Diabetes For Men

DIABETES FOR MEN How to avoid it, how to live with it

You don’t need to be a sugar addict to get diabetes.

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MEN’S HEALTH FORUM The Men’s Health Forum’s man manuals contain easy-to-read information on a wide range of men’s health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England, Scotland and Wales.

Our goal is the best possible physical and mental health and wellbeing for all men and boys.

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CONTENTS What is Diabetes?

Diabetes and Diet Diabetes and Exercise Diabetes and Sex The Medical Stuff Long-term Complications Who Can Help?

4 12 18 21 25 30 35

Men’s Stories: Men with Type 1 – p10, 28, 32 Men with Type 2 – p15, 23, 24, 31 Men with Pre-Diabetes – p20 Text by Jim Pollard • Edited by Jim Pollard • Cartoons by John Byrne Advisory Board: John Chisholm, Sara Richards, Su Wang Thanks to all the men with and without diabetes who helped with this.

Images: creativecommons.org (Credits p35) Published: June 2018 • Revision date: June 2021.

ONE MAN IN TEN HAS DIABETES. 60 PEOPLE DIE PREMATURELY EVERY DAY BECAUSE OF DIABETES. The authors and the publisher have taken care to make sure that the advice given in this edition is correct at the time of publication.

We advise you to read and understand the instructions and information included with all medicines and to carefully consider whether a treatment is worth taking. The authors and the publisher have no legal responsibility for the

results of treatments, misuse or overuse of the remedies in this book or their level of success in individual cases.

The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always get for any symptom or illness.

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WHAT IS DIABETES? About 4.6 million people in the UK are living with diabetes and around 12.3 million are at increased risk of it.

Some types of diabetes you can’t avoid, some you can. This booklet explains the different types, how to reduce your chances of getting diabetes and what to do if you do. It will be particularly useful for people who have been told they are at risk of the condition or have been recently diagnosed.

I’M CONFUSED. IS THIS BOOKLET FOR MEN WHO HAVE DIABETES OR MEN WHO DON’T? Both. It’s increasingly clear there is no hard line between having diabetes and not having it. The way we live today is putting most of us at risk. In 2015, Diabetes UK warned that the condition could ‘bankrupt the NHS’. It makes sense for all of us to understand the basics.

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What’s more, the best advice on diet and exercise – which you’ll find in this booklet – is much the same whether you are trying to avoid diabetes or already have it.

WHAT IS DIABETES? Diabetes - or diabetes mellitus to give its full name - is a condition that causes your blood sugar level to become too high.

GREAT, BUT WHAT DOES THAT MEAN? Our bodies convert food into energy. The main source of this energy is a sugar - glucose - which is created when food is digested. It enters the bloodstream – where we call it blood sugar – and fuels the body’s cells.

But this doesn’t happen automatically. We need the hormone insulin to allow glucose into the cells. Insulin is created in the pancreas, an organ that sits behind the stomach. It senses how much glucose has entered your blood and releases the right amount of insulin.

My complex diabetes is the direct result of not going to the GP.

If you have diabetes, this process doesn’t work.

DO THE MATHS: DO YOU DO THESE? > NOT SMOKE

> DRINK FEWER THAN 14 UNITS OF ALCOHOL A WEEK

> EAT 5 FRUIT & VEG A DAY > TAKE AT LEAST HALF AN HOUR EXERCISE A DAY Research shows that doing all four adds about 14 years to your life.

All of these things will also reduce your risk of diabetes.

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HOW MANY TYPES OF DIABETES ARE THERE? If your pancreas can’t make any insulin at all, this is called type 1 diabetes.

If your pancreas produces some, but not enough, insulin, or if your body’s cells are unable to react to the insulin produced, it is called type 2 diabetes.

Usually, people with type 1 are diagnosed younger and need to take replacement insulin for the rest of their lives. Usually, people with type 2 are diagnosed as adults and can improve their blood sugar control or even reverse their diabetes with diet.

But it’s not always as simple as that. There are people with type 1 diagnosed later in life because the condition has been dormant for some time. There are others who seem to have both type 1 and type 2 characteristics.

More recently, scientists think there may be more sub-divisions of the two main types.

LOADS OF FAMOUS PEOPLE HAVE DIABETES. IS IT REALLY THAT SERIOUS? Both types of diabetes are serious. They can damage the heart, eyes, feet and kidneys. They reduce the quality of life and indeed shorten lives.

The fact that some people live very well with it and even pursue sporting or other high-profile careers doesn’t prove diabetes isn’t serious. It proves that, if you take it seriously, you can live with diabetes. But it’s still much better to reduce the risk of it in the first place if you can.

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THE SYMPTOMS OF DIABETES >> feeling unusually thirsty >> peeing more than usual, especially at night >> feeling unusually tired >> loss of muscle >> frequent itching around the penis or even thrush >> cuts or wounds healing more slowly >> blurred vision >> unexplained weight-loss.

You should see your GP if you are experiencing several of these together.

Type 1 diabetes can appear within days.

