Patient perspective, Trainee perspectives

A diabetes diagnosis – defining a new normal

Josh Lock headshot
Dr Joshua Lock – Emergency Registrar

By Josh Lock

What would you do if you started to show symptoms almost pathognomonic of a disease? The typical ‘Aussie male’ response is to ignore it and hope that it just goes away. This was the position I found myself in almost 18 months ago.

I had recently become a first time Dad and was experiencing the sleepless nights and extreme exhaustion that comes with it. Thankfully at around two months, my wife and I found a routine that worked for our baby boy and he started sleeping through the night. But even with the few extra hours of sleep I was now getting, my exhaustion did not go away. I started to get up through the night to pee, blaming it on too much caffeine. I even joked to a colleague that it was my bladder that was keeping me up at night, not my baby. Then I began to notice I was peeing more during the day as well. I became extremely thirsty. I kept getting mouth ulcers, paronychias and had very specific dermatomal parethesias in my upper arms. I noticed my vision changed quite dramatically, to the point where I got my eyes checked (but left without any changes to my prescription).

Despite all this, it didn’t click until I had lost 10kg of weight in one week. I couldn’t ignore the symptoms any longer and decided to investigate with a blood sugar level… this is when my life turned completely upside down.

I’m 32 years old with no history of Type 1 diabetes in my family.

To this day I still have moments of disbelief. The thought that this will never go away (coupled with having to test my BSL multiple times per day and injecting insulin) can be so overwhelming.

I thought I knew diabetes.

I am an emergency trainee and we deal with diabetes (and the complications of it) on a daily basis. But what I didn’t fully appreciate was the emotional and mental fatigue that comes with managing the condition long-term (e.g. carb-counting, managing lows, dealing with the continuous BSL checking and insulin injecting, coping with the psychological impact of the disease, etc). It has definitely been a steep learning curve.

While I know Type 1 diabetes is far from some of the other devastating diseases we see in our practice, sometimes I just feel alone and overwhelmed by it. In a way, I’m privileged to have medical training and can have detailed understanding of the metabolic process (compared to a non-medical person). My job gives also gives me access to tools/specialists/medicines that help me manage the disease.

I can see that I was lucky to have 31 years without Type 1 diabetes, knowing that most are diagnosed at a very young age. I have good family support with my wife totally getting on board and I have a large extended family who are always around to help. But I’m the only one in my immediate circle with the disease and that’s what gets me down.

We are lucky to live in a time where there are so many technological advances available to manage this disease. I use an insulin pump to help deliver the insulin, and (when I can afford it) I use a continuous glucose monitoring system which measures a BSL every 5 minutes and streams the data directly to my phone. Being able to know my levels inan instant and how different foods affect me is invaluable.

While I have found that working with my disease does have its challenges, utilising this technology has definitely made things easier. Ultimately though you can’t always predict how your body is going to respond to certain foods, stressful situations, or even the insulin dose. Invariably I find myself too high or at some points I go low.  I have to manage these where I can-which sometimes means I just have to stop whatever I am doing and make sure that I look after myself.

I’m not used to having to do this and I don’t like that I need to – I don’t want to be seen as sick or weak.

Generally I am more fatigued than prior to my diagnosis, with levels that can sometimes be unpredictable, I’m still, at times, getting up through the night to pee. As a consequence of this I can be fatigued at work, or become fatigued quicker then I would like. As you could imagine, it makes night shift that much harder. I even get to the point that when I am doing something as simple as a IV cannula, or difficult as a central line insertion, the stress involved usually makes my sugar levels drop and I can sometimes have a minor hypo after doing the procedure.  This is incredibly frustrating –as before diabetes I didn’t have to worry about these things. Overall however I have managed to not allow it to affect me too significantly at work and I can usually do a shift without any major issues.

Until there is a cure, there is nothing that can bring me back to my old normal, so I know this is the new normal and I have to take each day as it comes. If I were to look for a silver lining, I believe this disease will help me to be a better doctor.

Since being diagnosed, I’ve been able to support those who have come into ED with their first time presentation of Type 1 Diabetes. I’ve been able to truly empathise with the shock and disbelief of being newly diagnosed and also offer support and advice based on my own experiences. I was in the exact same position as them not too long ago. I now see their presentation not just as a doctor looking to manage their condition right now, but as someone who knows what it’s like to manage it once they leave our hospital doors.

Thanks for letting my share my story.

About Joshua Lock

 

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