The number of people in the UK with diabetes (type 1 or type 2) has doubled over the last 20 years, according to Diabetes UK. Given that 10% of those with diabetes have type 1, which tends to be diagnosed when people are young, and that younger people can also develop type 2, it’s a condition that many young women can face – now or in the future.
So what’s it like to live with diabetes in your 20s and 30s? How does it change the way you eat, socialise, travel or plan for children?
Firstly, it is helpful to understand the differences between the two types (although recent research has suggested there are five sub groups).
Type 1 is an autoimmune disease. The immune system attacks the cells in the pancreas, which is then unable to make insulin (a hormone that regulates the amount of glucose in the blood). Once diagnosed, those with type 1 will take insulin for the rest of their lives, usually through injections, using a pen or an insulin pump.
Type 2 occurs when the pancreas does not produce sufficient insulin, or the body’s cells do not react to insulin. It tends to be diagnosed later in life and a significant risk factor is being overweight. However, as Faye Riley, research communication officer at Diabetes UK, explains, it is not the only influence. “[Type 2 diabetes] is not just something that is driven by obesity, it’s a really complex condition that we don’t fully understand yet.”
People with type 1 or type 2 diabetes must manage their blood sugar levels carefully. And they work to avoid hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar). Those with diabetes 1 or 2 can learn to recognise the symptoms of these, and prevent or treat them, but if untreated there can be serious consequences. Diabetes UK offers information about testing blood sugar levels and the Diabetes Research and Wellness Foundation offers Department of Health Information Standard accredited information leaflets.
One common misconception about type 1 diabetes is that it is only diagnosed in childhood. Take Tessa Nejranowski, a marketing and business development manager. She was diagnosed with type 1 at the age of 29, which, as she says, is quite unusual.
While at first Nejranowski was relieved to have a diagnosis, coming to terms with it and its implications was tough. Both type 1 and type 2, if not managed carefully, can potentially lead to serious complications.
Riley explains that type 1 symptoms can develop over the course of a few days and include excessive thirst, going to the toilet frequently, feeling tired and losing weight quickly. Type 2 has the same symptoms, but develops more slowly.
After her initial diagnosis, Nejranowski went to St Thomas’ hospital. Early on, she was referred to a course called DAFNE (Dose Adjustment For Normal Eating), which teaches participants how to control their diabetes. “That set me on the path to try and gain control and try and get my confidence back,” she says. A keen cyclist and runner, taking these up again also helped Nejranowski cope. Those managing type 1 have to take into account their blood sugar levels when exercising, according to Diabetes UK, including when they last ate and the amount of insulin in their system. However, there are benefits of regular exercise for those with both types.
Indeed, Annemarie Aburrow, 35, a consultant dietitian from Southampton, decided to take up running after she was diagnosed with type 2 diabetes two years ago: “I’m training for a marathon now, so I’m running three or four times a week.”
Like Nejranowski, Aburrow did not fit the mould for her type of diabetes – she was young and not overweight. However, there are other factors that increase the risk of developing type 2, including ethnic origin (studies show a higher prevalence in people of south Asian descent, African and African-Caribbean origin), and having had gestational diabetes (higher blood sugar during pregnancy).
Aburrow’s risk was increased by the latter. A mother of three, she had gestational diabetes during her last two pregnancies. She says of her type 2 diagnosis: “I didn’t have any symptoms at all. It was just that I’d gone for this routine blood test.”
Wajeeha Husain, 30, founder of Chocolateeha, has been attuned to her risk of getting type 2 diabetes since she was a child. “We act like we are diabetic because it’s in our genes,” she says. Of south Asian descent, Husain’s grandparents on both sides had type 2 diabetes and her dad has been told he is borderline diabetic.
And so, since childhood, Husain has been encouraged to avoid chocolate or adding sugar to drinks. She and her family regularly test their blood sugar and, as yet, Husain does not have the condition.
Aburrow tests her blood sugar once a day between 5 and 7pm; how often someone needs to test depends on which type they have (guidelines suggest at least four times a day for those with type 1). She also takes one metformin tablet each morning, a medication that lowers blood sugar levels. While Aburrow does not plan to have more children, she understands that having diabetes can complicate pregnancy.
Nejranowski is currently pregnant with her second child and has found that it requires careful management and many medical check-ups. “It’s full-on,” she says. “But it is for a good end point, and it’s not forever.” Nejranowski administers her insulin using a pump, which she says has probably made managing her diabetes during pregnancy easier, as she has tighter control.
Rosie Dennington, 26, from Oxford, and the owner of Rosie Red Corsetry, also wears an insulin pump. She was diagnosed with type 1 when she was 11, and got her pump in the second year of university. “It works a little bit like a drip, it has a cannula [tube] that you are taught to put in yourself, that goes into fat on your tummy.”
While Dennington says the pump is a commitment – users must control the amount of insulin being administered and it is always attached to the body, aside from short breaks when showering or exercising – it suits her over injections.
Dennington describes a few ways in which type 1 diabetes has affected her 20s. It has, for example, created some extra worry when travelling. When flying, both insulin injections and a pump require a doctor’s note to pass through airport security, and pumps can’t go through a security scanner.“It's taken a lot of the spontaneity out of my life,” says Dennington. “I can't just book a holiday abroad and go away at the weekend.”
The disease has also changed how Dennington sees her body. “I’ve had something like 22,000 injections in my stomach [...] and one of my stomach muscles has started to collapse,” she explains. But she says she’s not concerned if people look at her pump when she is wearing a bikini. Indeed, living with type 1 diabetes has taught her to value her body. “Not out of a sense of vanity or how it looks, but how it works, and I’m always still pleased that it does work.”
There’s reason to be optimistic about the disease as a whole. This has been a factor in the number of people living with diabetes. Riley says: “Treatments are improving all the time, people with diabetes are living longer.”