TELL ME MORE ABOUT TYPE 1 DIABETES About 10% of people with diabetes have type 1. It happens when your immune system malfunctions and attacks the pancreas, damaging it so it can’t produce insulin.

This autoimmune reaction often runs in families. If you have a parent or sibling with type 1 diabetes, you have a 12-times higher risk of getting it yourself than someone without a close relative with the condition.

Type 1 cannot really be cured. But it can be treated - see page 26.

TELL ME MORE ABOUT TYPE 2 DIABETES About 90% of people with diabetes have type 2. This can usually be controlled (and even reversed in some cases) using diet, exercise and medication.

The NHS health check was simple - less than 20 minutes.

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AM I AT RISK OF TYPE 2 DIABETES? We’re all at risk of type 2 to some extent. You’re more at risk if you: >> are over 40 (or 25 for south Asian people) >> have a close relative with diabetes – such as a parent, brother or sister >> are overweight or obese (especially if you have a lot of fat round your middle) >> have high blood pressure and/or high cholesterol >> have a lifestyle which involves a lot of sitting down >> smoke >> are of south Asian, Chinese, African-Caribbean or black African origin (even if you were born in the UK).

IS DIABETES MY FAULT? You can’t do anything about type 1 diabetes. It’s just the luck of the draw.

You can reduce your risk of type 2 diabetes. This booklet will help. But it’s not all your fault if you do develop it. There is evidence that our risk of type 2 diabetes may be traced back to the genetic variants introduced when modern humans interbred with Neanderthals 40-80,000 years ago - so that’s definitely not your fault.

We’re all born differently and, if you need medical help for diabetes, you have a right to it.

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HOW IS DIABETES DIAGNOSED? Glucose can be detected in urine but, for a proper diagnosis, you’ll need a blood test. You may need to have a fasting test (usually you can’t eat for 8-10 hours before the test). Exactly what happens will depend on your symptoms.

Sometimes diabetes is discovered when a person is having a test for something else. Or an NHS health check.

I’M TOLD I’M PRE-DIABETIC, WHAT DOES IT MEAN? There are a number of phrases thrown around which basically mean ‘you don’t have diabetes yet but, if you don’t change your lifestyle, you’ll almost certainly get it’.

These include: >> pre-diabetes, >> borderline diabetes, >> metabolic syndrome, >> insulin resistance, >> Impaired Fasting Glucose (IFG), >> Impaired Glucose Tolerance (IGT) and >> Impaired Glucose Regulation (IGR).

It’s good to know that you may be pre-diabetic because in a lot of cases (perhaps as many as 80%), type 2 diabetes can be prevented or delayed by lifestyle changes.

There’s information about all of these changes coming up.

If you’re concerned that you’re at particular risk of type 2 diabetes, ask your GP about the NHS Diabetes Prevention Programme.

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Harry, age 18, type 1 THERE’S A MENTAL HEALTH SIDE TO DIABETES THAT COMES IN TOO

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I was diagnosed at 16. I’d been ill for five years and diagnosed with IBS (irritable bowel syndrome). I was lethargic and would get bad sugar cravings.

I lost five and a half stone in the two weeks before diagnosis and was drinking a lot of water and peeing all the time. It was right before GCSEs. At first everyone thought it was stress. But five and a half stone is a lot of stress.

The nurse could ‘smell’ diabetes My GP gave me a blood test. Before the results, I was on a night out. I drank only soft drinks but, when my mum picked me up, she thought I was drunk. I was cold, staggering about. In the morning I couldn’t move. I was rushed to hospital and they said they could smell diabetes on me. They pricked my finger and said I was going into diabetic ketoacidosis (DKA). I spent five days in hospital on about six drips. Since then a lot of nurses have told me they can smell ketones on people. (For more on DKA and ketones, see page 26) I was assigned to an adult team and given an insulin pen. It gave a regular dose of insulin but my blood sugars were still up and down.

It wasn’t good.

I was moved to the paediatric team and the care was so much better than for recently-diagnosed adults. The paediatric team were amazed I hadn’t been told about carb counting. I was put on an insulin pump.

Then I got a continuous glucose monitoring (CGM) device, so I didn’t have to prick my fingers all the time. This synced in with the pump and things got easier. It’s not fair that in some parts of the country you have to pay for a CGM. There’s a mental health side to diabetes that comes in too.

The shock. I had counselling after the DKA but we weren’t prepped as a family. Emotionally, it was tough for my mum - most of our family are 200 miles away.

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My diet was dreadful when I first left hospital. I knew that high carbs would set the readings off and I didn’t enjoy injecting, so I tried to find food with no carbs. I discovered cheese and was eating absurd amounts of it. Really quite unhealthy in terms of cholesterol and fat. Now I eat a more balanced diet.

Not much education about diabetes They gave me a carb-counting app and that came in really handy when talking to my type 2 grandad. He’d had it for 10 years but my sitting down with him for 10 minutes enabled him to halve the drugs he’s taking.

There’s not much education about type 2 diabetes. My grandad didn’t even know he might be able to reverse it through diet and exercise.

