Diabetes the Slow and Silent Killer

Diabetes is a complicated word. The public only recognises it since it has been mentioned in the media for the last decade or so. However, few people really understand its meaning or realise its implications. Sure, do a quick survey and a few people will probably mention "sugar", "insulin", maybe even "pancreas" but few will consider "dementia" or even "death". Yet diabetes has shown itself to be a silent disease that slowly but surely destroys a person"s mind, reducing them to a shadow of their former selves, until eventually the body seems to catch up with the mind and succumbs to the inevitable. This is the story of the last 18 years of my Dad"s life. Dad"s background is probably average and less important than his lifestyle. Not a tall man (~5ft 6in), he was a classic rugby-forward build. While he played rugby and football at school, he did not later continue with any sports and was never motivated by exercise in general. As a boy, I would go on Sunday afternoon bicycle rides with him and as a teenager we would head down to the local 9‐ hole golf course. However, other than gardening, there remained little urge to exercise for his health.

His diet, maybe, was above-average, in that meals would be meat‐and‐two‐veg, confirmation that eating "greens" was good for one and that a varied diet was the important objective. However, typical of many, in the evening, Dad enjoyed a snack or two: 5‐6 digestive biscuits, a few fig-rolls, maybe some dates at Christmas, or a packet of crisps, or mini cheese biscuits. His alcohol intake was low, by today"s standards, yet he would enjoy a beer or glass of wine for Sunday lunch. None of this would be deemed exceptional or really suprising; indeed it would be fair to say he tried to eat sensibly while enjoying some well‐earned treats on the side.

Around the turn of the Millenium though, Dad started becoming thirsty at night. This did not go unnoticed as he would tend to pop downstairs for a glass of milk occasionally. However, after a while, he would need more than a small glass of milk and the frequency became every other night and then every night. At the time, my girlfriend was studying for her medical degree so after a cursory examination, she advised him to see his GP as she suspected diabetes. A GP appointment later and Dad was confirmed with diabetes and was required to take pills in order to counteract the sugar-insulin in‐balance in his body.

Now, one may think this would be a game‐changer for a person"s lifestyle in that they would review their habits and modify them accordingly. Sadly, this is not always the case. Dad came to the unshakeable conviction that, yes he had contracted a disease but he had gone to the doctor, been given some pills and now, though he was not-quite fixed he was able to carry on as before. The years since 2000 resulted in little change to his diet, despite attempts at eating more healthy recipes at mealtime, but there was no uptake in exercise. The GP arranged appointments to see dieticians but Dad tended to come away confused about what he could, and could not, eat since diabetes does not dictate prohibitions on any food. Rather, it simply requires that sugary things be eaten less often. What Dad was always wanting to know is could he still eat biscuits, crisps, potatoes and drink beer; to which the dieticians would say "yes" but always follow it up with "in moderation" or "as a treat". This vague and fluffy part, Dad failed to grasp and in the end it would get ignored.

As time passed, Dad"s pill dosage increased then was modified to something stronger culminating in moving onto daily injections of insulin. As had happened with the pills, the dosage slowly crept up in order to counteract the sugar in his blood. The fact is that diabetes is, simply, the result of an addiction to sugar. Diabetes is caused by sugar poisoning. Everything should be taken in moderation and sugar is no exception. However, our Western lifestyle places a premium on the use of sugar in a person"s diet. After all, Dad would have sugar in his tea, sugar sprinkled on his Weetabix, concentrated orange juice with his white-bread toast, never mind the biscuits and chocolate in the evening. Over the years, we tried hard to wean Dad off all of these but the biscuits and snacks still remained. The question begs could we have tried harder? Probably, "yes" is the answer but discussions of that nature would invariably end up in some kind of argument and in the end Dad would do what he liked. Even to the extent that the excuses would verge on the absurd with proclaimations that "beer was good because it had hops in it" and "apple pie could be counted as one of the 5-a-day due to the apples"!

