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This podcast episode focuses on type 2 diabetes. The first guest, John, shares his experience living with the condition, including his diagnosis and management. The second guest, Mary, is a clinical nurse specialist who discusses different ways to diagnose and manage type 2 diabetes. Type 2 diabetes is a chronic illness that affects millions of people worldwide. It can be prevented through maintaining a healthy lifestyle. Common symptoms include increased thirst, frequent urination, fatigue, slow wound healing, and blurred vision. John was diagnosed at 42 years old through a glucose tolerance test. He manages his diabetes through medication, diet, and exercise. He has experienced complications such as foot neuropathy but receives regular check-ups. Mary explains her role as a clinical nurse specialist in diabetes care and discusses various diagnostic methods. Overall, John's blood levels are stable, and he continues to manage his diabetes well. Welcome back to the Daily Dose of Nursing podcast presented by me, Sophie O'Mahony, a final year general nursing student from University College Cork, based in the south of Ireland, where I talk about all things nursing, big or small, including medical conditions and how to treat them by bringing in people who suffer with these conditions daily and nurses and doctors who specialize in treating these conditions. Today's episode is focusing on type 2 diabetes. Today I will be joined by two guests to discuss type 2 diabetes. The first guest is John, a man who has been affected by type 2 diabetes for 16 years. He will be telling us about life living with type 2 diabetes, how he was diagnosed, what symptoms he had and how he manages his diabetes. The second guest is Mary, a clinical nurse specialist who specializes in diabetes and who is currently working with Swansea Care in Limerick. She will discuss different ways to diagnose type 2 diabetes, different medications to help manage type 2 diabetes and she will share other helpful information for people affected by type 2 diabetes. For privacy reasons, I will be using pseudonyms for both guests. Type 2 diabetes is a chronic illness that millions of people around the world are affected by. The Health Service Executive, more commonly known as the HSE, in 2023 defined type 2 diabetes as a condition that causes the level of glucose or sugar in the blood to become higher than normal as the body cannot use insulin properly. The World Health Organization tells us that since 4 April 2023, around 95% of people with diabetes have type 2 diabetes. Canada Health 2019 informs us that unlike type 1 diabetes, type 2 diabetes is preventable. It can be prevented if a person reaches a healthy body weight, participates in at least 30 minutes of physical activity a day, has a healthy diet avoiding sugar and stops tobacco smoking. The National Health Service, or NHS, described the most common symptoms associated with type 2 diabetes as increased thirst, increased urination, especially at night, feeling tired or sleeping more than usual, wounds, cuts and infections taking longer to heal and blurred vision. Now that I've explained about type 2 diabetes, I'm going to begin speaking to my first guest, John. Hi John and welcome to the Daily Dose of Nursing podcast and thank you for coming in to speak about your life living with type 2 diabetes. I'm just going to start by asking you, what was your life like before you were diagnosed? Would you say you were healthy? Hello, thanks very much for bringing me on. My life was very normal. I didn't have any complications. I was exercising pretty regularly, playing five-a-side football with friends, playing a bit of golf with the Golf Society in Moork, going for a run at lunch times for between three and five kilometres two or three times a week, so I was fairly active. I reckon that I would have been pretty healthy and I had no indications that there was any problems or that I suffered from any conditions. Then we get to you being diagnosed. What age were you diagnosed? I was 42 years old when I was diagnosed. Oh really? And did you have any symptoms looking back now that you think were an indication of type 2 diabetes? I didn't have any obvious symptoms and now that I know what's involved, I still don't remember anything obvious. Okay, interesting. So nothing was obvious in terms of symptoms. Can you speak a bit about how you were diagnosed? Can you remember any tests they may have done? What happened was, in work they offered a free medical check-up for anyone that was interested, so I decided to go along. It was as a result of this that a high blood sugar reading was recorded, so I made an appointment with my GP and he did a blood glucose test where he took a blood reading and then asked me to go away and drink a bottle of Lucozade. I returned to him a couple of hours later and he ran the same test again and that's when he told me that I had type 2 diabetes. Okay, so it seems the GP performed a glucose tolerance test and that was the way you were diagnosed. So, how did you feel about being diagnosed? Would you say you were scared? Did you know what type 2 diabetes was? I wasn't scared at the time. I was reassured by the GP. I had heard of type 2 diabetes and I kind of knew that it had something to do with insulin or blood sugar but I wasn't very clear what it was exactly. I did not have questions about what it was and how it would affect me. The GP told me that it was a very common disease these days and many people had it. He said that initially we could try and manage it with diet and exercise and see where we went from there. I was checking back with him on a monthly basis but the blood sugars weren't improving so then he told me we would introduce medication gradually and see how we got on with that. I can't remember the initial medication I was on but it was probably some of the most common diabetes ones. At least the GP was very reassuring and educated you about how to manage your diabetes at the start. Were you referred to a specialist in diabetes at any stage? At that stage I wasn't referred to a specialist as he continued to monitor the condition himself. Subsequently though, I was referred to an endocrinologist to look after my diabetes and I've been attending him for about the past 12 or more years. Firstly I went to him on a 3 