There’s this stigma against type 2 diabetes with all this fat-shaming going on. Education about sugar would be better than a tax.

Diabetes has helped me mature. At 16 you think you’re immortal but the truth is I nearly died.

There’s this stigma against type 2 diabetes with fatshaming

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AN ANTIDIABETES DIET? You know what a healthy diet looks like. (If you don’t, there is information on the Men’s Health Forum website and in our manual ‘Eat. Drink. Don’t Diet.’)

All that stuff applies here, only more so - especially keeping an eye on carbohydrates and other sugar sources.

The suggestions here will help you control your diabetes if you already have it or reduce your risk if you don’t.

HOW BIG A FACTOR IS WEIGHT? A big one. If you’re overweight, lose some weight. Every kilo you lose will reduce your risk of diabetes - and also of heart disease, liver problems and cancer. Speak to your GP practice nurse about weight loss.

Watch your portion size. Smaller portions obviously help your weight but they reduce blood sugar surges too.

Regular balanced meals, plus healthy snacks in between, will prevent the blood sugar dips that lead you to crave something sweet.

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IT’S ALL ABOUT CARBS, ISN’T IT? Quite a bit. The starch and sugar in carbohydrates raise blood sugar levels.

If you have diabetes, you should ask your care team about counting carbs and calories. If you want to prevent diabetes, cutting carbs will help but you still want a balanced diet. >> Cut down on ‘free’ sugars. These are sugars that are added by you (to drinks or cereals) or by food manufacturers (to processed foods) or that occur naturally in honey, syrups or fruit juices. You should get no more than 5% of your calories from free sugars. (Tip: if you want to eat cake, choose one that uses natural sweeteners like carrots, raisins, dates, figs or bananas rather than sugar.) >> Check food labels for hidden free sugars (basically, any ingredient ending in -ose or which mentions corn syrup or cane.) You’ll be surprised where sugars turn up (even in breads, crackers and supposedly savoury sauces.)

The natural sugars in vegetables and whole fruit (but not fruit juice) are fine.

Cutting down on processed foods in general will help. >> Cut down on refined carbohydrates - these are the white versions of flour, breads, rice, pasta etc. You digest these more quickly, which leads to blood sugar spiking. Potatoes too. People who eat a diet high in these faster carbs are more likely to develop diabetes. Choose wholegrains if you can. >> Increase fibre - especially natural fibre (in fruit, vegetables, nuts, legumes and pulses) - to reduce blood sugar surges. (Smoothies are not the way to go because they pulp the fibre reducing its benefit.) More on fibre below.

Vitamin D may be important for blood sugar control. It is made naturally when skin is exposed to sunlight, so make sure you go outside. Other good vitamin D sources include fatty fish, milk, eggs and mushrooms. If you’re not sure you’re getting enough Vitamin D, check the NHS advice on supplements.

TYPES OF FIBRE Insoluble fibre helps improve bowel function: wholemeal bread, bran, wholegrain cereals, nuts, seeds and the skin of some fruit and vegetables.

Soluble fibre - which dissolves - lowers cholesterol and helps with blood sugar control: oat, oat bran, linseeds, barley, fruit and vegetables, nuts, beans, pulses, soya and lentils.

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IS THERE SUGAR IN MILK? Some sugars called lactose occur naturally in milk. These don’t count as free sugars. But anything added, like the flavouring in a milkshake or ice cream does count as free sugar.

I’M CONFUSED ABOUT FRUIT Understandable. A whole fruit itself does not contain free sugar. Nor does dried fruit as the sugar is still within the fruit.

But the juicing process changes this. You could say it frees the sugars up. (As a result, they’re absorbed into the body in much the same way as a spoonful of sugar). So a fruit juice does contain free sugar.

Easiest way to avoid the confusion is to choose whole fruit over juices or smoothies.

Fruit yoghurt might include natural sugars from both milk and pieces of fruit but it will include free sugars too.

FOODS AND SUGARS: SOME EXAMPLES >> A regular 330ml cola contains 36g of sugars and ALL are free sugars. >> A glass (200ml) of semi-skimmed milk includes 9.4g of sugar but NONE are free sugars (it’s all natural lactose from milk). >> A 125g pot of fruit yoghurt includes, for example, 15.9g of sugar of which 11.25g are free. Why? Because the natural sugars in the milk and in the fruit pieces themselves do not count as free. (However, this example shows that despite the natural fruit and natural milk, most of the sugars in flavoured yoghurt are actually free sugars - so watch out.) >> A 160g orange includes 13.6g sugar but NONE are free sugars whereas a 150ml glass of orange juice contains 12.9g of sugar and ALL are free sugars. In other words, eat an orange and it doesn’t count as free sugar, drink fruit juice and it does. >> A 5g portion of honey includes 3.8g of sugar and ALL are free sugars even though they occur naturally in honey.

The message is: read the labels very carefully.

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Brian, age 67, type 2 DON’T LEAVE IT TOO LATE TO TAKE NOTICE OF YOUR WEIGHT

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I was diagnosed at 50. I’ve always been overweight, even as a child. I noticed that I was drinking a lot of water. That was the trigger. The GP did a urine test there and then.

