The news that British Home Secretary Theresa May has been diagnosed with Type 1 diabetes at the age of 56 will draw the attention of anyone who has an interest in this condition — especially as it is so rare for someone of her age.
I have several patients with Type 1 diabetes, but as a father I have seen first-hand how it has dominated the life of my eldest son, Ben, for the best part of 30 years.
In my 36 years as a GP, I can’t recall a fiftysomething patient who has developed it out of the blue. Doctors occasionally see the onset of Type 1 in teenagers or young adults in their 20s, but later than that is very unusual.
I would imagine someone as organised as the home secretary will be able to manage her condition and go on living a relatively normal life. But as I have seen with Ben, even if you are meticulous in your management of Type 1 diabetes, you can only minimise — never completely absolve yourself — of complications.
May, who had been strongly tipped to succeed David Cameron as Conservative leader, admits she often works an 18-hour day. And although long ministerial hours will still be achievable, she will have to ensure that she eats regular sit-down meals.
There can be no erratic snacking on chocolate or crisps for the diabetic.
Like Ben, May will have to inject herself with insulin. Some people use pumps which infuse a continuous flow of insulin rather than several large shots, but these are not as common as the injections — simply because they are formidably expensive and fairly new.
But no matter how careful you are, mistakes will be made, and we see this with Ben all the time. If he has too little insulin, or too much food and not enough exercise, it won’t be long before his blood sugar goes stormingly high.
The penalty for that is serious complications such as eye and kidney damage and a greatly increased rate of atheroma formation, the process of clogging of arteries in the heart or brain with cholesterol deposits.
Too much insulin and he may pass out through too low a level of glucose in the blood, a so-called “hypo” (hypoglycaemic attack).
Ben developed diabetes when he was 7, and as a child he would become very aggressive, spitting at us and lashing out before passing out unconscious if we couldn’t get a sugary drink or snack down him in time.
Although Ben manages his diabetes with great care and has led a full life — gaining a history degree from Manchester University and carving out a successful career in TV commercials — he has by no means been immune to complications. The home secretary should take heed.
Diabetes is the most common cause of acquired blindness in the Western world, and six months ago Ben lost his driving licence because he has retinopathy — where the retina at the back of the eye becomes damaged.
He has passed out on countless occasions, sometimes on his own on a train, or in an airport where, distressingly, onlookers have mistaken him for a drunk. For that reason he wears a medical bracelet to alert people to his condition.
This will be something that May must be worried about. There is every chance that she might keel over at the dispatch box or in a meeting. For this reason, everyone around her — from her personal secretary to her driver — must be up to speed on her condition.
She will want to be independent, yet everyone must be aware of the signs and symptoms of her condition because every now and then a meal will get missed or she will take in too much insulin and she will go off beam.
A diabetic always wants to be independent but, as parents, we had to brief everyone from friends to teachers to skiing instructors about Ben’s condition in case he passed out.
Unfortunately, Ben has also suffered from kidney failure and had a transplant. Now, that kidney has also failed and he is due to go back on to dialysis.
One day in the next year or so, he hopes to have another transplant, this time of a kidney and pancreas, which should cure him of diabetes.
It is very new technology and I know of no patients who have gone through this operation, but it is part of the new world of transplanting that offers hope to diabetics everywhere. The tragedy is that he will have to wait for someone else to die before he can be cured.
Type 1 is most commonly called acute juvenile onset diabetes because it is a dramatic disease that suddenly appears and almost universally affects young people. Only a few weeks ago, a child of only 1 was diagnosed at my practice.
This is in contrast to Type 2 diabetes, also known as maturity onset diabetes, which, although it is also recognised by the presence of high glucose levels in the bloodstream, is almost a different disease entirely.
We see Type 2 in middle-aged and older people, usually in the context of excess body weight, the problem being a relative rather than an absolute deficiency of the hormone insulin.
But Type 1 diabetes is a medical emergency and an incurable illness that occurs because of the sudden loss of insulin, a protein hormone that is produced by nests of cells that are situated in the pancreas.
Insulin is vital for the control of blood glucose levels. Glucose is the most important currency — the pound sterling — of energy in the body. It is the preferred fuel for our heart muscle, it is the only energy source that our brains can use, and insulin is the hormone that controls glucose levels, mobilising it from stores and enabling body tissues to use the glucose at the site needed.
With Type 1 diabetes, quite suddenly, insulin production ceases — usually because the cells making it are rapidly killed off by antibodies or a virus.
Glucose levels then soar and the patient becomes acutely ill within days, with weight loss, thirst, weakness and eventually a state called diabetic ketoacidosis — a derangement of the chemistry of the entire body, with over-breathing, vomiting and eventual loss of consciousness.
Before the Twenties, when insulin was discovered and could be purified and then injected as a treatment, death was the outcome.
Thankfully, treatment has come a long way since those dark days.
Ben was diagnosed six weeks after he had suffered a bout of chicken pox. Doctors believe that a virus may trigger Type 1 diabetes in someone who has a genetic susceptibility.
We had noticed he had started climbing up to the sink to drink water from the tap as he was suffering from extreme thirst. He was also getting up regularly in the night to urinate.
These are common symptoms of diabetes but to my shame, I didn’t spot what was happening straight away. At the time, my wife was 38 weeks pregnant with our second son, Cosmo, and I simply thought Ben was being wilful because the new baby was nearly here.
In the end, I took a urine sample which showed his sugar levels were high. So I took a blood sample and to my horror, his blood sugar reading was six times higher than it should have been.
I rang Guy’s Hospital to inform them of my boy’s symptoms and to my astonishment, they asked me to bring him in a couple of days. When I told them he would be dead by then, they admitted him straight away.
There, he was diagnosed with Type 1, and my wife was admitted with him because she had to learn quickly how to manage our son’s incurable illness.
His treatment involves striking a careful balance between food intake and the dose of insulin needed. Diabetics must be particularly watchful over the amount of carbohydrate and starch they consume, as glucose forms the main building bricks of much larger starch molecules.
Insulin is usually injected between two and four times daily, depending on the needs of the individual.
Ben checks his blood glucose around four to five times a day — and it is likely that the home secretary will have to do the same.
He has to prick his finger and insert a dot of blood into a portable gizmo. It means he can govern carefully what he needs to eat and also calculate the correct insulin dosage to inject into himself at that moment in time.
The home secretary will have to get used to this routine and fit it into her already busy schedule. How much energy she has been using a day will need to be taken into consideration. Sitting in Cabinet meetings or an office uses less fuel than dashing about to constituency meetings, going to the gym, or hill-walking on holiday.
The essence of treating a patient with diabetes is to educate them so that they are able to self-govern and take full responsibility for managing their condition with rigorous self-discipline and meticulous attention to detail.
Only in this way are future complications minimised and a normal life possible — even for a future possible prime minister.
–Daily Mail