Diabetes takes away in stages. As the body succumbs to the amount of sugar, bits and pieces start to break. 2015 was really when Dad started to show signs of struggling with the disease. Never a very patient man, his ability to cope with things began to ebb and in its place his aggression began to increase. It no longer seemed to matter whether in public company or not, if there was something wrong then Dad would not hesitate to shout about it. At first, we would shout back and retaliate over his rudeness yet it soon became apparent that Dad did not even remember having these flash- anger moments. In April, he had his first major hospital visit when he suffered a hypo in the local shop, resulting in being blue-lighted by paramedics to casualty. This was followed in September, by Dad collapsing into the garden greenhouse, and again being rushed to A&E with a major cut on his arm and superficial cuts and bruises. At the time, we all believed this was another hypo as Dad described working in the garden and not having quit for lunch early enough. The doctors, themselves, were more concerned with checking his heart to rule out the possibility of a heart attack. No one considered the possibility of a stroke.

Dramatic incidents tend to be the exception rather than rule and this was very much the case with Dad. As 2015 became 2016, Dad"s behaviour slowly but surely altered. After the garden-fall, his confidence was severely dented so going into the garden all but ceased. As a diabetic, the nerves in his fingers and his feet had long since failed so his walking stance changed to a careful shuffling. His day was spent watching television, doing tasks around the house, punctuated by mealtimes and snacks in-between. Trips out with his camera no longer occurred and his behaviour started to become obsessional. He would fixate on an idea until it received appropriate appeasement. In contrast, Dad"s rationality began to noticeably decline to the point that trying to reason an alternative viewpoint became pointless.

In response to a GP referral, Dad was given an MRI (scan of his head), where the results, although not unexpected, were horrifying. He had suffered at least 3 mini-strokes and 1 large stroke, where the sugar in his body had basically damaged the blood vessels to the point it starved parts of his brain of oxygen, leading to irretrievable damage and tissue-death. The difficult behaviour could now be directly attributed to a physical cause - vascular dementia with largely frontal lobe damage. While the medical explanation may have become clearer, the question of how to look after Dad remained difficult at best. At this point, Mum required her own trip to hospital for an operation and since she was Dad"s primary carer, there was no alternative but for Dad to move to a care home while she tried to recover. It was to Dad"s credit that he understood Mum"s difficulty and willingly stayed in the care home for a month or so. Indeed, without ready-access to a kitchen and monitored- meals, his sugar levels initially became more even and Dad appeared to rally. Yet, it"s fair to say that the damage had already been done.

Dad"s patience with being in the home on respite care waned and he began to demand an end-date for when he could go home. Sadly, Mum just could not face the day-after-day suffering of coping with Dad"s demands, aggression and obsessional behaviour. Ironically, as the months of 2016 went by, the whole question of where should Dad be became less and less important. His ability to look after himself continued to slowly decline.

Little walks around the village, playing "pooh-sticks" in the stream, praying in the church became the fixtures of Dad"s life and he was more contented. Nevertheless, as summer and autumn gave way to winter, even these diversions ceased. Dad had a room upstairs in the care home and tended to remain there, sitting in a chair watching film after film on DVD: The Great Escape, Shawshank Redemption, The Count of Monte Cristo, The Bridge Over the River Kwai, Saving Private Ryan to name a few. He had his favourites and such was the damage done to his brain that he could watch the same set of DVDs day-after-day and would have no memory of having seen them recently. Yet, thankfully, he still knew us and could hold a conversation, even though he usually forgot the conversation the moment it had finished. By that point though, it seemed to matter little and became far more important to witness him still able to laugh with joy when he saw his grandchildren.

By Christmas 2016, Dad had fallen several times due to having no feeling in his feet. A major fall after Christmas, broke his collar bone and he had to be admitted to hospital. While there, he complained of shooting pains (peripheral neuropathy) which, as his words became mixed up, he called squiffles, so the doctors began treating him with a morphine-derivative. Despite this, he was due to return to the carehome in mid-January 2017 once the doctors had finalised his pain management. However, his discharge was delayed by two successive infections, which took their toll on his body, bleeding from his gut and then Dad suffered a large stroke, rendering him incapable of proper speech. After this, the wonderful hospital staff could only make him comfortable.

Dad died on 22nd January 2017 at the age of 67, just weeks before his 68th birthday.

Diabetes, the sugar poisoning disease, had done its job in a little over 18 years. The signs were there of a serious disease that demanded important changes in lifestyle. Yet the signs remained too subtle until it was too late while the lifestyle changes remained too great for Dad to ever sign up to. The seemingly ostrich-like notion that diabetes is merely an inconvenient adjunct to one"s life could not be more false. In the end, diabetes was the slow, silent killer.


©Paul Richardson 2017

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