Now I have three medicines: metformin twice a day, pioglitazone and gliclazide. I recently had an HbA1c test (see page 26) and my blood sugar is still highish. It’s better when I’m losing weight but I haven’t got the willpower to do that by diet alone. I know everything about diet except how to do it. Portion control is the main thing for me.

Work used to be just about everything to me. I was going to a lot of formal functions with fatty food and drink and I was overdoing it. Things improved when I went to working three days a week. At the same time, if I wasn’t on the council or volunteering, I’d be less of me. It’s about balance.

I took up the gym four years ago and should have done it ages ago. I also run but I’m a bit of a fair-weather runner and don’t like the cold and rain.

A factor in my stroke I do wonder if diabetes was a factor in my stroke four and a half years ago. It has certainly caused erection problems and made it more difficult to get health insurance.

My advice would be not to leave it too late to take notice of your weight. It gets harder as you get older. Type 2 can be put into reverse and it’s much easier to lose weight at 45 than 65.

Diabetes has made it more difficult to get health insurance

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SO, SHOULD I COUNT CARBS OR CALORIES? If you don’t have diabetes and just want to keep to a healthy weight, keeping an eye on total calories will work fine for most people.

If you have diabetes or are borderline, you might want to look at counting carbs too. Your care team can advise you.

Calories and carbs are not the same thing. If, like Ed on page 28, you fancy an ice cream, this example, which is from a real ice cream manufacturer, shows the difference between calories and carbs.

You could choose vanilla ice cream which has 235 calories per 100g or lemon sorbet which has just 155. In other words, the ice cream has 50% more calories than the sorbet. But if you look at the carbs, the vanilla ice cream has 23g (of which 19g are sugars) whereas the sorbet has 38g (of which 37g are sugars). So the sorbet has twice as much sugar as the ice cream. (The rest of the ice cream’s calories come from fat.) Your choice would depend on whether you are counting calories or counting sugars from carbs. (We’re not suggesting you eat either, by the way – it’s just to illustrate the point.)

WHAT ABOUT DRINKS? Easy. Avoid sugary drinks and go very easy on fruit juice (max: half a glass a day).

Two other tips: >> Drink plenty of water - it may help regulate your blood sugar and will certainly help you avoid sugary drinks. (A glass of water before a meal can reduce appetite too.) >> Coffee and tea, especially green tea, may also have properties that protect against diabetes. (But don’t add sugar to them.)

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ARTIFICIAL SWEETENERS? Artificial sweeteners in ‘diet’ or ‘zero’ or ‘light’ versions of drinks or other products mean you’ll have no immediate blood sugar problem but they won’t reduce your liking for sugar - perhaps the opposite - and may have health risks of their own. Stick to water, tea and coffee.

WHAT ABOUT BOOZE AND FAGS? Quit smoking – but you knew that already. The more fags, the greater the risk of diabetes. Risk goes down once you stop.

As for alcohol, it’s probably not a risk factor in itself (unless you drink more than the recommended amount) but it does contain a lot of calories. Calories mean weight and weight is a big risk factor.

If you have diabetes, talk to your care team about safe drinking. Alcohol can play havoc with blood sugar levels: your exact risk depends on your medication and treatment.

I’VE HEARD FASTING CURES DIABETES. It’s a nice idea. There is some evidence in diabetic mice that fasting helps the pancreas function better. As for humans, it’s early days and not yet advised.

Indeed, for those who don’t have diabetes, there is also evidence that on-and-off fasting may be harmful to the pancreas.

If you are fasting for religious or other reasons and have diabetes, it can increase your risk of hypoglycaemia (see page 27) and dehydration. You should discuss it with your care team to make sure you keep well. There is more information on fasting for Ramadan on the Diabetes UK and Muslim Council of Britain websites.

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DIABETES AND EXERCISE Physical activity is good. It increases the insulin efficiency of your body’s cells, so you need less insulin to keep blood sugar levels under control.

Every little helps. Just standing up and keeping moving. (The more time you spend seated, the greater your diabetes risk.)

But ideally you need to keep exercising to maximise the benefit. Find something that you enjoy and can do regularly for the long term. That means small changes, simple goals and taking it easy to make sure you don’t get injured. Going for a walk with mates will tick most boxes. The Chief Medical Office advises that adults should aim for at least two and a half hours of ‘moderate exercise’ (equivalent to brisk walking) a week.

If you have diabetes, you will need to check your blood sugar before strenuous exercise. Recommended blood sugar levels vary with age and type of diabetes. Talk to your care team for specific advice. They can also tell you what exercise you personally might want to avoid (eg. running if you have foot problems).

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Generally, when stress goes up, blood sugar levels do too. So anything that reduces stress including low-impact exercise like tai-chi or yoga is helpful.

I HAVEN’T GOT TIME. Build exercise into your everyday life: >> Get off the bus/train/tram a stop or two early >> Park the car and walk >> Cycle instead >> Use the stairs >> Exercise at home or in the park - you don’t need to go to a gym >> Play more with your kids >> Get into housework and gardening >> Walk and talk (on the phone or with colleagues).