monthly basis, then every 6 months and now I send him up with blood screening every 6 months and if everything is ok I physically attend only once a year. Interesting. Now I just wanted to ask you how you managed your diabetes over the years. Can you remember how it was managed by medication? I've had a number of medications over the years which were tried and changed for necessary. Some have worked better than others and I can't remember all the different ones at this stage. There are many different medications out there these days. It's hard to remember all the names as they were changed a lot over the years. Did you have any lifestyle changes that you had to make? Yeah, lifestyle changes were the usual recommended ones I suppose. Healthy diet, lots of exercise, to lose weight and to keep it off. I know blood glucose level checking is important when it comes to diabetes to avoid hypo or hyperglycemic extrals. How often do you check your blood sugar? I do blood checking at least once a day usually first thing after getting up in the morning and once more if I remember it during the day. Not eating immediately before going to bed and trying not to eat much after 6pm in the evening. All the usual advice, try and avoid all the sweets and sugary foods and drinks which is hard to do. It is hard to avoid sugar. It's in everything these days. Diabetes from what I know can come with some complications. Have you experienced any of these? The complications were and still are the usual ones, foot neuropathy where I have lost a lot of feeling mainly in the soles of my feet so I have to be careful when I am putting on my shoes checking there is nothing in them before I put them on. I have noticed some cuts especially on my feet take longer to heal and I have to be very careful that I don't get infected. Ulcers can be common but thank God I have only had one or two which really needed to be kept clean and monitored. I also attend a podiatrist every two months to get my feet checked and that also helps. Eyes are also worried so I need to get a retinopathy check done once a year and so far I have been good on that one. These complications are the most common and hopefully you don't experience them too often. I know you mentioned previously that you can't remember all the medications you were on during the years but can you tell us about the medications you are currently on? I am currently on Asymptic, a 1mg injection once a week, Leucobastatin 10mg once a day, Metformin 850mg three times a day and Forvega 10mg once a day. And how are you overall with your diabetes? I know you have had it a couple of years but do you think you manage it well and how are you feeling overall? My blood levels are fairly stable and I visited my endocrinologist about a month ago and he is happy with my blood sugars, my weight, blood pressure and all. The other signs are good too. So I am continuing with my current regime of medication, diet and exercise. I will get my bloods done again next April. I am feeling good but the most difficult part is coming into the winter when it is more difficult to get out and exercise than in the summer. But everything is going well so far thank God. Thank you so much John for coming in and sharing about your life with Type 2 Diabetes. You have shared very valuable information that could help any listeners affected by Type 2 Diabetes. I wish you the best in the future and I hope everything goes well for you. Thanks very much. Now we will speak to my other guest Mary, a Clinical Nurse Specialist working with Sláinte Care in Limerick. Hi Mary, thank you so much for coming on the podcast and giving us your time. I know you are very busy these days. I am going to start by asking you what exactly is your role and what you do in relation to Diabetes. Hi Sophie, I am delighted to be here and thank you for having me. I work as a Clinical Nurse Specialist in Diabetes Care in Limerick. 80% of my time is spent working in the Chronic Disease Hub in Limerick City and other primary care centres around County Limerick. The other 20% of my time is spent working with an endocrinologist who specialises in Diabetes Care. Interesting, you definitely have a lot of experience working with Diabetes. There are many different ways you can diagnose Type 2 Diabetes. Interesting, you definitely have a lot of experience dealing with Diabetes. There are many different ways you can diagnose Type 2 Diabetes. Can you share some insight into these ways? One of the main ways of diagnosing Diabetes is with a blood test. An HbA1c fasting blood glucose level or with a glucose tolerance test. An HbA1c is a measure of the amount of glucose attached to the body's red blood cells. It is present in everyone and it gives an indication of your blood glucose control over the last 2-3 months. Now certain conditions like haemochromatosis, renal failure, acute blood loss, recent blood transfusions and certain drugs can give a false reading of the HbA1c results. So you should take care before diagnosing someone. An HbA1c level of 42-47 mmol is considered pre-diabetes and a level of greater than 48 mmol is diagnostic of diabetes. As John mentioned previously, a glucose tolerance test is a way to diagnose Type 2 Diabetes. The glucose tolerance test takes several hours to complete in a hard blood test and you will be asked to drink a high glucose drink. I personally didn't know that the conditions that you have mentioned can give a false reading. That is interesting to know. So the diagnosing HbA1c is above 48 mmol for Type 2 Diabetes. I know you have been in this job a while. Have you ever seen someone who has been diagnosed with Type 2 Diabetes and reversed it? Yes, thankfully I have seen people who are able to reverse their diabetes but usually these people have a poor diet, eat a lot of refined carbohydrates like sweets, minerals etc. before they are diagnosed. Usually they are inactive, overweight and do not have a strong family history of diabetes. I recently met a 21 year old man who was 22 stone's weight. His HbA1c was 90 mmol on diagnosis but he managed to reverse his diabetes once he ate a low sugar breakfast, low carb lunch and got plain dinners from the local shop if he did refuse to cook. He cut up most of the crisps and chocolates and the kinds of minerals. He reversed his diabetes if he did not have it long and low family history of diabetes.