. I didn't realise that. And my wife had remarked on it, and said, 'There's something funny there in there cistern,' you know. But you don't realise those things. You don't look for them. Unless you are primed to look for them. I don't think you would. And I think that most people that I have spoken to who have got diabetes they had exactly the same problem, they didn't recognise the symptoms prior to' I think if you have got a family where the diabetes is inherent in the family, I think people might recognise the symptoms then, but if you haven't I think it would be fairly difficult. It is only when you become unwell more often or not that you, you're diagnosed.

 

Philip describes how he feels 'light' when his levels are too low.

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I get very good warnings. I know when I'm coming down round between the 4 and 3 mark, I know I'm coming down, and I've got extremely good warnings right from the word go. So I know that I've got to do something, and of course I always carry my glucose tablets with me, and a couple of Mars Bars in my pocket. So, I can always adjust.

How do you know then? How do you know when you're about to '?

I get a light feeling, a funny feeling. I can't really explain the feeling. It's you know when I say a distant feeling. You' 'Lightness'. I always think if you've had... a number of drinks and you are starting to go 'light' - you're not drunk, but you're starting to, things aren't quite as sharp as they should be - and it comes on quite... I know when I am coming into that point between 4 and 3, or 3 and 4 whichever way. I know then that I am going low. I have been low. I have been down to 2.8 but that has been for other reasons, you know when I have gone down, it' s a, not getting my meal on time and that type of thing but you can't always cater for. You try to sort of look at all emergencies that could possibly have and try to cater for them. But you can't always, there have got to be times when you can't. And in 10 years, 9 years, I think, I've done pretty well.

 

Philip says that it is impossible to fool the HbA1c test.

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The HBA1c of course when you have that done, that gives a long-term recording of what your blood sugars have been, and this something you can't hide from them. You can hide tests, I mean you can say 'I'll test at this time and I know it will only be that', you know, but if you are over or under, you can sort of say, 'Well I can test now and all those tests will say I am at this particular point, which will look good', but the HbA1c you can't. You can't organise or sort or do what you like, they'll know what you have done when you have that blood check.

So you know it's you have got, if you go every 12 months of course it means that you can do what you like for 9 months and then the other 3 months you have got to be careful, but you don't do that, because it is really about 12 weeks that they can look back on when they look back at the HbA1c. But if you're sensible you wouldn't try to - well you've got to look after yourself.

 

Philip sticks to a particular routine with his insulin but says other kinds of routine may work...

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I stick to a fairly standard regime where I have my breakfast, my lunch, my evening meal and a little snack at night before I go to bed. And my, the way I use my insulin that suits me perfectly, I go up and down a bit. But other people who are leading active lives and they want to keep their life as normal as possible, do things when they want to do them, rather than when their regime tells them they've got to do it. I think it is a much better, DAFNE, Dose Adjustment For Normal Eating. And I think it is a much better system for people with active lives.

So is your insulin, I mean the level that you take is that sort of fixed, you don't change it that much?

I don't change it that much at all. I have 26 of a morning, 18 of an evening before my evening meal and that seems to suit my lifestyle. If I am more active, if I'm going to be active, I tend to may take a little Mars Bar or something, have a chew at that. And that will raise my blood sugars to counteract the effect of the exercise that I am doing. So once again it's coming back to this self-management. To be able to look ahead and say [to yourself] 'Well' I'm going to be doing that, I'm doing this, I'll have that before I do it, and that'll balance me out while I'm doing it'.

These are suggestions that people have made you know over the years, and it suits me.

And I think everybody is an individual as far as that goes. And each person has got to adjust their regime to themselves, not to what other people are doing. They've got to adjust it for themselves I think. Trying to tell people, 'Well you should do this and you should do that, and you should do that, like I do' - that's wrong. I think there's only one person who should tell you what to do and that is the doctor, or the clinic staff.

I think you should recognise your symptoms, be able to recognise when you are going low - particularly when you are going low - look at what you are doing if you are driving and things like that; what precautions should you take if you are driving any distance. I think all these things come under your self-management. You've got to plot it ahead. You've got to look ahead at what you are going to do, how you are going to do it. You've got to be able to analyse I think your feelings to a certain degree, what's happening to you. And carry on with your normal life.

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