Can work help? Some employers have a gym or offer gym membership or cycle-to-work schemes.

NEED TO LOSE WEIGHT? As well as type 2 diabetes, being overweight increases your risk of heart disease, stroke and some types of cancer.

So get the tape measure out. As a man, you have a: >> HIGHER risk of health problems if your waist size is more than 94cm (37 inches) and an >> EVEN HIGHER risk if your waist size is more than 102cm (40 inches)

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George, age 55, pre-diabetic IT WAS VERY HELPFUL FOR THE GP TO TELL ME I WAS AT RISK

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The GP told me I was pre-diabetic six months ago at a routine check-up. I thought it meant I’d need insulin if I didn’t change my ways.

It was quite straightforward for me. I grew up in Glasgow and everything was sugar-based. I liked ‘three for £1’ chocolate bar offers. I don’t drink tea or coffee so I was drinking Lucozade instead.

I felt tired. My face felt bloated. My skin was red and itchy. That’s all gone. Now I feel like I want to go for a run rather than can’t be bothered. That’s the biggest difference. I eat more fruit and veg - an apple, orange, banana rather than a bar of chocolate. And I drink water or diluted juice.

I used to exercise a lot which is why I think I got away with such a bad diet for so long, but I got injured carrying a heavy load doing up the house. As a man, you think you’re indestructible.

Food labels are confusing I think it was very helpful the GP telling me I was pre-diabetic.

I just thought I was run down - I didn’t put it down to what I was eating.

I did a bit of research and started reading the food labels but they’re very confusing when it comes to sugar. If you look at apple juice, it has loads of sugar but is it artificial or natural? It’s better to eat an apple than drink a juice. Also I’ve found a caffeine drink with no sugar. Believe it or not, it’s sugar-free Irn-Bru.

I didn’t drink tea. i was drinking Lucozade instead.

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DIABETES AND SEX Poor erections and reduced sex drive may be warning signs for diabetes.

Erection problems are also a warning sign for heart disease. So it makes sense to see your GP. Whether caused by diabetes or not, these problems can be sorted out. And treatments may be simpler and cheaper than you think.

DIABETES HAS AFFECTED MY ERECTIONS Many men get erectile dysfunction (ED) anyway, especially as they age. But diabetes does increase the risk. It is estimated that over half of all men with diabetes will be affected.

Keep an eye on your blood sugar before sex just as you would before any other type of exercise. See your GP and make sure they know about other medication you are taking (sexual problems can be a side effect of some drugs). Consider counselling if you think your mental wellbeing or your relationship with your partner may be part of the difficulty.

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I’VE JUST LOST INTEREST IN SEX There is a relationship between diabetes and testosterone. Men with diabetes, especially type 2, are more likely to have lower testosterone levels. This can affect sex drive and make ejaculation more difficult. Losing weight will usually help. Your doctor can advise about other treatments.

ANYTHING ELSE? Men with diabetes are at increased risk of Peyronie’s, a disease where the penis is bent too much for comfortable sex.

There’s more on all this stuff on the Men’s Health Forum website including many things you can do for yourself and how doctors can help.

The good news is that most of the foods that help prevent sexual dysfunction (such as fruit, veg, wholegrains, heart-healthy fats, nuts and fish) are also good for diabetes.

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Andrew, age 50, type 2 ON A DAY TO DAY BASIS, DIABETES AFFECTS ME MORE THAN HAIRY CELL LEUKEMIA

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I was diagnosed three and a half years ago. I had no symptoms.

But I have high cholesterol and a regular blood test came back that I was just over the borderline into diabetic. Other tests confirmed it. My mum has diabetes and the hospital knew about this, so it was routinely checked.

I take metformin. I straight away concentrated on reducing sugar which wasn’t too hard. I’ve never been someone who eats lots of sweets, chocolate or fizzy drinks. I cut out desserts and cake but recently sugar levels have crept up.

I need to consider savoury carbs as well as sweet Now I need to consider the savoury carbs as well. I was eating a lot of ready meals a year or so ago and they really affected my levels. I was having potatoes nearly everyday and bread. It was always toast for breakfast. Now I have oats, either hot or cold.

Unfortunately I probably take less exercise now. We have a daughter and, before she came along, I spent more time walking and cycling. That has got to change too.

Two years ago, when I discovered I had hairy cell leukaemia (HCL), I rather forgot about the diabetes. HCL can be dangerous as it affects your immune system but, if you know you’ve got it, they can manage it quite well. I’ll need chemotherapy every 2-15 years but really, on a day-to-day basis, diabetes is more of a problem.

Ready meals really raised my blood sugar levels

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Shaun, age 46, type 2 I HAVE A SWEET TOOTH AND I LIKE FAST FOOD

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I was diagnosed four years ago after a blood test. I was shocked.

I’d been feeling a bit tired and thirsty but didn’t know why.

The doctor told me my body was making less insulin. I control it with metformin - one after breakfast, one after tea. I’m also trying to eat better food - more vegetables. But I have a sweet tooth and like fast food. When I get tense, I like a bun. I’m trying to drink water instead. Drinking less diet cola helps too.

Friends who can support me I walk and have started to play 5-a-side football. I hadn’t played football for 20 years. I’m sure I wouldn’t have done that if not for the diagnosis.

I was borderline obese but I’ve lost a stone. I have a group of friends who can support me. One of them already had type 2 and she told me the signs of high and low sugar. She could tell by my eyes. The doctors don’t tell you enough. It’s like you’re on a conveyor belt.

My friend told me the signs of high and low blood sugar

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THE MEDICAL STUFF This basic information on the medical side of diabetes is useful to know even if you don’t have the condition. It may help you spot symptoms in someone else.

HOW IS TYPE 2 DIABETES TREATED? If you can’t control your type 2 diabetes using diet and exercise alone, you may be prescribed medication to lower insulin and blood sugar levels.

Usually you’ll be given metformin first. It’s available in tablet and liquid form.

But there are a number of drugs available and it may take time to find the right mix for you. Ask about an NHS medical exemption certificate so you don’t have to pay for prescriptions.

You’ll need regular blood tests and some people with type 2 may also need to take insulin - see page 26.

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HOW IS TYPE 1 DIABETES TREATED? You’ll need to inject insulin, perhaps 2-4 times a day. (It has to be injected because swallowed tablets would be broken down by the digestive system and not enter the bloodstream.) Your care team will show you how. Common methods include the insulin pen or insulin pump.

Your blood sugar will be monitored long-term by your care team (using the HbA1c blood test) and often several times a day by you. This is usually through a blood glucose meter (which involves pricking your finger to get a drop of blood) but there are also continuous glucose monitoring (CGM) devices available which are worn just underneath the skin and measure blood sugar automatically every few minutes. Ask your care team about CGMs. You may need other medications to reduce the risk of complications.

WHAT HAPPENS IF BLOOD SUGAR GETS TOO HIGH? If levels get too high in type 1, it can lead to diabetic ketoacidosis (DKA).

Signs of DKA include peeing a lot, thirst, lack of energy, blurred vision, stomach ache, being sick, collapsing and unconsciousness. There is often a smell of ketones on the breath. High levels of this chemical in your blood are a sign that the body is burning its own fat for energy, not glucose. Ketones smell sweet, a bit like pear drops or nail polish.

DKA is very serious and can kill if untreated. If you develop DKA symptoms (even if you have not been diagnosed with diabetes), get to hospital immediately. It’s important to be aware of this as sometimes the first thing adults with late onset type 1 know about it is a when they have DKA. In type 2, high blood sugar over time can lead to Hyperosmolar Hyperglycaemic State (HHS). It is usually caused by illness or dehydration. It too is potentially life-threatening so seek medical help urgently. (Because people with type 2 diabetes still produce some insulin, ketones may not be created and so there is no smell.)

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WHAT HAPPENS WHEN BLOOD SUGAR IS TOO LOW? Hypoglycaemia, or low blood sugar, is sometimes called a hypo.

You feel shaky and weak with slurred speech and confusion (a little like being drunk). A quick hit of sugar (or glucose tablets) followed by a slower carb like fruit or a sandwich should return blood sugar to safe levels in an hour or two.

In more serious cases, you can lose consciousness and may need an injection of the hormone glucagon.

It is important to react quickly to a hypo so, if you have diabetes, make sure your family and friends know the signs and what to do.

If you haven’t been diagnosed with diabetes but keep developing the symptoms of low blood sugar and craving sugar, see your GP.

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Ed, age 51, type 1 DIABETES IS SERIOUS BUT DOCTORS NEED TO UNDERSTAND REAL LIFE

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I was diagnosed ten years ago. No family history. I had standard symptoms. I went to the GP because I’d proof-read a document on diabetes.

I was sent straight to hospital and have been on insulin ever since.

I’ve managed pretty well I’d say but generally I’ve been disappointed with the information available from doctors and voluntary organisations. For example, diabetes complicates what you can take for hay fever but there’s no information out there.

I see a specialist twice a year and occasionally the GP, but there is no coordination between the two. Most useful is a face-to-face chat with other people with diabetes. You can’t overestimate the value of talking to someone who gets the day-to-day reality.

You meet people who’ve had it all their lives and do terrible things.

One guy used the same needle every day and only changed it when it started to hurt. Another told me he always had a hypo when he got to the office. Turned out he didn’t have any breakfast and then cycled ten miles to work. Again, a guy who’s had it for years.

Pricking your fingers is the worst thing I’ve had a couple of sessions on carb counting so you can estimate the right amount of insulin needed rather than just guessing. But it can be hit and miss. I have hypos too often. The specialist says I should do better but I don’t know how. Going low feels better than letting it get too high. You can’t prick your fingers every five minutes.

Pricking your fingers eight times a day is one of the worst things.

My diabetic nurse told me about CGM. She said it would cost £100 a month so I’m not even going to try it. Hopefully it will be an option on the NHS one day.

Injecting insulin is recommended in the side (by pinching an inch and injecting) or in the thigh, away from muscle. For slower-acting insulin, it’s the backside. The problem I have is bruising. How often

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can you vary the limited amount of space on the body? Inject too often in previous sites and a hard, fatty deposit builds up – not pleasant. I can imagine after 20 or 30 years it becomes quite painful. Reordering prescriptions is a pain too. Of course you can’t expect a year’s worth of needles/insulin but having to reorder test strips, it’s overcomplicated.

I haven’t fainted or fallen over. It’s fear of this that drives you to manage it. I somehow manage to wake myself up and grab a handful of jelly babies if I go low during the night. Doctors need to stress how serious diabetes is but they need to understand what’s practical and realistic too. I was warned about erection problems when first diagnosed and that’s a real motivator.

Life can be overwhelming and diabetes sets the bar higher Foodwise, I probably have a sweeter tooth than ten years ago. If I fancy an ice cream, I’ll have one and take the insulin. But I eat consciously better now. Drinking complicates it. Numbers rise and then they dive down again. You have to be careful when you exercise and watch your numbers before and after. (Your numbers need to be a bit higher beforehand.) My daughter showed me an app to count my steps.

I’m on antidepressants, but I was taking them before I was diagnosed so I’m not sure how closely diabetes and depression are linked. Sometimes I do get down about the diabetes itself. You have to try to be stoic but life can be overwhelming for everyone and this sets the bar even higher. Just the practical stuff of checking blood, carbs and injecting is probably an hour a day and you’re thinking about it much, much more.

I don’t know if bandying around stats about it taking 20 years off your life is helpful. I don’t like those sort of overkill fundraising messages and it certainly doesn’t make me feel better.

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THE LONG-TERM COMPLICATIONS OF DIABETES Raised blood sugar levels can damage: >> the arteries - increasing the risk of high blood pressure, heart disease and stroke (by up to five times) >> the nerves - which can lead to numbness and pins and needles >> the feet - people with diabetes are over 20 times more likely to have a lower limb amputation, so look after your feet, wear shoes that fit properly and get your feet checked every year by a trained professional like an NHS podiatrist >> the blood vessels in the eyes - causing vision problems (people with diabetes should get an eye test every year) >> the blood vessels in the kidney - which can lead to kidney failure >> sexual function (see page 21).

Diabetes may also increase the risk of depression, dementia and cancer.

Don’t underestimate diabetes. As well as the impact on quality of life, it is estimated that type 1 diabetes can shorten your life by 20 years and type 2 by 10. However, those are averages. If you take diabetes seriously, you can have a long, enjoyable life. This simple booklet is a starting point.

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John, age 55, type 2 MONITORING MY NUMBERS REALLY HELPS ME MANAGE

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I was diagnosed 13 years ago. I was overweight. Then I began to lose weight and was passing a lot of water. I do feel I brought diabetes on myself. My diet was terrible. I still remember the night before my diagnosis: I sat down and had two sugary doughnuts and a can of cola as a snack.

I’m managing excellently now with diet, exercise and medication.

I minimise sugary and starchy food and I’m currently losing weight, which is what I want to do. Porridge every day. A fair amount of fruit. Natural fats. I like baking and still bake pastries for my family.

I just eat a smaller quantity of them. I haven’t lost the love for sugary or fatty foods. It’s just my head telling me not to.

I walk two miles to work and two miles back again. It means I hit my target of 13,500 steps on my app. I am running 10Ks too (I’ve figured out a 10K route around my house). I also do a weekly military bootcamp.

My GP sent me on a diabetes awareness course where they emphasised our blood sugar targets on the HbA1c test (see page 26). I’m an accountant and perhaps it’s a geeky, bloke thing but the numbers are important for me. Following them keeps me in the zone. I monitor my HbA1c closely. I used to do Weight Watchers, I respond to that discipline.

A while back, my practice nurse gave me a good telling off when my sugars started to go up. She threatened to take me off a particularly costly drug that helped to manage my sugars if I didn’t keep my side of the bargain. That sort of message works with me.

So far I’ve had a clean MOT for all the complications but I am acting aggressively now while I am still fit and able. Currently my sugars are at pre-diabetic levels and I want to retain this plateau or even get it better.

My advice to the newly-diagnosed would be not to panic but to be proactive. Talk to your GP. Ask questions. They will help you if you show you want to tackle it.

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Ben, age 47, type 1/2 I WAS VERY HARD-WORKING. PROBABLY TOO MUCH.

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About four years ago I suddenly noticed I was breathless and urinating all the time. I didn’t have my energy.

I went to the GP a couple of times. They said an ear infection or maybe the flu. Eventually, after three appointments, I was sent for a blood test. Afterwards, I drove to work and, as I sat down to my sandwich and fizzy drink for lunch, I got a call saying my blood sugar was so high I should go to my nearest hospital. At the hospital, they started showing me how to inject myself.

It was 4.30pm Friday. I threw up. It was such a shock.

I lost my sight By the time of diagnosis, I’d lost a lot of weight. And, shortly after, the pressure in my eye caused me to lose my sight for about four weeks. The nurse asked me to read the letters on the board and I said ‘what board?’ It was very scary.

Looking back, had I left it any longer, my first symptom would have been losing my sight or collapsing in a coma.

Cold turkey Starting to inject myself was, I should imagine, like going cold turkey. I was sweating. I couldn’t see much or do much.

I was very hard-working. Probably too much. 50 to 60 hours a week. Grabbing a drive-through meal, no exercise. I covered the whole of southern England. A lot of travel. Now I carve out time for myself to eat a proper lunch, walk the dog and swim, ride the bike or go to the gym.

I keep my weight in check and watch what I eat. I try to get lots of fruit and greens (spinach, watercress, avocados). Oats. Oily fish. A bit of red meat here and there. I count carbs carefully. I use the app on my phone to check everything.

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I must prick my fingers 6-7 times a day. You need to be careful of bruised fingers. You don’t want to ruin the ends of your fingers in case one day you lose your sight. They would be very important then.

Battle with my local CCG They lent me a constant glucose monitoring (CGM) device when I did a 100-mile hike. The readings showed I was having a lot of hypos at night.

It turns out my diabetes is not 100% type 1. I still produce some of my own insulin but in a sporadic way and that was causing the problem. If the pancreas has a spurt, it means I can suddenly feel very dizzy and have low sugar.

It took two years to get them to do the test that proved this.

Then I had to battle with the local NHS Clinical Commissioning Group to get a CGM. My advice is that if you don’t feel right, keep going back. GPs aren’t infallible. You’re not wasting anyone’s time.

If you don’t feel right, go back to your GP

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WHAT CAN I EXPECT IF DIAGNOSED WITH DIABETES? Diabetes UK has a list of 15 Healthcare Essentials which they see as the minimum anyone diagnosed with diabetes should expect. It’s a good starting point for talking to your care team. >> Get your blood glucose levels measured (HbA1c blood test) >> Have your blood pressure measured >> Have your blood fats measured >> Have your eyes screened for signs of retinopathy >> Have your feet and legs checked >> Have your kidney function monitored >> Get ongoing, individual dietary advice >> Get emotional and psychological support >> Be offered a local education course >> See specialist healthcare professionals >> Get a free flu vaccination >> Receive high-quality care if admitted to hospital >> Have the chance to talk about any sexual problems >> If you smoke, get support to quit >> Get information and specialist care if you are planning to have a baby

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WHO CAN HELP? Men’s Health Forum www.menshealthforum.org.uk Health information from the Men’s Health Forum NHS Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/lifecheck www.nhs.uk/change4life apps.nhs.uk Call 111 (24-hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours.

Search ‘type 1 diabetes’ and ‘type 2 diabetes’ for diabetes information.

NHS Diabetes Prevention Programme: preventing-diabetes.co.uk Diabetes UK www.diabetes.org.uk The leading UK charity for people affected by diabetes.

Telephone and text chat services available.

9-7 Mon-Fri 0345 123 2399

Diabetes Research and Wellness Foundation www.drwf.org.uk Aim to ‘raise awareness to all forms of diabetes so that people may take preventative actions where possible’.

Diabetes.co.uk www.diabetes.co.uk Community website that they say has developed into Europe’s largest community of people with diabetes and people without diabetes alike.

Juvenile Diabetes Research Foundation jdrf.org.uk Fund type 1 diabetes research to improve lives and ‘one day eradicate the condition for good’.

PHOTO CREDITS: Thanks to David McCairley plus Jim Pollard, Elzoh, Bare Knuckle Yellow, Ollie Harding, Ari Merretazon Knight Foundation, Paul Hamilton, Craig Cloutier, D Sharon Pruit, Robert

Couse-Baker and frankieleon who were all kind enough to make their images available through the Creative Commons. (If this is not the case, please contact us.)

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The InDependent Diabetes Trust www.iddt.org An organisation for people living with diabetes run by people living with diabetes.

FEELING DESPERATE? Samaritans 116 123 Emotional support 24/7 www.samaritans.org Calm 0800 58 58 58 www.thecalmzone.net Full credits, links and licences at: menshealthforum.org.uk/ MMreferences

DIABETES FOR MEN Diabetes in men is increasing. Men are more likely to get it than women, more likely to experience complications like leg amputation and more likely to die from the condition. One man in ten already has diabetes and thousands more either don’t know they have it or are at serious risk of it. Are you one of them?

In this easy-to-read handbook we talk to men with all types of diabetes, explain how to reduce your chances of getting the condition and look at what to do if you do get it. DIABETES FOR MEN will be particularly useful for people who have been told they are at risk of the condition or have been recently diagnosed: > what exactly is diabetes? > how diet may beat diabetes > how physical activity can help > how diabetes can affect sex WARNING: Reading this booklet could seriously improve your health.

ISBN: 978-0-85761-019-5 www.menshealthforum.org.uk

At last, I can see why understanding diabetes matters in my life.